Every year, nearly a quarter of a million Americans choose to have rhinoplasty surgery (colloquially called a “nose job”). The rhinoplasty operation is one of the five most popular types of plastic surgery according to the American Society of Plastic Surgeons (ASPS). The reasons people choose to have rhinoplasty surgery may be purely cosmetic, or they may be corrective as well. Some people want to have a bridge bump flattened or a large nose tip reduced in size, and others want to have a deviated septum (the dividing cartilage in the nose) straightened for easier breathing, and others want to appear younger and may have a drooping nose tip reduced.
Among men, rhinoplasty is the second most popular type of plastic surgery chosen (after liposuction). It is also popular among younger adults. Almost half of all the rhinoplasty operations done in 2008 were on people from age 19 to 34. The earliest recorded “nose jobs” are attributed to Shshruta, who was an Indian physician who was practicing around the year 500 BCE. His written text, titled Sushrutha Samhita, recorded rhinoplasty by himself and his understudies on people whose noses had been amputated as punishment for crimes. In the modern era, John Orlando Roe is credited with performing the first intranasal (inside the nose) rhinoplasty in 1887.
Rhinoplasty specialists may come from different medical training backgrounds. For example, they may be trained as an ear, nose, and throat surgeon, or a plastic surgeon. Ask any prospective rhinoplasty specialists about their training and how many procedures they have performed. Your nose is front and center of your face – one of the first things people notice about you – so you don’t want to trust your nose to just any surgeon.
Rhinoplasty is usually not covered by medical insurance unle ss it is being done to correct a birth defect, to reconstruct a broken nose, or to correct a breathing problem. You should talk with both your physician and your insurance company if you think you might have coverage for the procedure. If you do, be sure to obtain proper preauthorization for the procedure, and ask about coverage for anesthesia, revisions, and other costs. Ask if your premiums will go up as a result of having the surgery and if your future coverage will be affected by your having the procedure.
In the two weeks leading up to your rhinoplasty operation, follow any instructions given to you by your rhinoplasty specialist. Some of the guidelines commonly given to rhinoplasty patients for the weeks leading up to the surgery include:
- Avoiding aspirin or anti-inflammatory medications.
- Quitting smoking. Smoking during recovery greatly increases the risks for complications such as poor wound healing and tissue death.
- Arrange for transportation to and from the surgery.
- Arrange for a caregiver for the first one to three days after surgery.
- Fill any post-op prescriptions in advance.
- Make sure you have on hand a thermometer and antibacterial soap.
- Discuss the use of any homeopathic medicines with your rhinoplasty specialist.
- Make a comfortable recovery area with books, magazines, television, heating pads, laptop computer, etc.
- Have walkie talkies, a bell, or a baby monitor on hand for communicating with your caregiver.
- Stock up on frozen meals and “easy” foods like soup, applesauce, gelatin, yogurt, and juice.
- Prepare ice packs, or use packs of frozen peas to reduce swelling.
- Consider buying a laxative, because pain medications can be binding.
- Consider buying or borrowing a hand-held shower head and bathroom chair.
- For surgery day, wear loose clothing which can be removed afterward without it having to go over your head.
There are two major types of rhinoplasty operation: open rhinoplasty and closed rhinoplasty. You may undergo general anesthesia or heavy sedation, and the surgery can take from one to four hours. Open rhinoplasty involves an incision being made across the columella, between your nostrils, as well as incisions inside the nose. This procedure is the one often used for more complicated cases. Some surgeons prefer this technique for the greater visibility it gives the surgeon. It will result in more swelling and bruising than with a closed rhinoplasty.
Closed rhinoplasty is a rhinoplasty operation where the incisions are only inside the nose. Recovery is faster and swelling is less pronounced than with open rhinoplasty. The only drawback is that your rhinoplasty specialist will have a more limited range of changes he or she can perform using a closed procedure. Regardless of whether you have open or closed rhinoplasty, you should sleep with your head elevated for a week after the surgery to minimize swelling and help it subside quicker.
The results of your rhinoplasty operation won’t be apparent immediately after surgery because of swelling and bruising. The thickness of your skin will have an effect on the results you get. Thicker skin won’t “drape” as well over the newly-altered underlying structure as will thinner skin. On the other hand, thick skin can hid irregularities of cartilage and bone better than thinner skin.
You or the recovery nurse will phone the person giving you a ride after the surgery. You’ll make the quickest recovery with the least chance of complications if you follow your surgeon’s instructions beginning when you recover from the anesthesia or sedation. During the first 24 hours of postoperative recovery, your nose will hurt. It may feel like a bad allergy attack or a bad head cold. You will probably have a hea dache, and your face will feel puffy. If you have wisely already procured your prescription pain medication beforehand, you’ll start taking it according to instructions after you return home.
Plan on remaining in bed for at least a couple of days after the operation except for trips to the bathroom. If you have a recliner, that is a good place to sleep the first couple of days so your head will remain elevated. Swelling and bruising may become more apparent for the first few days. In fact, you might realize you have one or two black eyes. This is common. Cold compresses surrounding your nose will help keep swelling down and will feel good. It is not uncommon, however, to look worse than you feel. After a week or two, most bruising will be gone, as will most swelling. Usually by this time, you’re the only one who notices any minor swelling or bruising that remains.
The stuffy nose feeling will last for a few days, and you may have some nasal bleeding and discharge. Sustained bleeding or large volumes of blood are not normal and should be reported to your rhinoplasty specialist. Try not to blow your nose for at least a week to avoid disturbing the incision wounds. You may have gauze packing your nose, and if so, your doctor will remove it on your post-op visit that takes place a few days after surgery. Removal of the packing will result in an immediate improvement in how you feel. After two weeks, all of the packing, splints, sutures, and dressings will be removed. Your surgeon can tell you exactly when this will happen.
The final results of your rhinoplasty operation will take a while to become apparent. Depending on how quickly you heal, residual swelling and bruising may remain for six months or longer after the procedure. You won’t see your “final” nose until all the swelling is gone. If a year goes by and you find that you are unsatisfied with the results, you may need to consult with your rhinoplasty specialist or obtain a second opinion from another rhinoplasty specialist to determine what, if anything can be done to improve your results. Revision rhinoplasty is fairly uncommon, but it does happen.