Introduction to Rhinoplasty
In this article few experts opinion about a nose job or otherwise known as a rhinoplasty will be shared for informational purposes. Make sure to read article completely to understand well about nose job for USA. I’ll be sure to discuss the cost associated with rhinoplasty and will insurance cover it or do you have to pay out of pocket?
What Is a Rhinoplasty?
But what is a rhinoplasty? A rhinoplasty is a procedure that addresses the skeleton of the nose primarily, so both the cartilage and the bone. And it’s different from a simple septoplasty that is just addressing the cartilage of the septum, which is that partition between the two sides of the nose.
A rhinoplasty is usually more involved and it can be done through either an open approach or closed approach. Closed means that the incisions are all internal on the inside of the nose and open means that there’s one added incision where the whole skin of the nose is kind of flipped up so you can really see the nasal skeleton really well. So what conditions can a rhinoplasty address?
Functional and Cosmetic Benefits of Rhinoplasty
A rhinoplasty can mainly address issues of breathing, those are the functional type of problems, as well as cosmetic concerns. So things like a wide nose, a bump on the nose, a hump, bulbous tip, wide tip, a deviated nose, right? Sometimes the nose can be deviated because the tip cartilages are off. Sometimes it’s deviated because the actual bones are deviated. And so you have to address kind of all portions of the nose in order to get it straighter.
Those are the types of general conditions. Of course, when it comes to breathing, there are many other types of issues that, you know, could explain poor breathing through the nose. A rhinoplasty can only address some of those concerns. Some of it has to do with the inner lining of the nose and are addressed in other ways other than just a rhinoplasty. So who is a good candidate for a rhinoplasty?
Who Is a Good Candidate for Rhinoplasty?
Well, first of all, it starts with realistic expectations, right? Sometimes there’s a complaint that I get of something super, super minor where you really can’t see it unless there is a certain light coming at the nose at a specific angle. And then maybe you can see a little shadow. That’s generally not a good type of candidate for rhinoplasty. It should be a visible quote-unquote deformity that the surgeon can spot, that the patient can easily identify.
You need to really have a target of what you’re going after and not just have it be just something that isn’t always there. It’s there some days and not other days. So that’s important. And also just the patient needs to understand the risks involved, the general process, the recovery process, the surgical process, that usually this is done with you asleep. This isn’t something that’s just done under local anesthesia in the office. So just someone who really understands that process, that’s really important.
Open vs. Closed Rhinoplasty Approaches
Is an open rhinoplasty better than a closed rhinoplasty? Again, it depends on surgeon preference. It depends on if you’re working just on the bridge of the nose or also on the tip of the nose. I believe that the tip of the nose is best addressed through an open approach. It gives you many more options for grafting, for example, that you can’t really otherwise do. I think closed approach is a valuable technique and is something that can be used if it’s just a bridge that needs to be addressed.
More often than not, personally, I’m opening the nose, both for primary cases and revision cases. But for that, I think you can find surgeons who favor a closed approach and still get nice results. I always recommend to patients, don’t come in requesting a specific approach. Find a surgeon who you trust, where you like their results, you like their overall approach, and just trust that they’re gonna use whichever approach they’re most comfortable with to get you the results that you’re hoping for. So how do you prepare for a rhinoplasty procedure?
How to Prepare for a Rhinoplasty
Well, there’s a whole list of things in terms of medical type of preparation. You want to make sure that you have medical clearance if that’s required. If you’re a young, healthy person, usually you don’t really need any special medical clearance. If you have an underlying condition like diabetes or asthma or high blood pressure, you definitely want to get cleared by your primary care doctor so that they kind of say it’s okay for you to go under anesthesia.
Then you also want to talk to the anesthesia team in whatever facility you’re going to for surgery to make sure that there’s a plan in place that they’re comfortable putting you to sleep and that you understand kind of what that all entails. And then you want to avoid things that might make you bleed more during surgery. So that could be even spicy foods. It could be certain medications.
Even something as benign sounding as Motrin can actually thin the blood. So usually your doctor will give you a list of things to avoid to try to reduce the risk of bleeding because it’s a very vascular territory, the nose. So you really want to make sure that you’re properly prepared in that sense and that’s going to help you, it’s going to help your surgeon, and it’s just going to lead to hopefully a better result overall.
