A Comprehensive Guide to Rhinoplasty Surgery

Introduction to Rhinoplasty

Rhinoplasty which is often called nose job in colloquial terms is a popular plastic
surgery performed throughout the world to correct nasal defects. People who
want the shape and size of their nose to be changed usually go for this surgery.

Since nose is the center of the face and the first thing to be noticed about a
person, it is apparent that most people who have slight defects want it to be
corrected and yet maintain their natural appearance.

Nose reshaping or restructuring procedures improve the appearance of the nose

along with adjusting the shape, size, proportion and symmetry considering the
overall facial and personality traits of the person.

During a Rhinoplasty procedure, the surgeon makes incisions along various parts
of the nose and corrects the internal structure of the nose consisting of cartilages,
tissues and tiny bones. The idea is to makes corrections in such way that the nasal
profile is adjusted to the desired shape and size.

An experienced surgeon will usually take into account various aspects to the
patients nose type, personality and ethnic identity, and decides on the best
technique and procedure to be carried out in order to get the perfect results.

When a highly reputed and experienced surgeon performs the nose job, it can
change the life of the person as they see an overall improvement in the
appearance and the nose looks more natural and complimenting to their overall
face.

A successful nose job is one which does not leave any scars or weird looking
marks on the nose and provides the patient with the confidence for being their
true self. If the person gets compliments on his appearance by others but they
cannot pin-point what exactly has changed in his personality then we can safely
assume that the procedures were a total success.

Defects Corrected by Nose Job

Nose job can correct many defects pertaining to the alignment of the nose and
the shape or size of the nasal traits. The defects are mainly categorized into two
types

Functional Defects These are the aspects related to the working of the nose and
the functions it performs. People with these defects usually face health issues and
require immediate medical intervention to ease them of the pain.

Deviated septum is one of those serious issues which lead to a lop-sided nasal
profile causing breathing and other respiratory problems to the patient. The
septum causes obstruction in the breathing leading to lack of oxygen to the vital
organs in the body.

By operating on the tissues, cartilages and nasal bones the surgeon can fix the
septum and ease the airflow through the nasal passage. This correction will
automatically lead to more straighter and attractive looking nose. It also helps in
improving his overall health.

Cosmetic Defects These are the slight or sometimes more prominent physical
features and appearance of the nose which the person wants to correct. These
are usually related to how the nose looks and whether the person feels it is
congruent with other facial features.

Rhinoplasty surgery is also an aesthetic enhancement surgery where the surgeon

makes slight corrections to the nasal profile and improves the overall appearance
of the nose.

The defects corrected by nose job are

Nasal asymmetry and dislocation of prominent nasal parts

Uneven nostrils making the nose look disfigured
Upturned, hooked, flat, crooked, celestial, pointed, protruding, drooping
nose
Visible humps, bumps, depressions and protrusions on the nose
Enlarged nostrils with smaller upper nasal structure
Bulbous nostrils with excessive volume and flesh with weaker or narrower
nasal wall
Excessive or too narrow width of the nasal bridge
Perforated nasal septum or other damaged internal parts
 Weaker cartilages and bones leading to drooping and disfigured nose
(elderly rhinoplasty)
Excessive inflammation of the nasal walls due to allergies
Correction of Sinusitis, Asthma, Bronchitis and other respiratory diseases
Correcting enlarged and swollen turbinates
Nasal polyps growth due to allergies and irritation
Radix correction (upper bony portion of the nose)
Tip rotation and reduction
Projection and nasolabial (area above the upper lips) adjustments
Alar base correction to make the nose fit in
Deviated septum correction
Congenital defects or under-developed nose
Tight or closed nostrils creating health issues to the patient
Females with male nasal profile and vice versa
Wounds, injuries or fractures caused by accidents
Any foreign objects stuck inside the nose
Failed or unsatisfactory primary nose job

Medical Terms Used By the Surgeons

The medical fraternity is known for using some words and terms which goes
beyond the understanding of a common man. This makes the entire discussion
meaningless to that person. To avoid this scenario and to prepare you for the
upcoming consultation sessions we have created a list of common medical terms
used during Rhinoplasty.

