The Two Types of Rhinoplasty
Joseph W. Rucker, MD, FACS
Nasal surgery has become more popular in recent years because the nose is the most noticeable facial feature. We can often disguise protruding ears with various hairstyles and soften the appearance of our eyes with makeup, but our unwanted nasal features can’t be hidden or disguised. In the 500 Rhinoplasty procedures that I have performed, I have employed a conservative approach. This method avoids the dreaded “operated on” or “done” appearance.
There are two types of Rhinoplasty procedures. The first is a reconstruction of the nose that has been disfigured by injury or has become damaged from disease, such as skin cancer. I like to categorize this type of procedure as a functional Rhinoplasty. The procedure is performed to relieve such symptoms as a complaint of the inability to breathe through one or both nostrils and the associated complaints of excessive mouth breathing or headaches.
The disfigurement of the nose is most commonly caused by some traumatic event such as a sports injury. This can result in a displacement of the partition inside the nose that separates one nostril from the other (nasal septum). The external framework can also be affected leaving the condition commonly called a twisted nose. The functional Rhinoplasty is often covered by insurance.
The second type of Rhinoplasty is cosmetic, with the ultimate goal to produce a better appearance of the nose. I refer to this second type as an aesthetic Rhinoplasty. Because this is a purely cosmetic procedure, it is not covered by insurance.
If a functional Rhinoplasty is to be performed, a preoperative evaluation and detailed history of any injury is taken and the nose is examined to determine the degree of nasal airflow impairment. The internal nasal partition (nasal septum) is examined for any signs of displacement. The external framework is also examined to determine any displacement of the nasal bones, which can often happen after a nasal fracture.
In the case of an aesthetic Rhinoplasty, I feel the most important aspect of the initial consultation is to determine whether the results of the procedure can realistically meet the patient’s expectations. Difficulties can arise when a patient states, “I want my nose to look exactly like this” and presents me with a picture of a celebrity. This type of result is often not realistic because other facial features contribute to the nasal appearance and the nasal framework may not allow a specific result. However, certain characteristics of someone else’s nose may be incorporated into each individualized Rhinoplasty.
The procedure is often done in our office operating suite with a local sedation anesthetic. It is an outpatient procedure and takes about two hours. Most patients rate the pain as a 5 on a scale of 1 to 10. The vast majority of incisions are hidden inside the nose and a nasal splint is left in place for one week. Recovery time is reasonable and most patients are socially presentable in 8 to 10 days. Eighty percent of the swelling has resolved within ten days, with the remainder reducing over a two month period. Complications are rare, but may arise. The more common ones are infection, asymmetry, scarring and bleeding.
The Rhinoplasty procedure can be a positive method to address a twisted nose or concerns about one’s nasal appearance. It is my recommendation that a less aggressive approach is better and patient expectations must be fully evaluated.