And then there are certain things like, you know, not eating or drinking, um, usually after midnight, you know, the, the, uh, day before your surgery, there’s some very kind of specific things that your doctor will kind of talk to you about. Hopefully we ask patients to use something called the habit cleanse, um, type of cleaning solution so that the skin is as clean as it can be.
Usually they do that type of, uh, of cleaning the, the night before the surgery and, uh, but again, lots of just little logistical things like making sure you have someone to bring you home after the surgery. You don’t want to be driving yourself. You will have had anesthetics and medications and it’s not something that you want to just go home. And usually the facility that you get your surgery in you know, they’re not going to let you go home alone. So just preparing for things like that is very important.
How Rhinoplasty Is Performed
How is a rhinoplasty procedure performed? Well, we have a whole other video where we kind of dissect the mannequin and point out all the anatomy and the different approaches to both the bridge and the tip of the nose and the septum on a mannequin. So definitely make sure to kind of watch that video. But in general, the surgeon picks an open or closed approach. The nose is the skin is numbed up and it’s not just done for numbing. It’s also done for vasoconstriction to reduce the bleeding.
So that’s done. Usually we put something called pledges into the nose and those are meant to decongest the nose. So again reduces the bleeding and it kind of creates a little bit more opening inside of your nose and then the incisions are made. The cartilage and the bone that’s supposed to be worked on is exposed and then sometimes things are removed, such as extra bone that might be on the hump, for example, or extra pieces of cartilage that need to be kind of reworked, reshaped, recarved. And then other times there are little grafts of cartilage that we place back into the nose.
And so all of that work is done. And then eventually, once all that inner work is done, the nose is closed back up, sutured up. We use a splint on the outside, usually some silastic splints on the inside. Very few doctors these days will pack the nose. That used to be something that was done, but patients hated that. There were studies done showing that that’s not necessary to pack the nose, and so patients definitely like that now because they can usually breathe at least decently well, even right after the surgery. And then those inner splints and the outer cast and any sutures are removed typically at one week after surgery. Icing is good to do for the day or two after the surgery.
You definitely want to rest up, no heavy lifting, at least one week of just really limited activity. and no like physical activity involving like contact sports type of activity for at least six weeks, especially if your nose is rebroken because you don’t want to risk having it shift again. So that is an important consideration afterwards. Swelling, some bruising is kind of expected. some oozing of blood for about 48 hours until it dries up is expected.
I usually give patients an antibiotic prophylaxis infection though some of the recent studies actually suggest that we don’t have to give antibiotics that infections are generally very rare in that area. We give pain medicine. It’s typically just uncomfortable primarily in the first evening and then the pain level drops significantly into day two. Occasionally there’ll still be some pressure and just discomfort into a couple days after surgery. So you don’t usually need a narcotic after the first evening in my experience. And then saltwater spray, I recommend to start about 48 hours after the surgery to just kind of keep the nose clean and reduce the chance of a lot of crust building up inside.
What to Expect After Rhinoplasty
What can you expect after a nose job or rhinoplasty? Well, expect that the recovery is going to take some time. Okay, that’s the number one thing. Of course, you want to expect a nice result, but expect that it’s going to take time. So we always tell patients it can take about a year, sometimes more, before you see your final result, which is super frustrating for many people, and I understand that, but that’s kind of how the body is.
Usually, in one week, you’re still really swollen, and then that swelling will settle down over the course of the next few months, and then it’ll take much longer for all of the swelling to go away. The area where the swelling is really gonna linger the longest is gonna be the tip of the nose. So just expect that the tip is gonna look a little bit bigger.
And what I tell for a while, what I tell people is that the thicker your skin, the thicker the skin envelope, the longer it’s gonna take for that swelling to dissipate, okay? The thinner your skin, the less you’re gonna swell and not for as long of a period of time as a general rule. Okay, there are exceptions, of course, but that’s kind of the general rule. And then in terms of the overall recovery, like I said, a year to 16 months approximately, but you’ll kind of know what you have after about three to four months, though the tip can just be really frustrating, especially in patients with thicker skin. So a really important conversation that we have before surgery to really set the proper expectations.