Rhinoplasty Surgery to reshape or restructure your external nose and

internal nasal parts
General Anesthesia Administration of gas through a mask to make the
patient unconscious
Local Anesthesia Numbing agents injected in and around the place where
surgery is to be performed.
Intravenous injections Sedative drugs are injected through the veins to
calm to nerves and help the patient relax
Deviated septum misaligned nasal wall separating the nostrils. This causes
breathing problems as well as crooked nose
 Cartilage Connecting and supporting tissues in the nose
Columella the skin from upper lip to the nasal tip and where incisions are
made
Cartilage harvesting Taking cartilages from other parts of the body like rib
or ear for supporting the nasal structure
Grafting polishing the cartilage harvested from other parts and
transplanting them inside the nasal structure
Septal Hematoma bleeding and pooling of blood in the nasal cavities and
area where surgery is done causing severe infection
Revision Rhinoplasty Corrective procedure to make good any mistakes
from first surgery

Things to Look for in a Cosmetic Surgeon

Rhinoplasty is an important surgery for your personality and life. It is also a

complex surgery requiring an expert hand at work. In order to get the best results
possible from the surgery, you have to make sure that you get along well with
your doctor.

Before committing with a surgeon for the nose job you have to make sure that
you are thoroughly convinced that the surgeon is the perfect person for operating
on you and he completely understands what you desire out of this surgery.

Building a good rapport in the initial consultation sessions by interacting with your
surgeon will help you to know many things about the surgery, the surgeons style,
important things that matter during and after surgery etc.

You can ask the surgeon some questions while talking to him. But, you need to
maintain the casual tone and not go overboard while interviewing him. You do
not want to intimidate him with your constant questioning, which after some
time, may seem like interrogation.

Usually the surgeon would have answered these questions many times in the past
and created a brochure or pamphlet to be given to the new patients on arrival.
The common questions are usually answered here along with highlighting the
reputation, experience and past successful surgeries performed by the surgeon.
You can go through it to get most of your questions answered.
Some of the questions to ask your surgeon while making the final decision are

Are you certified by the American Board of Plastic Surgeons (equivalent

board for your country of choice)?
The American Association of Plastic Surgeons
The American Academy of Facial Plastic and Reconstructive Surgery
Are you a permanent member of (country) Medical Association and
Medical Professionals?
Were you trained in the field of plastic surgery and especially Rhinoplasty?
What is the experience you have in nose job procedures?
Where would you be conducting the surgery?
Does your clinic have license to perform such surgeries?
Will you be using the surgical facility of hospitals or other medical centers?
Am I fit for nasal surgery?
How can I prepare best for the surgery?
Which surgical technique are you going to use?
Are your methods conservative or radical?
How long will it take to recovery completely in my case?
What complications may arise during surgery and how will you handle
those?
What are the changes which can be seen overtime in my nose?
What options do I have if I am dissatisfied with the results?
Do you provide financing options or discounts for full cash payments?
Can I see some before and after pictures of your past Rhinoplasty patients?

Am I a Good Candidate for Rhinoplasty?

In order to have a successful nose job you have to check whether you are ready
for this change in your physical appearance, your personality and the overall
change it will cause in your life.

Expecting unrealistic results will usually lead to disappointment and a vicious

cycle of re-examination of your nose by a different surgeon and a revision
Rhinoplasty. If you understand the limits of what can be achieved you will usually
be very happy with what you get.
Here are some questions which are warning signs for you to stop and reassess
your decision. These questions hint more towards your psychological setup,
emotional stability, rationality and connection to the reality.

Do I want to get the surgery done to look like my favorite celebrity?

