A rhinoplasty is an operation performed to alter the appearance of the nose. The
appearance of the nose is determined by the shape of the underlying bony and
cartilaginous skeleton and by the thickness and pliability of the overlying skin.
Most patients requesting nasal surgery have considered what type of nose they
would like. It is not possible to accurately and consistently reproduce a specified
nose. However, general changes can be made with a very pleasing result. Nasal
surgery may be performed under a local anaesthetic which numbs just the nasal
area, or a general anaesthetic may be used. In a "closed" rhinoplasty all
incisions are made inside the nostrils, through which the work is done, thus
leaving no external scars. In a "open" rhinoplasty a small incision is made across
the "columella" (the skin beneath the tip separating the nostrils) allowing better
visualization of the anatomy although leaving a small inconspicuous scar.. These
incisions provide access to the cartilage and bone of the nose which can be cut,
trimmed, and manipulated to reshape the nose and alter its external appearance.

What changes can be performed on the nasal dorsum?

The nasal dorsum is the upper portion of the nose commonly called the bridge.
The underlying framework consists mainly of the nasal bones but also of the
septal cartilage.

The most frequent operation on the dorsum is removal of a large dorsal hump. This is performed by sanding down the hump on the bone, leaving the bridge flat with the bones and cartilage spread.

The bones are then weakened at their base at the cheek and then brought
together to form a narrower nasal bridge. Occasionally the nasal dorsum has no
hump and is only wide.

In this situation the nasal dorsum can be narrowed by removing bone
along the side of the dorsum of the nose. In some people the nasal dorsum has a
scooped out appearance or a ski jump type nose. In this situation the nasal
dorsum can be built up by adding either cartilage, bone, or an implant beneath
the skin to augment the framework.

What can be done to the nasal tip? The wide and bulbous nasal tip can be reduced by trimming the cartilage in this area.

The amount the tip narrows depends on the degree of which the overlying
skin contracts. Better results are achieved with an open rhinoplasty.

Can the Nostrils be narrowed?

In some patients the nostrils are very wide with a flared appearance and they
may wish these narrowed. To do this it requires removal of small skin wedges
and this results in external skin incisions. These scars which lie in the crease
where the nostrils join the cheek are permanent but usually inconspicuous.

Can the nose be shortened?

The length of the nose can be shortened or a drooping nasal tip can be elevated
by trimming the septal cartilage (the internal cartilage separating the nasal
cavities).

Can asymmetry be corrected?

Patients who have a crooked nose from an injury may have this corrected by
refracturing and straightening the bones and cartilage. Unfortunately it is often
difficult to achieve a perfectly straight nose once injured and surgery may not
totally correct the deformity. Restoring the shape of a traumatized nose is
covered under the B.C. Medical Services Plan however only for the immediate 12
months following a documented fracture.

What is the recovery period like?

Following the operation the nose has an external splint for about a week. There is
bruising and swelling about the eyes for 1 to 2 weeks. Pain is usually moderate
and is controlled with oral medication. Numbness and swelling of the nasal tip
and lining persist for some time. Nasal stuffiness is present for several months.
They are not conspicuous, but do result in a slow softening of the nasal contours
and opening of the nasal airways. Because of these factors, here is a gradual
contour change in the nose which continues for one to two years.

Vigorous activity should be avoided in the first several weeks to avoid bleeding
problems.

What are the limitations?

The character of the overlying skin can have a dramatic effect on the outcome of
this surgery. Thick, oily, porous skin does not conform as readily to the
underlying framework, and it is therefore less likely to show changes, particularly
at the tip of the nose.

The size of the nasal passages must be maintained at a reasonable level,
otherwise permanent nasal stuffiness will be a problem. This limits the amount of
size reduction possible. The nose should harmonize with the other facial
features.

Internal scarring in the nose will also affect the appearance of the nose. Truly
drastic changes are usually not compatible with the basic framework and soft
tissue structure of the nose.

What are the more common complications?

The complications of anaesthesia, whether local (freezing) or general, are part of
the risk of even minor surgery. Serious problems are rare.

Infection can occur in 1-2% and may require use of antibiotics. In 3-4% of
patients a nosebleed can occur within the first several weeks of surgery and may
require packing of the nose. The basic mechanisms of circulatory compromise,
skin loss, and poor scar formation are complications as in any surgery. Rarely
permanent bruising or pigmentation of the skin can occur. Damage to the tear
drainage system is very uncommon.

Occasionally some local tenderness may persist for some time. Nasal stuffiness
may occur from the swelling however this is usually temporary and may result in
a change in the sense of smell. The most common problem is that of minor
irregularities in contour (about 20%), and for this reason, touch up procedures are
fairly common.