Rhinoplasty Frequently Asked Questions
Article by Maurice M. Khosh, MD
New York Facial Plastic Surgeon
What are the approaches for rhinoplasty?
There are two major approaches for performing rhinoplasty, closed and open technique. Your doctor chooses the surgical technique based on patient’s features and desired effect. In revision rhinoplasty, typically an open approach is employed as this allows better visualization of the nasal cartilages and bones and the effect of prior surgery on these structures. In primary rhinoplasty, open approach is only undertaken when significant nasal tip work is desired or when notable asymmetry is present.
What kind of anesthesia is used for rhinoplasty?
General anesthesia is most commonly used for performance of rhinoplasty. This technique allows for complete control of patient’s breathing and it translates into the safest method of providing anesthesia. Additionally, general anesthesia avoids the risk of patient coughing or moving during surgery. The patients nonetheless leave the hospital to return home after general anesthesia and thus the surgery is categorized as outpatient surgery.
When is revision rhinoplasty performed?
A revision rhinoplasty may be necessary in two distinct scenarios. The first scenario is in the patient in whom the rhinoplasty failed to reach the anticipated cosmetic outcome. This could be exemplified in a person whose nasal hump was not reduced adequately, or one in whom the nasal tip was not made narrow enough.
The second category of revision surgery is in those patients in whom an overly aggressive surgery was performed. An example would be a patient whose dorsum was reduced excessively or one in whom the nasal tip was made to look pinched.
Obviously, the approach to these two categories of patients is entirely different. In one additional cartilage or bone may be removed and in the other cartilage may need to be added in order to affect the desired outcome. In either case, your doctor, with his knowledge in the anatomy and the physiology of the nose, should be able to help you achieve your anticipated goal of the shape of the nose.
What kind of pain or discomfort should I expect after rhinoplasty?
Surprisingly, there is little discomfort with rhinoplasty. In the past, surgeons had used packing inside the nose, which was uncomfortable and painful. I do not ascribe to use of packing inside the nose and patients therefore find recovery relatively pain-free. Most patients do not need any pain medication past the second day.
What is the recovery for rhinoplasty?
Recovery after rhinoplasty is generally quick. It is exceedingly rare that patients would have extensive bruising of the nose such that you may have seen on an extreme makeover show. Typically, most bruising is resolved after five days. Rarely, some mild persistent bruising may last up to two weeks.
For the first two days, there will be oozing of blood from the nose and you may have to wear a small gauze underneath the nose to collect any draining blood. Externally, tape may be applied to the bridge of the nose or there may be a plastic cast applied. In either case, the patients may shower and get the cast or the tape wet. It was advised that patients use salt-water nose sprays to help cleanse the nose and the inside. You are advised against blowing your nose until the first postoperative visit five to six days following surgery.
In most cases, the external appearance of the nose becomes evident in approximately two weeks. It will, however, take several months before the final shape of the nose is appreciated.
Most patients may return to their work and daily activities at 10 days after rhinoplasty. Your followup visits will be scheduled at approximately one week, one month, three months, six months, and one year after surgery.