Am I doing this to please my spouse, partner or someone I admire and want
to emulate?
Is this surgery purely meant to help me in my career or relationships?
Am I over critical about my appearance and always think what others might
be thinking about my nose and overall appearance?
Do I want a picture perfect nose created by the surgeon?
Do I spend most of my day looking at my nose and its shape in the mirror?
Do I have emotional balance to live with the current nose that I have?
Will I still be happy and satisfied in my life if I do not get this nose job?
Am I still a teenager who is going through the growth phase?
Have I gone through multiple cosmetic surgeries in the past?
Am I attaching all my failures and disappointments to the defect of nose?

If you said yes to any of the questions above, it shows that, to some degree, you
are relating your self-worth to the shape of your nose. While, getting a nose job
done to look better is not wrong, it shouldnt become an obsession or a meter to
measure your beauty and personality.

You would be a perfect candidate for Rhinoplasty if you expected just a minor
change in your nose and would want to retain the uniqueness of your nose
pertaining to your ethnicity. Of course, some nose jobs require a complete
reconstruction and makeover in order to make the nose look normal, but most
cases require just a minor adjustment.

You will be most happy and contended after your nose job if your expectations
are realistic and understand the limitations of Rhinoplasty surgery.

Preparation for a Successful Nasal Procedure

Rhinoplasty procedure will be successful when the patient discloses his medical
history to the surgeon and all the steps go smoothly without any complications.
The patient should block out at least two weeks from his schedule for the surgery.
The entire operation will be done within a few hours and the patient will be given
discharge within a day.

The patient has to maintain a good and healthy diet to be physically healthy and
sustain the stressful event of surgery. He should maintain proper nutrition to
speed up healing after surgery. He should eat plenty of fruits and vegetables,
whole grains and lean protein. Vitamin supplements of A and C are usually
recommended by the doctors.

Smoking and drinking alcohol should be avoided before and after the surgery for
at least a few weeks. This may slow down healing or may create undue
complications during the surgery. Any herbal medication or supplements should
also be stopped or discussed with the surgeon to take his consent for
consumption.

Surgeons also warn against certain foods which can cause surgical complications
and are known to be blood thinners. These make it hard for the blood to clot and
keep wounds fresh after the surgery. The surgeon may also prescribe certain
additional supplements if he finds your pre-surgery tests are not up to the mark.

The patient should maintain a proper sleep cycle and get plenty of rest before and
after the surgery. He should also maintain proper hygiene and avoid any makeup
or other creams before coming to the surgical facility.

During the initial phases of the surgery the patient should remain calm and follow
instructions. Placing trust in your surgeons ability will help immensely in
remaining relaxed throughout the surgery.

Recovery phase is as important as the surgery itself. After the surgery the patient
is given many instructions for proper and speedy recovery. He should record
everything sincerely and follow the advice to the T.

Rhinoplasty Techniques

There are many types of Rhinoplasty surgeries which vary according to the
requirements of the patient. But, the surgeon typically uses either of the two
techniques while performing these surgeries.
Open Rhinoplasty This procedure involves making incisions along the columella
and making adjustments or reshaping. The overlaying skin on the nose is raised
and secured and the surgery is performed. This gives the surgeon visual access to
the inner structure of the nose. This has an advantage of ease, perfection and
total control over the other technique.

Closed Rhinoplasty This procedure involves making incisions inside the nostrils.
The scars are hidden and the recovery is faster than the open technique. But, this
is difficult when compared to the prior.

The technique chosen for the surgery is left at surgeons discretion. He decides
which one would be the best option for the case and the goals of the surgery.

Types of Rhinoplasty Surgeries

Nose restructuring surgery can be divided into various types depending on the
goals to be achieved. Some of them are

Reduction Rhinoplasty This surgery is performed to address bumps or

humps on the nose along with reshaping the nose to fit in to the overall
face. Any excessive features like elongated nose tip, bulbous nostrils,
excessive width of the nasal bridge and voluminous nose are corrected
through this surgery.

The doctor removes small amounts of cartilages, bones and tissues from
the nose to cause the reduction in the size and contours of the nose.

