When did they start this procedure?
The history of rhinoplasty began in antiquity. “Rhinoplasty,” derived from the Greek words rhinos (“nose”) and plassein (“to shape”) is a surgery performed to achieve two results:
- To improve the breathing function of the nose and/or
- To improve the cosmetic look of the nose.
Surgical rhinoplasty began in ancient Egypt and ancient India. In India, it was developed by the ayurvedic physician Sushruta (c. 800 BC).
What is this procedure?
Rhinoplasty, sometimes referred to as a “nose job” or “nose reshaping”, enhances facial harmony and the proportions of your nose. It can also correct impaired breathing caused by structural defects in the nose. Rhinoplasty, or nose reshaping surgery, improves the shape, size, and symmetry of a person’s nose, bringing it into better proportion with the rest of the face.
Who needs this procedure?
Men and women of all ages benefit from rhinoplasty. Nose reshaping is one of the more popular cosmetic surgery procedures for teenage patients. Younger patients also need to demonstrate emotional maturity and understanding about the cosmetic surgery process. Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties. For patients of any age, it is important to have realistic expectations. Rhinoplasty can help you improve upon your existing nose, but it cannot deliver “perfection” nor can it give you the nose of someone else.
Are there non-surgical treatments?
Non-surgical rhinoplasty, also known as a non-surgical nose job, injection rhinoplasty, or the “15-minute nose job”, can be a lower-risk, lower-cost alternative (with less pain and less downtime) for those who may have otherwise considered surgical rhinoplasty. While non-surgical rhinoplasty cannot reduce the size of a large nose, the creation of symmetry or smoothing out of contour irregularities can actually make the nose appear smaller on the face. Non-surgical rhinoplasty can be useful to: Reduce the appearance of a “bump” by filling out the surrounding tissue, Reduce or eliminate unsightly depressions, dents, or grooves, Improve symmetry, create a lifting effect on a drooping nasal tip, Raise and define a flat bridge (popular in Asian and African-American populations), Correct a “scooped out” or “saddle-nose” profile.
How Non-Surgical Rhinoplasty Is Done?
Tiny amounts of injectable dermal filler (such as Radiesse, Artefill, Juvederm, or Silicone) are injected into areas that need to be filled out to achieve a smoother, more symmetrical appearance. The filler is injected in minuscule amounts using what is called a microdroplet technique. This procedure is not exactly a quick fix, as the end result is only achieved after a series of several treatments, with at least 4-6 weeks in between sessions. This gradual approach is necessary because of the way these fillers work. Over a period of time, the natural tissue built up around the filler creates more volume in the area, so the result cannot be accurately judged at the end of each injection session. Non-surgical rhinoplasty does not require general anesthesia or IV sedation. Only a local anesthetic is used, sometimes in conjunction with an oral sedative to relax the patient. Because of this and the fact that there is no actual cutting involved, this method carries less risk than a surgical rhinoplasty procedure. There are, however, some risks, which include: Hypersensitivity reactions, Infection, “Lumpy”, asymmetrical, or otherwise unsatisfactory aesthetic results, Nasal skin damage.
What is the surgical treatment like local or sedation?
Anesthesia Options for Rhinoplast
Rhinoplasty can be performed under various depths of anesthesia including local anesthesia, intravenous sedation (also called twilight anesthesia, MAC anesthesia, or IV sedation), and general anesthesia. Each option has advantages and disadvantages, including variations in cost, awareness, safety, and side effects. Because rhinoplasty is considered to be an elective, pre-operative testing is sometimes performed to determine anesthetic suitability. Regardless of the anesthetic option, all rhinoplasty anesthesia is performed in conjunction with local anesthesia (lidocaine mixed with epinephrine) to numb the nose and to reduce bleeding.
Although many surgeons prefer intravenous sedation for rhinoplasty, this is not the best anesthetic approach for optimal safety, effectiveness, and comfort. Twilight anesthesia relies upon the skillful dosing of powerful anesthetics through an intravenous catheter. IV sedation must render the patient unconscious and motionless without suppressing respiration (breathing). Although some experienced anesthesiologists are very skilled at achieving just the right dose of anesthetic, in many instances the patient is not rendered fully unconscious and sudden movements or even a disoriented and combative patient may disrupt the operation. Although less expensive than general anesthesia, the risks, discomfort, and effectiveness of IV sedation make it inferior to general anesthesia.
