1. How will my nose look after a rhinoplasty?
One of the most important considerations about having a rhinoplasty is to end up with a ‘new’ nose that makes you happy. While no surgery can absolutely be guaranteed as to how it will look, there should be a good understanding between the you and your plastic surgeon as to what your goals are. This is why computer imaging is so important before surgery. It serves as a method of communication so that what you would like and what is possible can be meshed into an image of a likely outcome.
As a plastic surgeon, we can reasonably predict what each patient will say bothers them about their nose. Whether it is a nasal hump, a wide tip, a downturned nose or a nose that is off center, we can quickly see what makes one’s nose out of proportion. The pupose of computer imaging is to make sure what we see is the same as you see. And it also allows us to know how to modify the changes we might do (e.g., more hump reduction, too much tip narrowing, tip up too high or still too low) so that it meets your needs better.
2. Does rhinoplasty leave scars?
Rhinoplasty can be done two ways, open and closed. While there may be some debate and advocates for either approach, most rhinoplasties today are done through an open approach. This does leave a small horizontal scar on the strip of skin between the nostrils. (columella) The remainder of the incisions are hidden inside the nose just like a traditional closed technique.
While the open approach does result in a scar, it almost always heals so well that it is virtually impossible to find when the scar matures. In some patients, you can only see that scar if you are within 10 cms or less. And it requires one to be looking from below the tip of the nose…a very unnatural viewpoint.
3. Will rhinoplasty improve the breathing through my nose?
Nose surgery can be done to change the external appearance of the nose (aesthetic rhinoplasty) or to improve obstructed breathing through the nose. (functional rhinoplasty or septorhinoplasty) Often both are done together.
Functional nasal surgery, however, is done completely inside the nose and works on those structures that contribute to air flow. This includes the septum (straightening a deviation), turbinates (reduction or partial resection) and manipulation of the internal nasal valve. (cartilage grafting for expansion)
It is important to realize that doing the two together has many benefits. Straightening a deviated septum can help straighten a crooked nose and is a good source for cartilage grafts. Turbinate reductions help open up an airway that may be adverseloy affected by some of the external changes. Expanding the middle vault with grafts can make a pinched-looking nose wider and make the dorsal lines more symmetric.
4. Will insurance pay for my rhinoplasty?
While we all would like health insurance to cover all of our medical needs, rhinoplasty is not usually one of them. Expenses related to improve breathing are almost always covered within the limits of your policy, any external changes to the appearance of the nose however are not. There are certain exceptions to that exclusion if there is a documented medical reason for how the nose is deformed. Birth defects (e.g., cleft lip and palate) and traumatic injuries (e.g., fractures)are the two main examples. I emphasize the word ‘documented’ as just saying that it occurred is not sufficient.
5. What can be done if I am unhappy with how my nose looks after surgery?
For most rhinoplasties, the biggest risk or complication is that of an undesired appearance outcome. This is usually not a large cosmetic problem but more like an irregularity, a dip or deviation, or some location of asymmetry of the bridge, tip, or mostrils. As a plastic surgeon, we are very sensitive to how even a minor ‘problem’ is of a big concern to a patient, particularly when it is on their nose.
When one sees something on their nose after surgery that displeases them, one should first be patient. The nose is unique in that the skin continues to change on the nose for months after surgery, sometimes even up to a year. What may be there to day, could be gone or even more apparent months from now. Secondary or revisional surgery is not usually done for at least six months from the initial surgery. The primary reason is that we want to operate on a ‘stable target’, not a nasal feature that is in a state of evolution. Also, it is important that the stiffness of the nose tissues has had time to settle down and become softer again. Revisional surgery done too early is highly prone to fail.
The risk of the need for revisional rhinoplasty surgery is not rare. Because of the many different types of nose problems and types of surgery needed, no one can give a reliable estimate that applies to any specific patient. In my Indianapolis plastic surgery practice, I use the estimate of a 10% risk…a not insignificant number.
6. What type of anesthesia is used for rhinoplasty surgery?
Surgery of the nose has a history of being done under local or IV sedation in many practices. While some plastic surgeons still do so, one should never compromise the ‘fear’ of anesthesia vs a good outcome. Comfort of the patient and the ability to manage any bleeding that may occur during surgery is best done under general anesthesia. Many older patients can recall having their nose done when they could hear or feel their ‘bones being broken.’
Today’s anesthesia techniques and drugs are so good, I see no reason to use anything less than a general anesthetic for almost all cases.
7. I have heard that rhinoplasty is a difficult surgery to do, why is that so?
While the nose is a small structure in comparison to the rest of the face, there is a lot of complex anatomy packed in there. Contrast the nose to the chin, for example, which is much larger. The chin has only two pieces of important anatomy (solid piece of bone and soft tissues) while the nose has three bone and six pieces of cartilage covered by a very thin layer of skin. The interrelationship of how this anatomy comes together, what changes occur by altering parts of it, and how it responds to healing and scar contracture make rhinoplasty less predictable than almost any other facial surgery that we do.
Dr. Barry Eppley
Indianapolis, Indiana