Augmentation Rhinoplasty This is the opposite of the prior type. The

surgeon adds volume and cartilages to places which either lack volume or
have collapsed due to ageing, wound, infection or congenital defects.

This procedure usually requires cartilage harvesting and grafting to achieve

the desired goals. The surgeon uses computer 3d programs to simulate the
end result. Dermal injectable fillers may also be used to achieve the desired
increase in shape and size. This is a non-surgical approach to Rhinoplasty.
 Ethnic Rhinoplasty This is a procedure performed for individuals based on
their racial and ethnic characteristics. It refers to people from African
American, Afro-Caribbean, Asian, Hispanic, Middle Eastern and other racial
origins.

This surgery requires a thorough understanding of the unique facial

contours of the racial type. They should then be matched with the desires
of the patient and a delicate approach should be adopted to bring about
the changes while maintaining their uniqueness.

Reconstructive Rhinoplasty This is a complex surgery where the patient

has lost most or all parts of the nose due to some infection, cancer,
accident, wound or other serious conditions. The surgeon has to make use
of grafting procedures for skin and cartilages, flap techniques and other
advanced methods.

This procedure calls for multiple surgeries over a period of time to get the
exact results. This specialized operation may prolong over several months
and also has to be done by a highly experienced surgeon.

Post Traumatic Rhinoplasty This surgery is done for people who have
suffered an injury to the nose causing functional as well as cosmetic
damage. The doctor may have to fracture the nose to set it right and help
the patient breathe freely with a proper looking nose.

It is advisable to visit the doctor immediately after the injury. If the patient
delays, the body will start its natural course of healing and create further
damage to the weakened septal structure.

Teenage Rhinoplasty This is a surgery meant for the adolescents. The

doctors usually recommend them to wait until they are adults when their
nose is fully grown. But some cases require surgical intervention to correct
health issues or trauma to the nose.

Unlike a normal adult surgery, this operation requires the doctor to take
extra care of the tender nose structure of the young patient and also make
 him/her feel at ease while consultation sessions and operation.

Elderly Rhinoplasty This procedure is carried out for people whose nose
is degenerating due to old age or other degenerative diseases. Our body
has a natural capacity to replenish the dead cells and tissues with the new
ones. But as the body ages, it loses its capacity.

The nose will start losing its shape and volume and may look distorted. The
surgeon can make corrections either through cartilage grafting or through
dermal fillers to add volume and shape and create a normal looking nose.

Revision Rhinoplasty This is also called secondary nose job where the
imperfections of the first nose job are fixed. A Revision procedure may not
include a full-fledged operation but may be completed by using dermal
fillers. The surgeon may use this to complement the primary surgery and fill
in the areas on the nose which require minute changes.

Cost of Nose Surgery

The costs vary widely depending on various factors and the type of Rhinoplasty
surgery to be done. Each case is unique posing new and complex challenges to
the surgeon. The cost of surgery will usually be in the range of $5000 to $15000.

The surgeon may make use of advanced technology to achieve perfection and
reduce recovery time. Newer and improved methods may cost more for the
patient.

The costs are directly proportional to the experience of the surgeon. Higher the
reputation and experience of the surgeon more will be the fees. The physical
location of the surgical facility will also make a difference in the overall costs. A
surgery in metro city will cost you more than one in a smaller town.

During the surgery any emergency procedure carried out to contain the situation
from going out of control will also add up to the overall costs.

An overview of expenses is given below

Surgeons fees
 Surgical staff and support staff fees
Anesthesiologist fees
Operation theater and surgical unit fees
Hospital room and other facilities availed
Clothing, gowns and other special facilities
Pre-surgery medical tests
Prescription of medicine
Seeking expert advice on complex cases
Emergency procedures for surgical complications
Transportation to and from the surgical unit
Visa, air fare and domestic travelling for foreign patients
Service tax of the hospital
Health care tax levied by local authorities
Miscellaneous expenses

Arrangement of Funds for Nose Surgery

Saving: Nose job requires you to plan in advance and save up funds. The
expenses will vary depending on the complexity of your case and the
procedures required. Therefore, it is wise to have a buffer stock of funds to
meet any contingency. Setting aside a certain amount every month for a
period of time will help you pay without creating any burden of debt in the
future.

