Maybe you have a bump that makes you feel self-conscious about getting your picture taken. Or perhaps it's a deviated septum that's causing you to have breathing problems. Whether it's for cosmetic purposes, health reasons, or a combination of factors, rhinoplasty (nose reshaping) is one of the most popular plastic surgeries in the United States. In fact, more than 280,000 Americans underwent rhinoplasty in 2007, according to the American Society for Aesthetic Plastic Surgery.
History
Reportedly first performed by an Indian physician named Sushruta circa 500 B.C., early rhinoplasties were used to reconstruct noses that had been amputated as criminal punishment. Often regarded as the "father of plastic surgery," Sushruta developed methods and techniques that are still practiced today.
It wasn't until 1887 that John Orlando Roe performed the first rhinoplasty in the West. Twelve years later, a surgeon named Jacques Joseph was the first to operate on the nose of a patient strictly for cosmetic reasons. Since that time, millions have sought out this groundbreaking procedure.
The Procedure
Rhinoplasty is usually performed as an outpatient procedure under general anesthesia. The surgery itself typically lasts between one and two hours.
During the procedure, the plastic surgeon separates the skin of the nose from the bone and cartilage that supports it. The surgeon then reshapes the nose by refining the tip, increasing or decreasing overall size, altering the angle between the upper lip and the nose, or narrowing the nostrils. In many cases, bone and cartilage are removed or added in from another part of the patient's body for more precise support and shape. Artificial implants are often used as well.
There are two different methods of rhinoplasty, open and closed, which are differentiated by the way the interior of the nose is accessed during the procedure. There are advantages and disadvantages to both, and your doctor can advise as to which is best suited for your desired outcome.
Open: The surgeon will either begin by making the initial incision across columella, which is the thin strip of tissue that separates the nostrils. Making the incision across the columella gives the surgeon greater access to the bone and cartilage by allowing her to lift the skin off the tip of the nose and shape the cartilage very precisely. The main drawback of this option is that the incision will leave a small scar on the underside of the nose.
Closed: For this type of surgery, the doctor will make the incision on the inside of the nose, which means there is little risk of scarring, unlike with the open procedure. It allows slightly less freedom to the surgeon, but still offers more than adequate reshaping possibilities. The scar-free outcome makes this option the most popular, but again, your doctor will be able to advise you as to which is best suited for your specific needs and goals.
Recovery and Results
Whether you undergo open or closed rhinoplasty, the recovery process is generally the same. Once the surgeon has completed the reconstruction, the incision is stitched up, and a splint is applied to help the nose retain its new shape. Nostrils are sometimes packed with pieces of gauze to control bleeding and keep the septum in place. However, because nasal packing is often associated with increased pain after surgery, most surgeons only use it when absolutely necessary.
During the first day or so after surgery, expect your nose and head to ache and your face to feel puffy and swollen. Black eyes and bloody nasal fluids are common, but if the amount of blood seems abnormally high, contact your surgeon immediately.
Pain medication and cold compresses can be used to manage most of these effects, but you should plan to stay in bed as much as possible during the first few days. One to two weeks after your surgery, most of the swelling and bruising should be gone, and the doctor will remove all of the dressing, stitches, and nasal packing.
The majority of patients are able to resume sedentary daily activities within two days to a week, but even after this initial period, it's best to avoid strenuous activities that increase blood pressure for up to three weeks.
Because the extensive tissue altering that takes place throughout the nose and surrounding area results in significant swelling, it prevents patients from seeing the full results of the surgery for quite some time. Major swelling will be decreased within two weeks, but minor swelling can remain for up to a year. It is important to not get frustrated if the results are not immediately what you expected.
Cost
Rhinoplasty is a costly procedure, ranging from $4,000 to $12,000, depending on the structural/cosmetic changes that will be made to the nose. Most insurance companies will not cover the cost of this type of surgery when it is done for cosmetic reasons only. However, some may cover a rhinoplasty that is necessary for medical reasons or is being done for reconstructive purposes after an accident. For those whose insurance policies don't cover the surgery or who don't have insurance, companies such as Capital One offer financing options specifically designed for patients undergoing cosmetic procedures.
