Rhinoplasty

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What is rhinoplasty or septorhinoplasty?

Rhinoplasty refers to surgery performed on the nose to remodel or reconstruct the external nose. Septorhinoplasty refers to rhinoplasty in addition to reconstruction and remodeling of the nasal septum, the internal wall which separates the two sides of the nose. The two terms are often used interchangeably because reconstructive and aesthetic nasal surgery almost invariably includes the nasal septum.

When should septorhinoplasty be performed?

Septorhinoplasty is performed for reconstructive or aesthetic purposes. Following trauma, the nose may be severely fractured which may lead to blockage of nasal breathing or a severely deformed external nasal appearance. In this instance, septorhinoplasty is performed for reconstructive purposes, and to improve function (breathing). However, the majority of septorhinoplasties are performed for cosmetic reasons to enhance the aesthetic appearance of the nose. This is performed for both men and women.

Who is qualified to perform this type of surgery?

As with any surgical procedure, septorhinoplasty should be performed by a well-trained surgeon. Specialists who perform “plastic” surgery of the face include ENT (Ears, nose, and throat) specialists, plastic surgeons, and others. Facial plastic surgery is one of the areas of expertise of ENT surgeons. It is an integral part of specialty training in ENT and a requirement to obtaining a specialist’s license in ENT in Canada and the USA.

Who is qualified to perform this type of surgery?

As with any surgical procedure, septorhinoplasty should be performed by a well-trained surgeon. Specialists who perform “plastic” surgery of the face include ENT (Ears, nose, and throat) specialists, plastic surgeons, and others. Facial plastic surgery is one of the areas of expertise of ENT surgeons. It is an integral part of specialty training in ENT and a requirement to obtaining a specialist’s license in ENT in Canada and the USA.

What can be achieved in terms of improving the appearance of the nose?

Much can be achieved in terms of enhancing the appearance of the nose. However, what can be achieved is not necessarily what should be performed. The nose sits amidst the framework of the face and as such needs to fit within this framework. Therefore, the proportions of the nose must be in harmony with the existing facial proportions. For example, shortening the nose excessively in a tall person with long and narrow facial dimensions leads to an undesirable overall result. In addition, while most requests for modifying nasal features are realistic, certain requests such as “I would like to make my whole nose smaller” may or may not be feasible or desirable. These considerations need to be discussed openly with your surgeon to insure a positive outcome.

Should I ask to see a digital image of the possible modifications which will be made?

This may give you an idea of the possible outcome of your nasal surgery, but can occasionally lead to disappointment. It is important to remember that every person’s anatomy is different and everyone does not heal in the same fashion. This is where the surgeon’s advice enters. He or she is able to assess how the nose will be shaped and heal after surgery based on assessing multiple factors, including the anatomy, skin type, and tissues of a particular patient’s nose.

What questions should I ask my surgeon?

It is a good idea to ask the surgeon about his or her training, including additional training or courses particular to septorhinoplasty, level of comfort performing such a procedure, and the number of septorhinoplasties he or she has performed. In addition, there should be a frank and open discussion about the realistic expectations of surgery as well as what can or cannot be achieved.

What are the risks involved with septorhinoplasty surgery?

The risks of bleeding and infection are common to any surgical procedure. These risks are small in the case of nasal surgery. The use of foreign materials such as implants or grafts in nasal surgery slightly increases the risk of infection. Other risks and complications specific to the procedure depend on what procedures are performed by the surgeon for a particular desired result. It is important to discus these risks and possible complications with your surgeon.

Should septorhinoplasty be performed under local or general anesthesia?

The type of anesthesia administered – general or local – does not significantly affect the level of discomfort or the final outcome of the nasal appearance, but may influence the overall experience of the patient. Frequently, patients who undergo surgery under local anesthesia report a very positive experience. However, this choice remains between surgeon and patient and is determined by multiple factors such as the patient’s preference, the planned procedure, the surgeon’s preference, and the institution where surgery is to take place.

Is it painful?

Overall, this is not a very painful or uncomfortable procedure, with relatively little discomfort. The level of discomfort is dependent on multiple factors, mainly the patient and the extent of surgery. Everyone has a different pain threshold and tolerance level. Other factors which influence the level of discomfort include: whether a packing is left in the nose for a prolonged period after surgery and whether the procedure includes breaking the bones of the nose (whether or not this is performed depends on the surgical plan and the modifications to be performed).

How much does it cost?

This is highly variable according to local norms and rates, surgeon’s reputation (name recognition and brand name), surgeon’s experience, operating room fees, and the planned procedure. The latter depends on the complexity of the nose to be operated on, and the planned maneuvers. These factors may not seem obvious to the untrained eye, but often, what may might appear to be a minor deformity requiring a minor alteration, is, in fact, a highly delicate task that requires skill, experience, and finesse. In addition, whether the planned procedure is a primary (first time) or revision (previously operated) surgery impacts on the skill, experience, and time required in the operating room.

How long do I need to book off work or school?

Patients are usually mobile and able to carry on normal activities very quickly after surgery. By 2 or 3 days after surgery, healthy patients are usually recovered to 90%. If the procedure was done under general anesthesia, it may take 4 or 5 days to regain one’s energy level. Usually, it is safe to take 7 or 8 days after surgery to completely recover. Another factor which may preclude work is the bandage / splint placed on the bridge of the nose in the vast majority of patients. Depending on the nature of the patient’s work, he/she may chose not to return to work until the splint is removed approximately one week following surgery.