Insurance Coverage: Insurance companies provide health policies which

can be tapped into to fund these surgeries. But, you have to be aware of
their clauses and terms of settlement of claim. Having a discussion with
your insurance agent will help you know exactly what will be covered and
what is not.

Most insurance providers do not cover cosmetic surgeries. Surgeries done

for functional and health reasons are usually covered. However, you need
to make sure whether it will be partial or umbrella coverage. This means,
whether the insurance company will cover only the costs involved in
surgery and fees of the surgeon or will it cover the entire amount that went
 into your Rhinoplasty surgery.

In-House Financing: A reputed surgeon will help the patient by availing

various financing options. The patient can pay the amount in a few
installments for either a small interest rate or no interest.

Some reputed clinics have a tie-up with banks and other financial
institutions for providing financing for the surgery. They can help you get
the loan quicker at a lower interest rate or sometimes zero interest
financing.

Bank Loan: This is another option where you can directly approach a bank
and take a person loan citing the reason. You may have to do a bit of
research on whether your countrys bank gives loans for overseas
procedures. You may also approach the bank in the country where you are
going to have the surgery done.

Depending on whether you are eligible for a loan you can make certain
calculations on whether a loan in domestic country or foreign country will
be beneficial to you through currency exchange rates.

Full Cash Payment: Most clinics give their patients discounts on making full
cash payments. You will have to discuss it with the clinic staff to see how
much you can save by making full payment. If you have the cash available
you can settle your dues and get good discount.

Detailed Procedure of Nasal Operation

The surgeon may choose to operate on the patient with open procedure or closed
procedure. The procedure involved in same for both with only an exception of
where the incisions are made.

Step 1: Anesthesia Once the patient is brought into the surgical theatre he is
made to feel comfortable by general talks and slight humor while the
anesthesiologist prepares the equipment for administration.
The patient may be given either a general anesthesia or a local anesthesia. Usually
the doctors prefer general anesthesia as it gives them total control over the
patient and help them complete the work without any difficulty.

The patient is made to wear a gas mask through which anesthesia is given. Within
a few seconds the patient become unconscious and the surgeon gets the green
signal to proceed with his work.

Step 2: Incisions Depending on the technique, the surgeon either starts making
incisions along the columella (the part where the upper lip meets the base of
nostrils) or inside the nostrils to access the nasal structure.

The skin is raised and secured with medical clips while other sensitive organs like
eyes are secured with protective gear. The flesh is cut through to access the bony
part of the nose which is to be operated upon.

Step 3: Correcting Deviations The surgeons first preference will be to correct

any functional problems. He corrects the deviated septum and anything which is
causing health problems to the patient.

If cartilages or tissues are required to be placed inside the nose to correct the
functional problems, the surgeon will harvest them from either an ear or through
the right lower rib.

Step 4: Reshaping and Restructuring the Nose After correcting functional

problems, the surgeon heads towards making cosmetic changes to make the nose
look beautiful and aesthetically fit in to the overall facial traits.

The surgeon may make use of implants or cartilage and skin grafts to achieve the
exact shape and size desired. He may also make small fractures and remove parts
of the bone to align the entire nasal structure perfectly.

After the procedure is completed the surgeon secures the new structure with
dissolvable medical sutures (threads) while the body adjusts to the new shape
and activates its natural healing mechanism.

Step 5: Closing the Incision The skin is gently brought back to its original place
and secured with medical stitches. Splints are placed within the nostrils and also
over the nose to protect the newly created structure. Bandages are placed
beneath the nostrils to soak blood and fluids oozing out.