With General Anesthesia respiration is maintained by a ventilator, the depth of anesthesia can be adjusted to keep blood pressure low and thereby minimize bruising, swelling, and bleeding. A motionless and comfortable patient with minimal bleeding translates into far better operating conditions and more favorable surgical outcomes.
Perhaps the biggest reason against the use of general anesthesia is fear of post-operative nausea and vomiting. While post-operative vomiting is not only unpleasant, following rhinoplasty, vomiting may dramatically elevate blood pressure levels leading to much heavier facial bruising, swelling, and discomfort. By combining narcotic-free general anesthesia with other medications that suppress nausea, the incidence of clinically significant vomiting after rhinoplasty has almost been eliminated. Surprisingly, the absence of narcotics does not appear to compromise effective pain control as most patients are off pain relievers within 24 hours of surgery. However, in most cases, the reduction in post-operative pain is a consequence of good intra-operative anesthesia care resulting in less tissue trauma.
What is the recovery like?
Nose Job Recovery
After a nose job, people usually wear a nasal splint for the first week. You can expect swelling and some bruising around the eyes after surgery that will begin to improve after the third day. It can, though, last up to two weeks. Expect your nose to have a little swelling. This will go away over the period of six months. The final shape of your nose will be apparent after it has completely healed. Strenuous activity for three to six weeks after surgery should be avoided. You may return to your social activities as soon as within two to three weeks without any recognizable signs that you had a procedure done.
During your rhinoplasty recovery, a splint and/or packing may be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing. You may have a “nasal drip pad” under your nostrils to collect any blood that may drip from your nose. Packing and the nasal drip pad will be removed within 2 days after surgery. The splint is removed in about a week. Your nose may be stuffy and you may have trouble breathing for a short time. The skin on the tip of your nose may be numb. You may have some itching or shooting pain as the feeling returns. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery.
- Resting as much as possible, getting enough sleep will help you recover.
- Keep your head raised for several days after surgery. Sleep with your head up by using 2 or 3 pillows.
- Try to walk each day. Increase the amount you walk each day.
- Take a week off from work. It depends on the type of work you do and how you feel.
- Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 2 to 3 weeks or until your doctor says it is okay.
- Do not blow your nose for at least 1 week after surgery. Wipe your nose gently with a tissue. If you need to sneeze, sneeze with your mouth open.
- Avoid bending over until you are told its okay to do so.
- Do not rub your nose for 8 weeks. Use sun block on your nose and wear a hat with a brim to avoid getting sunburn. Put on sun block or makeup gently.
- No swimming for 1 week.
- It is common for your bowel movements not to be regular right after your surgery.
- Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
- Your doctor will tell you if and when you can restart your medicines, along with new medications he will give you.
- If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, He or she will tell you if and when to start taking those medicines again.
- Take pain medicines exactly as directed.
- If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
- After the stitches or staples are out, you may wash the incision with soap and water and gently dry the area.
- If you have strips of tape on the incisions, leave the tape on for a week or until it falls off. Or follow your doctor’s instructions for removing the tape.
- Put ice or a cold pack on your nose for 10 to 20 minutes at a time, every 1 to 2 hours for 3 days (when awake) or until the swelling goes down.
- Do not set glasses on your nose for 4 weeks.
- For 1 week, avoid wearing clothes that you pull over your head.
How long does it take?
Rhinoplasty generally takes 1.5 to 3 hours and is usually an outpatient procedure. As with any surgery, the time for rhinoplasty surgery varies from person to person.
Regardless of whether you require a simply rhinoplasty, which takes only 1 hour.
REASONS THAT AFFECT SURGERY TIME
- Minimal changes will generally take 1 to 1.5 hours. If there are more extensive changes taking place, then the surgery could last up to 3 to 4 hours.
- Method of rhinoplasty being performed. There are 2 types of procedures when it comes to rhinoplasty. One is open and the other is closed. While both require cutting inside the nose, open surgery requires an extra cut on the outside where the nostrils join together.
- The amount of grafting that needs to be done. If you are lengthening your nose or making it wider, you will probably need to have cartilage grafted in. The cartilage is taken from the nose, ears, or in some cases, a rib. This will add to the amount of time that the surgery will take.
