Nose Reconstruction (Rhinoplasty)

What is rhinoplasty?

Rhinoplasty is an operation that changes the shape of your nose.

When is it used?

This operation can be used to improve the appearance, size, or angle of your nose. For example, it may make your nose smaller or larger. It can also be used to correct deformities and blockages caused by injury, disease, or birth defects. Sometimes it may be done to make it easier for you to breathe.

Your provider will discuss with you the reasons you want the surgery and the results you can expect.

How do I prepare for a rhinoplasty?

• Your healthcare provider will take photographs of your face and nose to help plan the operation.
• Before the surgery you will have a complete physical exam, possibly including blood tests or urine tests. A recent cold, allergies, or sinus problems may postpone the operation.
• Plan how you will take care of yourself after the operation. Find someone to drive you home after the surgery. Make sure a family member, friend, or relative can stay with you at least 24 hours after your operation if you will not be staying at the hospital after the surgery.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should stop smoking at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.
• If you are taking daily aspirin for a medical condition, ask your provider if you need to stop it before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.
• If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.
• Follow any other instructions your provider gives you.

What happens during the procedure?

You may be given a sedative and a narcotic before you receive a local or general anesthetic. The anesthesia will keep you from feeling pain during the operation. When you are asleep or your face is numb, your surgeon will reshape the cartilage and bone inside your nose. Most of the incisions are made inside your nose to limit noticeable scars. Some rhinoplasties are done with a small cut on the bottom of the nose. This cut is not usually noticeable after you heal.

Sometimes bone or cartilage is removed from the nose, and sometimes bone and cartilage grafts are added. Grafts can be taken from another part of your body, or a synthetic material can be used.

Your operation will last 1 or 2 hours, depending on the amount of work that is needed.

After your nose is reshaped, the surgeon may pack thin pieces of gauze into each nostril to control bleeding. You will have a small protective splint taped over your nose to hold the reshaped bones and cartilage in place. You will wear the splint for 5 to 10 days. A small drip pad will be taped under your nose to catch any drainage or blood that seeps through.

What happens after the procedure?

You should rest in bed with your head raised the first day after surgery. This helps decrease swelling and bleeding. For 1 to 2 weeks after surgery your face, nose, and eyes will be bruised, swollen, and discolored. Ice packs will help reduce the swelling, bruising, and discomfort.

Your healthcare provider may prescribe medicine to reduce drainage and a mild pain reliever for pain.

If you have packing in your nose, your loss of smell will lessen your appetite. You may prefer a liquid or soft diet, but you can eat whatever you feel like eating.

You will want to brush your teeth and rinse your mouth with a mouthwash often because you will be breathing through your mouth until the packing is taken out or your nose becomes less swollen. You also will want to drink lots of beverages because your mouth will become dry.

If you have packing, it will be removed in 1 to 7 days. After the packing is removed, do not blow your nose for 48 hours. Also try not to cough too hard. Blowing your nose or coughing may start bleeding.

After the swelling and bruising improve, your healthcare provider may take pictures of your nose and face so that there is a before-and-after record of your operation. You may not be able to see the final improvement from your operation for weeks or months.

What are the benefits of this procedure?

• Because your nose is such a visible part of your face, a more satisfying shape will give you a better body image.
• If you had any deformity that made it hard to breathe, you will be able to breathe more freely.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local anesthesia may not numb the area enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• You may have excessive bleeding that you may not notice because it drains down the back of your throat.
• You may have recurring nosebleeds from the crusting in the area of the cut in your nose.
• You may have trouble breathing from the narrowing of the nasal passages, or a reduced sense of smell.
• You may have an infection.
• You may develop a hole in the septum. The septum is the wall dividing the two nostrils. The hole may cause crusting or bleeding from the edge of the septum or a whistling sound when you breathe in.
• Your nose may feel or look a little different.
• Your nose may not be perfectly straight or symmetric.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You notice excessive nasal drainage or bleeding from your nose on your drip pad.
• You are spitting up or vomiting blood that has run back into the throat.
• You are swallowing often and then belching, which is a sign of blood draining down your throat and collecting in your stomach.
• You have a nosebleed that does not stop in 10 to 15 minutes despite efforts to stop it. (To try to stop it, rest with your head elevated. Put ice on your forehead or nose and use your thumb and forefinger to put gentle pressure on your upper lip at the bottom of your nose.)

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.