Any protective gear is removed and the patient is ready to be shifted to the room.
The anesthesia effects will gradually wear out and the patient comes into full
consciousness.

Step 6: Recovery and Follow up The recovery period will take anywhere from a
few weeks to a full year. The nose will gradually take the new form where the skin
is adjusting to the internal structure.

The patient is required to visit the clinic for follow up sessions where the surgeon
will check the progress and give prescriptions for medication.

Recovery Period for Rhinoplasty

The recovery begins after the patient is given discharge. Many instructions are
given to the patient to be followed religiously in order to have speedy recovery.

For the first week there will be fluids and blood oozing out of the nostrils. The
patient is required to frequently clean the blood and keep the area clean to avoid
any kind of infection. The fluid should not be allowed to accumulate inside the
nostrils as this might lead to crystallizing and causing more damage to the delicate
inner structure.

The head should be rested on an elevated place and should be above the rest of
the body. This helps the blood flow to be on the lower parts of the body and not
cause pressure on the head and nose.

The medications are prescribed which should be taken properly while maintaining
healthy diet with lots of fresh fruits and vegetables. The body should be given
complete rest for the first few weeks when it is at its weakest.

The patient is advised to avoid any kind of strenuous physical activity during the
first few months as this will lead to increase in the heart rate and corresponding
faster breathing through the nose. The delicate structure which is still healing may
be ruptured by this pressure and bleeding may occur internally.
After a month or two when the surgeon gives his consent, the patient can resume
his day to day activities with low intensity exercise and aerobic activities. The
nose will take shape and will be fully recovered by the end of the year.

Alternative to Rhinoplasty Surgery

Non surgical Rhinoplasty is a cosmetic surgery which does not create any incisions
and scars on the patients nose. It is a non-invasive procedure done to correct
minor defects and deformities of the nose.

The surgeon makes use of dermal filler agents to be injected into the lower
regions of the nose. The filler comes pre-packed with a hypodermal needle and
syringe which are used to access the subcutaneous regions of the nose.

This procedure gives temporary results and is completely safe for most of the
patients. Only the highly skin-sensitive may be required to have a test before
deciding if the injection will work safely. Only the FDA tested and approved
injectable fillers are used in the treatment.

Most dermal fillers are hyluronic acid based or calcium based. These are widely
used filler agents. Some of the popular dermal fillers are Jevuderm, Restylane,
Voluma, Perlane and Radiesse.

Liquid medical grade silicone is also used through a microdroplet technique by the
surgeons over multiple sessions. The gel is injected in small quantities over a
period of time to get the desired results.

The patients who are wary of Rhinoplasty surgery or want just a minor
adjustment can go for this alternative route.

Risks Involved in Nose Job

Although Rhinoplasty is a safe procedure and the surgeons take utmost care while
operating on the nose there remains some degree of risk which has to be taken
into account before opting for the surgery.
The risks involved are explained to the patient and his consent is sought before
beginning the procedure.

Some of the risks involved are

Severe reaction to anesthesia

Allergy to medication, chemical smells and surgical instrument
Internal bleeding causing hematoma
Infection in and around the place of surgery
Numbness in and around the nose
Uneven healing and scars left behind after surgery
Perforation of nasal septum while operating
Swelling around the eyes and cheeks
Slow recovery
Results not par with the desired level
Possibility of a revision Rhinoplasty

Final Remarks on Rhinoplasty Procedure

Nose job is one of the common procedures done throughout the world for
correcting many defects of the nose. With the advancements in the field of
medical technology and continuous improvements in the surgical procedures,
plastic surgeons are now able to make laser precision correction with reduced
down-time.

If you are unhappy with the shape or size of your nose consult with the nearest
surgeon and book an appointment for discussing the options that you have for
correcting the defect.

Many people around the world have found new hope in their career, relationships
and life in general due to improved physical appearance. A virtuous cycle sets in
where there are improvements in all areas of their life and ultimately they lead a
happy and fulfilled life.