OVERVIEW
If you are considering surgery to change the size or shape of your nose, the current options are much greater and more satisfying than ever before. Surgery of the nose has advanced in recent years, giving the plastic surgeon and the patient more options than ever before. The surgeon now has the ability to “customize” your procedure based upon your specific needs and anatomy. This current ability to “customize” nasal surgery has evolved over the past fifteen years. In the past, nasal surgery was taught and practiced using a “cookie cutter” approach. Plastic surgeons of the time performed the same operation on practically all their patients regardless of their preoperative appearance.
Today, the emphasis is placed on looking at your nose individually. Dr. Glassman will discuss with you which features of your nose need change as well as those features best left untouched. Now, each nasal surgery is “customized” based upon your unique anatomy. With the emphasis on diagnosis, Dr. Glassman will create a plan to obtain the most satisfying result.
INDICATIONS
Nasal surgery can be performed to change consequence of genetics, birth defect or injury. It can be done to enhance your appearance and/or to improve your nasal breathing. Potential changes include:
decreasing the overall size of the nose
removing the bump on the bridge
narrowing a wide bridge
refining and narrowing the tip
adding “projection” to the tip
narrowing the nostrils shortening the nose
improving the transition between the nose and the upper lip
straightening the nose if it is crooked
straightening a deviated septum (the dividing wall between the air passages) to improve nasal breathing
restoring the height of the bridge following injury or previous surgery
In younger patients, the surgery can be performed after the skeleton of the face is fully developed. This usually occurs in young men by the age of sixteen. Skeletal growth is usually complete in young women by the age of fifteen. In adulthood, the surgery can be performed at any age.
If you have had a previous operation on your nose and are unhappy with the outcome, you may be a candidate for secondary nasal surgery. If too little bone and cartilage have been removed at the original surgery, additional reduction of your nasal skeleton may be indicated. If, however, too much tissue has been removed or the remaining tissues are distorted, the procedure may involve grafting bone or cartilage from other areas of your body.
PRIOR TO SURGERY
At your initial consultation, Dr. Glassman will ask you to express your concerns about your appearance and to describe your symptoms. Your goal for the eventual appearance of your nose will be discussed. Your medical history will be reviewed and a physical examination will be conducted to determine if nasal surgery is best for you. If you are a good candidate for surgery, Dr. Glassman will explain what can be done to assist you. He will discuss the steps of the proposed surgery and the variables that may affect the procedure. Physical characteristics such as the size and shape of your nasal bones and cartilage as well as the thickness of your skin may affect the technical considerations.
Dr. Glassman may request that you visit your private medical doctor for a check-up and for any necessary lab work and x-rays. Precise preoperative instructions are provided, and all necessary prescriptions are given to you in advance of the surgery. All aspirin, aspirin-containing products, and anti-inflammatory products must be stopped at least ten days before and for ten days after surgery. You will be provided with a complete list of which medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of vitamins and homeopathic preparations to take prior to and after the surgery. This is done to promote healing and limit bruising.
Some insurance companies will pay for nasal surgery if it is medically necessary. Our office staff will help you determine if you are eligible for such benefits. Dr. Glassman will write a “predetermination letter” if required by your insurance company.
ANESTHESIA
In most nasal surgeries, general anesthesia is used. However, in some cases, local anesthesia with intravenous sedation may be used. Dr. Glassman and our anesthesiologist will help you make the decision of which type of anesthesia is best for you.
THE PROCEDURE
Nasal surgery is generally performed as an outpatient in a private facility. It may be combined with other procedures, such as facial surgery and/or body contouring.
After anesthesia is given, small incisions are made inside the nose. Miniature instruments are used to separate the skin from the underlying supporting framework of bone and cartilage. The bone and cartilage are then sculpted to the desired shape. The nature and extent of the sculpting are dependent on your nasal anatomy and the desired contour. Finally, the skin is redraped over the new framework and dissolvable sutures are used to close the incisions.
Another technique commonly used is the “open approach” which involves making a small skin incision across the columella (the vertical strip of tissue separating the nostrils). This provides more exposure in complex cases and is often used in secondary rhinoplasties. This incision heals very well and is usually inconspicuous three weeks after surgery.
When the surgery is completed, a splint is applied to maintain the new shape of your nose and to limit the amount of postoperative swelling. If the surgery involves straightening your septum, soft nasal splints may be placed in your nostrils to stabilize the septum. You will then be awakened and taken to the recovery room. The operation takes one to two hours.
THE POSTOPERATIVE PERIOD
The first one to two hours after surgery are spent in the recovery room. When you are fully alert, you will be able to return home in the care of a friend or family member. A private nurse can be provided at your request.
You will be encouraged to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. There is very little if any pain following nasal surgery. Pain medication is prescribed, although it is usually not necessary.
The following morning, your nose will be inspected and cleansed in our office. There may be mild bruising and swelling which lasts for one to two weeks. A subtle degree of swelling will remain for several months. If you have nasal packing, it will be removed after a few days, and you will feel more comfortable. By the end of one week the splint will be removed.
Most patients may drive a car and return to work or social activities after one week. Strenuous physical exercise is avoided for three weeks following nasal surgery. Contact sports are to be avoided for six weeks after surgery. You can wear contact lenses after a few days; however, if you wear glasses, you will be given special tape to suspend your glasses from your forehead. It is important not to allow the glasses to rest on the bridge of your nose for six weeks after surgery.
RISKS AND COMPLICATIONS
As with any operation, nasal surgery has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare. Like all surgery, the risk of bleeding, infection, scarring or an anesthetic problem is present. Since all of the incisions are inside the nose, there are no visible scars. When the “open” technique is employed, the small scar across the columella is usually not visible.
In about five per cent of nasal cases, a second procedure may be required to correct a minor deformity such as a small residual bump on the bridge. The corrective surgery is usually minor in nature.
RESULTS
If your nasal airway is obstructed, you are more dependent on mouth breathing which is much less efficient. This condition leads to early fatigue when exercising and symptoms of dry mouth. Nasal obstruction may also lead to snoring and chronic sinus infections. Septoplasty and nasal airway surgery are performed to alleviate these problems.
Additionally, changes in the size and shape of the nose can lead to a dramatic improvement in your facial appearance. It is of great importance that your new nose be in proportion to your other facial features. It should be “balanced” and natural in appearance. It is of great importance to Dr. Glassman that your result not appear to be “artificial” or “surgical”.
ADVANTAGES OF NASAL SURGERY
When you have surgery on your nose, it is important to preserve or restore normal function as well as to achieve an attractive cosmetic result. If you are having trouble breathing through your nose, the functional advantage of the surgery can be as dramatic as the emotional change that accompanies an improvement in your appearance.