- If you have breathing issues that need to be addressed, the surgery can take longer. There are 4 types of rhinoplasty that can help correct breathing difficulties: nasal septoplasty straightens a deviated septum; turbinate reduction reduces the mucous membrane-covered “shelves” of bone that are usually a source of allergy irritation; polyp removal; and nasal valve collapse.
How long has it been around?
Before Jacques Joseph of Berlin became the father of modern cosmetic rhinoplasty, followers of Sushruta were refining the noses of 6th-century inhabitants of Northern India. His method involved removing flaps of skin from the forehead or cheek of the patient and using it to reconstruct a new nose. The Roman medic Celsus seems familiar with his techniques when he describes the reconstruction of lips, ears, and nose. Reconstructed noses of one kind or another were popular precisely because the removal of noses (and ears) was a common punishment in wartime or for those who committed adultery or treason. Sushruta and his followers developed their practice to replace those noses, genitalia, and ears that had been amputated for religious, military, or criminal punishment. But the reconstruction of the nose was not solely about treating the victims of harsh criminal systems; it was about beauty and even character. Changing the shape of one’s nose, therefore, was not just about repair or beautification; it was about improving social status. Nose jobs began to catch on in Europe in the late 16th century as a result of the syphilis epidemic. One of the lesser-known symptoms of syphilis is the manner in which it can destroy the soft tissue in the nose and lead to a gaping hole in the middle of the patient’s face. The result wasn’t just discomfort, it was also social stigmatization.
What are the complications?
- What are the risks of rhinoplasty?You will have to decide if the benefits will achieve your goals and if the risks and potential complications of rhinoplasty are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications.Rhinoplasty surgery risks include:
- Anesthesia risks
- Poor wound healing or scarring
- Change in skin sensation (numbness or pain)
- Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication
- Difficulty breathing
- Unsatisfactory nasal appearance
- Skin discoloration and swelling
- Possibility of revisional surgery
These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.
What can you do to speed up recovery?
- You may be eager to see the results of your rhinoplasty (nose reshaping) procedure right away, but the recovery process takes time. During this time, there are steps you can take to speed things up and ensure that everything heals properly.Rhinoplasty Recovery TimelineThe average rhinoplasty recovery time is one year. That may sound like a long time, but it becomes much more manageable when it’s broken down into a timeline. The following recovery milestones may vary from patient to patient:
1 Week: The splint can be removed from your nose and you can go out in public without showing noticeable signs of surgery unless there is bruising around the eyes. This may take 2 weeks to resolve. It is safe to resume activities of daily living.
2 Weeks: The majority of the facial swelling has subsided and most of the bruising should have resolved.
3-4 Weeks: You can safely return to cardiovascular activities such as jogging, swimming and cycling.
6 Weeks: The bones are stable; you can resume resistance workouts (weight lifting), wearing glasses and blowing your nose.
3-6 months: The numbness and abnormal sensations in your nose and nasal skin should be resolved.
1 Year: The healing process is complete – swelling should have subsided entirely and the nose’s new shape is fully refined.
Listen to Your Doctor
First and foremost, follow your doctor’s instructions. You will receive specific instructions on what medications to take, when to take them, how to care for the surgical site to prevent infection, and when you’ll need to come back in for a follow-up exam.
Listen to Your Body
Your plastic surgeon will be able to see how your rhinoplasty recovery is going from the outside, but only you will know how you’re feeling. Listen to your body – if something doesn’t feel right after surgery, discuss it with your doctor right away.
Keep Your Head Elevated
Sleeping on your side after rhinoplasty isn’t just uncomfortable – it can prolong your recovery time by causing additional bruising and swelling. To avoid this, you’ll need to keep your head elevated at night for 6 weeks following surgery. One of the easiest ways to do this is to prop your head up on two or three pillows or use a foam wedge. Sleeping in a recliner also works well.
Use Cold Compresses
In the first 72 hours after surgery, using a cold compress can help reduce swelling. Just be careful not to apply the compress directly to your nose. Instead, apply it to your cheeks so that you don’t accidentally shift any bones or cartilage.
Get Plenty of Rest
The congestion you feel after surgery may make it more difficult to fall asleep, but rest is a vital part of the recovery process. Your body uses energy to heal itself, and getting a solid seven or eight hours of sleep each night gives your body time to restore that energy.
