Q. How old must I be to have this surgery?
- Unless you have had an injury or breathing problems, it is usually advisable to wait until the bones in your face are no longer growing. Bone development is complete in girls by about age 16 and in boys by age 17. But these are not rigid rules. A child with a nasal deformity due to a cleft palate will often be treated in childhood. If a nose is particularly unattractive, it is better to operate earlier, even in the mid-teens, and spare some grief and ridicule that will predictably occur otherwise. One memorable 14 year-old patient of mine was transformed after her surgery from being socially withdrawn to becoming much more outgoing, confident and popular; there would have been nothing to gain and possibly much to lose by waiting.
Q. Will I have a scar on my nose?
- Possibly. The "closed approach" uses incisions that are entirely hidden within the nose and will not lead to visible scars. The "open approach" uses an external incision across the columella (the vertical column separating the nostrils) and leaves a scar that is usually inconspicuous.
Most of the time, I use the closed approach. However, in patients who have had previous nose surgery (called "secondary rhinoplasties"), I often use an open approach, to provide more exposure of the tissues. I prefer to avoid a scar if I can do so without compromising the result. Fortunately, the "open approach" scar heals remarkably well and is inconspicuous, so when it is needed, it is an acceptable tradeoff for an improved surgical result.
When the nostril bases are narrowed (commonly for the non-Caucasian rhinoplasty), small incisions are used around the bases of the nostrils, which leave scars that are typically well-concealed in these natural creases.
Q. Can you make me a nose that looks like someone else?
- No. It is impossible to replicate the tissue characteristics of another person. Even if that were possible, it would be inadvisable, because one person's nose would look out of place on another face.
Q. Do you need to break the bones?
- The answer depends on whether there is excess bony tissue of the dorsum or bony asymmetry that can only be corrected by trimming and adjusting the nasal bones. If there is a hump, or if the dorsum is too wide, it will be necessary to remove the hump by rasping (filing) it down and then repositioning the nasal bones.
If the tip is to be narrowed, it may be beneficial to also narrow the dorsum to balance the reduced tip. Usually, patients don't like the idea of having their nose broken. They may have seen this maneuver on TV and understandably are not smitten with the idea of being on the receiving end of a mallet and chisel! However, most patients with a large nose understand they need a bony reduction. I reassure them that they will of course be asleep during the surgery and usually the postoperative discomfort is not as bad as they imagined.
Some patients with large, projecting, or bulbous nasal tips may require a "tip rhinoplasty" alone. In this case, the cartilages are trimmed, but the nasal bones are left alone. In tip rhinoplasties, there is swelling of the tip of the nose, but very little swelling and bruising of the face. There is virtually no discomfort after a tip rhinoplasty and minimal downtime.
Q. Will I have any packing in my nose?
- Usually, nasal packing is unnecessary. If I do find it necessary to use packing, I take it out the next morning. Packing is uncomfortable because it forces you to breathe through your mouth, so I avoid it whenever possible.
Q. Can I blow my nose?
- Do not blow your nose and avoid sneezing for two weeks. Avoid bumping your nose or being struck by an elbow or young child. Keep in mind that nothing is actually holding the nasal bones in position as they heal- there are no little screws to keep them in place. The surgeon places them in the desired position and may apply a splint as an extra precaution. We don't want any undue pressure or movement that might move the nasal bones out of position. They do heal quickly though, and by a week or so after surgery they are unlikely to move unless you are actually struck in the nose.
Q. When does the splint come off?
- Usually I take the splint off five days after surgery. When I do a tip rhinoplasty, without any bony work, I probably won't even use a splint. If the splint comes off before five days, don't worry, just leave it off and be careful not to bump your nose. You need to keep it dry or it will come off.
Q. How awful will I look?
- Expect to have swelling of the nose and face. And there will be bruising under the eyes. Patients usually look worse than they feel and this probably explains why most people think it's a painful procedure. Patients having tip rhinoplasties (no bony work) have swelling of the tip of the nose, but very little swelling or bruising of the face. Makeup may be used to help hide facial bruises.
Q. How long does it take for the swelling goes down?
- Swelling of the dorsum goes down quickly, within a month. However, swelling of the tip of the nose is notorious for taking a long time to go down. It will take months, possibly a year to fully subside. However, it is likely to be smaller than it was before surgery after a few weeks, so the fact that it takes awhile to see the final result does not usually pose a problem – patients just need to be informed so they don't expect their final result right away.
Q. Are there stitches?
- Yes, there are sutures on the inside of the nose that dissolve on their own. External sutures (they are usually a blue color) may be used when the nostrils are narrowed, or for an open rhinoplasty. These are removed about one week after surgery.
Q. What happens to the extra skin?
- The skin is elastic and will gradually contract down to fit the reduced size of the nasal framework. This is a remarkable property of skin, unlike artificial materials. Patients are amazed that the skin "shrink-wraps" down like this so that extra incisions to remove skin are not required.
Q. How much time off work will I need?
- Most patients take one week off work to allow the swelling to partially subside. Bruising is usually present for a few weeks. Patients with jobs that call for a high level of physical activity will need two weeks off. Of course, I've had patients get back to work much sooner, particularly if they are not too concerned about bruising or swelling, or wearing a splint in public.
Q. Will I be able to wear my glasses right away?
- No. You can wear contacts, but glasses cannot be worn after surgery for at least one week, to allow adequate healing of the nasal bones. In the meantime, you may tape your glasses to your forehead, or adjust them to rest on your cheeks. If you've had a tip rhinoplasty, it is okay to wear glasses.
Q. Will insurance help pay for my surgery?
- There may be insurance coverage for surgery to correct a breathing problem or nasal deformity following injury. We need to check first with your insurance company. Of course, insurance will not pay for surgery that is judged to be cosmetic or not medically necessary.
Q. How long does the surgery take?
- The surgery takes one to two hours, sometimes more if it is particularly difficult, such as a secondary rhinoplasty that involves grafting.