Provider sitting with patient in clinic room smiling

Rhinoplasty

Plastic Surgery

Surgery on the nose can be purely cosmetic, purely functional, to improve breathing, or a combination of improving both function and appearance. Improving the function of the nasal airway frequently involves surgically straightening the septum (septoplasty) when significant external deformities of the upper third of the nose are present then osteotomies or surgically re-breaking the nose is often required in effort to achieve both a straighter septum and aesthetically straightened appearance of the nose on the outside.

Nasal Valve

Functional collapse of the nose can occur at the level of the nostril termed (external valve or vestibular) collapse which can be dynamic meaning the nostril collapses during inspiration or static meaning it is narrow at baseline. This can also occur at the level of the internal nasal valve or midvault of the nose. This area is the area that is targeted by Breathe Right Strips™ and with functional rhinoplasty is often addressed through spreader grafts or spreader flaps that open up the midvault subtly in effort to affect change of the narrowed area. Cartilage from the patient’s own septum is frequently used to strengthen the nose as is the case with alar batten grafts to prevent external valve collapse. Spirox Latera™ is an absorbable nasal valve implant designed to decrease nasal valve collapse by creating a temporary batten to support the nasal sidewall and even after the implant dissolves in 12-18 months theoretically continues via scar to support the sidewall though long term results are lacking.

Turbinates are internal nasal structures made of concha bone with vaso-erectile lining tissue which swells in response to allergies, temperature, pressure, positioning and the normal alternating from side to side termed the “nasal cycle” Shrinking the turbinates through nasal steroid medicines such as fluticasone or mometasone nasal sprays is beneficial when allergic disease underpins nasal obstruction though sometimes the turbinates can be surgically reduced to improve nasal airflow, such surgery may be referred to as submucosal resection (SMR) of the turbinates, turbinoplasty, or turbinate reduction as is typically accomplished via minimally invasive endonasal approaches to the turbinates. The turbinates can be reduced through unguarded needle tip cautery, unguarded bipolar cautery, specialized turbinate microdebrider blades, and Coblator™ devices to name a few that all essentially incite scar on the inside of turbinate so that it can’t swell as much after surgery.

Open Rhinoplasty

An open rhinoplasty approach refers to a small external incision on the base strut called the columella of the nose. Coupled with internal nasal incisions this incision allows the soft tissues and skin that cover the cartilaginous framework of the nose to be lifted giving excellent exposure to the nasal framework which can be reshaped. Tip rhinoplasty is frequently a part of cosmetic rhinoplasty to improve the nasal tip in effort to make it more refined, more symmetric, and narrow or to decrease bulbosity. Tip surgery can be performed through open or closed approaches though open approaches do lead to longer postoperative swelling but improve visualization.

Closed Rhinoplasty (Endonasal) Rhinoplasty

This approach still requires incisions but they are all on the inside of the nose. Ideal for hump takedown to improve the profile in noses with prominent dorsal convexity or humps or for limited tip surgery. Decreased swelling but decreased visualization

The approach used in rhinoplasty is determined by a combination of patient specific anatomy, patient desire and surgeon training and experience with these techniques and some surgeons employ closed rhinoplasty for virtually every nose they operate on while others prefer open rhinoplasty approaches for most approaches.

Post-operative Rhinoplasty Instructions

  • Septal splints are frequently used to help stabilize the septum after septum. They are frequently sewn if for 5-7 days though can be left in longer in instances of septal perforation repair.
  • A nasal drip dressing of gauze is frequently taped below the nose and can be changed and discontinued as needed.
  • Generally avoid blowing the nose for the first 2 weeks
  • Nasal saline spray can be used every few hours, nasal decongestant sprays can be used for the first 2-3 days post-op.
  • Keep the nose dry and any tape or cast dry in event your nasal bones were surgically straightened.
  • Antibiotic ointment can be used to the external incision if you had a columellar incision (open rhinoplasty)
  • Sutures will be removed from the base of your nose at time of splint removal at 5-7 days post-op
  • Cool compresses can be used around the nose every few hours to minimize bruising and swelling in the first 2-3 days, and is particularly helpful if your nose required surgically breaking of the nasal bones.
  • Head of bed elevation is also helpful to reduce swelling
  • Prescription pain medications such as tramadol, Tylenol with codeine or hydrocodone/Tylenol combinations are frequently needed the first 5-7 days and can be weaned off and alternated with ibuprofen for pain control.
  • Though the majority of the swelling will subside by 1 month, swelling will continue to subside for the nose for many months and will take up to 2 years for subtle internal swelling to fully abate. These subtle changes are less visible as they are felt deep within the nose as the internal scar matures over time.