Maintain a Healthy Diet
Eating a balanced diet post-surgery can help to speed up your recovery by giving your body the nutrients it needs to heal itself. A diet consisting of nuts, meat, eggs, yogurt, fish, and other protein-rich foods will help your body rebuild the damaged tissue in and around your nose. You’ll also want to make sure you’re getting plenty of vitamins in your diet, namely Vitamin A and Vitamin C.
Steamy showers, hot bowls of soup, and relaxing saunas might are not so good for your swollen nose. Heat will cause the tissues in your nose to swell even more, which is why it’s best to stick to a diet of cool and room-temperature foods, take lukewarm showers, and stay out of the heat in the weeks after your nose reshaping procedure.
Don’t Blow Your Nose
After surgery, you’re going to experience some congestion for a few weeks, maybe even a few months. This feeling is caused by swollen nasal tissues. Resist the urge to blow your nose and talk with your doctor about using a saline nasal spray to gently moisturize your nasal passages until the swelling goes down. You can resume blowing your nose after 6 weeks from surgery.
Avoid Vigorous Exercise
In most patients, it takes roughly 6 weeks for the bones in your nose to heal following surgery. During this time, you should avoid strenuous exercise. Even movements that seem harmless like stretching, lifting, or bending over can increase nasal swelling. Wait until your doctor gives you the green light to resume normal activity before you begin to ease back into your workout routine.
Don’t Wear Glasses
Sunglasses, reading glasses, prescription glasses – anything that puts pressure on your nose as it’s healing can cause additional bruising, swelling, or even indentations that will require revision rhinoplasty down the road. Your facial plastic surgeon will advise you on when it’s safe to start wearing glasses again. In the meantime, switch to contacts, if you can.
Stay Out of the Sun
It’s always a good idea to protect your skin from getting too much sun exposure, but this is especially important after a nose job. Not only is your nose more prone to sunburn in the weeks and months following the procedure, but too much sun can also cause any scarring you have to darken and swelling to increase.
Don’t be tempted to use aspirin as a pain killer. It thins the blood, and this can make bleeding more likely and prevent blood clotting that is needed to speed up rhinoplasty recovery. For this reason, aspirin should be avoided for two weeks before and after surgery. Vitamin E supplements and Ibuprofen and Motrin should also be avoided for the same reason.
Do you need to rest up afterwards and for how many days?
- 1-5 days post-surgeryGet cozy, rest, ice, and hydrate to speed your rhinoplasty recoveryOver these first few days, blowing your nose could open your incisions, so don’t risk it. You might also have a slight headache. Aspirin or ibuprofen will increase your bleeding risk, so try to stick to the pain meds prescribed by your surgeon, if you feel like you need them. Just know that they’ll probably make you constipated, so make sure you have laxatives on hand. Your doctor will probably recommend using small, light ice packs on your eyes and cheeks for 15 minutes every hour, to reduce swelling. Just be sure not to put too much pressure on your nose.
1 week post-surgery
Between five to seven days after surgery, your surgeon should remove your splint and cast, and you’ll get your first look at your new nose. If you don’t love what you see, keep in mind that the swelling will go down, and your final result might look very different.
1-2 weeks post-surgery
Head back to work
Once your splint is off and the worst of your swelling has gone down, you could head back to work, with makeup over your bruises. If you want to be really discreet, you may want to wait up to two weeks for the swelling to go down.
2-3 weeks post-surgery
If you have glasses, you can wear them normally again.
Glasses can put pressure on the bridge or the sidewalls of your nose, which can complicate healing and feel really uncomfortable. After the few weeks, you may be able to start wearing glasses again for short periods, with frequent breaks.
3-6 weeks post-surgery
Start exercising again
In the first few weeks, exercise could increase your blood pressure to a point beyond what’s healthy for your healing tissues.
You should follow your surgeon’s recommendations on physical activity and exercising. It is important to avoid any strenuous activity or exercise that increases blood pressure for the first two to three weeks post surgery.
For 3 months post-surgery
Keep your nose protected from trauma
It’s especially important to avoid any accidental bumps during these first three months of healing, when it’s more vulnerable.
6 months post-op
Expect your nasal swelling to be almost gone
At this point, your swelling should have dramatically subsided. Keep in mind that things are still healing and settling, so you won’t see your final results for another six months, at least.
1-3 years post-rhinoplasty
Evaluate your final results
Most people will be able to assess their final results a year after their nose job. It takes at least this long for your skin to shrink to the level of new underlying framework or bridge structure, and up to three years if you’ve had a lot of work on the tip.