RHINOPLASTY

M. TAVALLALI, M.D.

Rhinoplasty is the name of the operation to correct deformities of the nose. Its primary purpose is to improve the appearance and, in some instances, to improve function. The excess bone or cartilage are removed and that remaining is reshaped. After alteration of these supporting structures, the skin is allowed to redrape over them to give the nose its new shape. The changes may be subtle or dramatic depending on the needs of the patient.

My goal in rhinoplasty is to produce a nose that appears natural, functions properly and is in balance and harmony with the rest of the face. The “operated look” is one that should be avoided. The patient’s wishes in regard to the type of nose desired are always considered, but there are limiting factors. Skin texture and thickness, previous injury and facial proportions and contour play an important role in what can and should be achieved. All of this will be discussed with you during your consultation.

The following is information to give you a better understanding of what is involved in having rhinoplasty. If you have any questions, jot them down so we can discuss them at a later time.

What is the earliest age rhinoplasty can be performed?

I prefer to wait until skeletal growth has ceased. This is usually around 14-15 years in girls and 16-17 years in boys. Exceptions are made in problem cases.

What determines the type of nose a person should have?

This is determined mainly by the proportions and relationships of the other facial structures. Sex plays a role in that females should have smaller, softer appearing noses than males.

Is it possible to show what the new nose will look like?

No. During one of your visits photographs will be taken which I use for study. I will sketch what I believe to be the most desirable shaped nose for your face and what the surgical goal should be. This is for discussion only and to help us agree on what our surgical goal should be. Computer imaging will however give you an idea of the possible shape.

Will insurance pay for nasal surgery?

Most insurance companies will pay only if the patient has a breathing problem or if the nasal deformity is the result of an accident. If the breathing problem is corrected at the same time the rhinoplasty is performed, they will usually pay on the part of the surgery performed to improve breathing. If they pay part of the surgical fee, they usually pay most of the anesthesia and hospital costs.

Is it necessary to pack the nose?

Usually not, especially if there is no major breathing problem prior to surgery. Even if there is, I try to avoid packing and use small soft plastic splints, which have a built-in airway. If packing should be required, I usually try to remove it within 48-72 hours.

Is there much pain?

It is surprising how little discomfort there is associated with rhinoplasty. Usually oral pain medication the first day or two is all that is necessary for any discomfort that may be present.

How many office visits are there after surgery?

If the surgery is performed in the hospital, most patients go home the same day. There will be a cast on the outside of the nose. You will return to the office at 6-7 days for removal of the cast, again in another week and at 6-8 weeks for routine check-ups. I also like to see you one year after surgery to make certain you are doing well and that the results are as we expected.

How much swelling will there be?

Although medicines are given to keep it to a minimum, this varies with different patients. Some swelling and bruising of the nose and around the eyes is expected. This reaches its peak 2 days after surgery and then starts subsiding. Swelling is usually still present when the plaster cast is removed at one week. After 10-12 days, all visible swelling will have disappeared but there will be a feeling of numbness and stiffness at the tip of the nose which means some swelling persists. It will take this swelling several months to subside completely, but it will not be noticeable to anyone but the patient. In patients with thick, oily skin, swelling is slower to resolve.

What are the limitations after surgery?

Patients usually go back to school or to sedentary work within one week after surgery. There should be no strenuous activity for two weeks. After that, strenuous activity may be resumed but you should not participate in any activity in which the nose could be bumped for the total of eight weeks. Excessive sun exposure should be avoided for eight weeks.

How soon after surgery can glasses be worn?

Glasses can be worn while the cast is on. After it is removed, they can still be worn but should not rest on the nose for eight weeks. We will show you how to do this. Contacts can be worn as soon as the swelling goes down around the eyes.

What if other surgery is needed?

During your consultation, your entire face will be evaluated. If I feel there are other procedures that would improve your appearance, they will be discussed with you. The most frequently performed adjunctive procedure is chin augmentation (mentoplasty to correct receding chin)

Does the nose grow as people get older?

No. However, as a person ages the fat in the area of the nasal-lip junction may be partially absorbed. This results in a drooping of the nasal tip which makes the nose look longer. In such situation, turning the nose up slightly adds to a more youthful appearance of the face.

Are there ever incisions on the outside of the nose?

Occasionally a small incision is made in the skin between the nostrils where it joins the upper lip. This is under the nose and is rarely visible. If the base of the nose is too wide, it is narrowed by making incisions in the creases on both sides where the nostril and cheek join. The resulting scars are hidden in the creases.

Hopefully, this information has given you a better understanding of rhinoplasty. Please feel free to call our offices at 703-876-9400 or 301-907-3838 to schedule a complimentary consultation with Dr. Tavallali. We look forward to seeing you soon.

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