Nose Surgery

What is Nose Surgery?

Nose surgery, also known as rhinoplasty, enhances facial harmony and the proportions of your nose. Nose surgery can also correct impaired breathing caused by structural defects in the nose.

Nose surgery can change:

• Nose size in relation to facial balance
• Nose width at the bridge or in the size and position of the nostrils
• Nose profile with visible humps or depressions on the bridge
• Nasal tip that is enlarged or bulbous, drooping, upturned or hooked
• Nostrils that are large, wide, or upturned
• Nasal asymmetry

If you desire a more symmetrical nose, keep in mind that everyone's face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.

Nose surgery that's done to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.

Nose surgery is a good option if:

• Your facial growth is complete
• You are physically healthy
• You don't smoke
• You have a positive outlook and realistic goals in mind for the improvement of your appearance

Consultation and Preparing for Surgery

During your consultation be prepared to discuss:

• Your surgical goals, with regard to both appearance and breathing
• Medical conditions, drug allergies, and previous medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• The options available to you for nose reshaping
• Examine and measure your face
• Take photographs
• Discuss your nose surgery options
• Recommend a course of treatment
• Discuss likely outcomes of a nose surgery and any risks or potential complications

Prior to surgery, you may be asked to:

• Get a lab test
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding

Your plastic surgeon will also discuss where your procedure will be performed. Nose surgery may be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center or a hospital. Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Be sure to ask your plastic surgeon questions. It's very important to understand all aspects of your procedure.  It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress.  Don't be shy about discussing these feelings with your plastic surgeon.

The Procedure

Step 1 - Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

Step 2 - The incision

Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.

Step 3 - Reshaping the nose structure

An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafs. Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.

Step 4 - Correcting a deviated septum

If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.

Step 5 - Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Step 6 - See the results

For a few days splints and gauze packing will likely support the nose as it begins to heal. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your nose surgery. 

A nose surgery procedure to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.

Risks and Safety

The decision to have nose surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications.

The risks include:

• Anesthesia risks
• Bleeding (hematoma)
• Infection
• Poor wound healing or scarring
• Change in skin sensation (numbness or pain)
• Nasal septal perforation (a hole in the nasal septum) is rare.  Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication
• Difficulty breathing
• Unsatisfactory nasal appearance
• Skin discoloration and swelling
• Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Recovery After Surgery

After your procedure is completed, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.  

You will be given specific instructions that may include how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

Results

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

The results of nose surgery will be long-lasting. As your body ages, it is natural to have some gradual changes to your face including your nose. But most of your improvement should be relatively permanent.

A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Cost

Prices for nose surgeries can vary. A surgeon's cost may be based on his or her experience and geographic office location. Many plastic surgeons offer patient financing plans, so be sure to ask.

Cost may include:

• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Prescription medication
• Surgeon's fee

When nose surgery is performed to improve breathing function, the cause is most commonly an obstructed airway. This procedure, whether performed alone or in conjunction with cosmetic nose surgery, is considered reconstructive and may be covered by insurance. This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

Your satisfaction involves more than a fee:

When choosing a plastic surgeon for nose surgery, remember that the surgeon's experience and your comfort with him or her is just as important as the final cost of the surgery. Plastic surgery involves many choices. The first and most important is selecting an American Society of Plastic Surgeons (ASPS) member you can trust. ASPS member surgeons meet rigorous standards:

• Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®
• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with "cosmetic surgery" in its name. By choosing a member of The American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.

This procedural information is intended strictly for educational purposes. Only models are depicted in these procedural information pages. It is not intended to make any representations or warranties about the outcome of any procedure. It is not a substitute for a thorough, in-person consultation with a board certified plastic surgeon.