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If you are considering rhinoplasty...

If you are considering rhinoplasty...
Are You A Good Candidate For Rhinoplasty?
Selecting A Surgeon
Consultation
Planning The Surgery
Preparing For Your Surgery
The Risks Of Surgery
Anesthesia
The Surgery
Rhinoplasty For Asians
Your New Nose
After The Surgery
Follow-Up

Rhinoplasty, or plastic surgery of the nose, is one of the most popular cosmetic surgery procedures. The nose occupies the prominent central area of the face, and thus determines to a major extent whether the face is considered attractive or not.
You may be considering rhinoplasty to enhance your appearance, or for reconstructive purposes such as correcting birth defects or traumatic injuries to the nose.



If you are considering rhinoplasty...
the following information can help you understand the procedure, how it's done and what results can be expected. However, each patient has individual needs and features, and it is only by consulting with a plastic surgeon that you can best understand how plastic surgery can help you.

Rhinoplasty is most often thought of as either a nose "lift" or a nose reduction. In actuality, plastic surgery of the nose may involve the following techniques, done singly or in combination:
-nasal bridge augmentation or reduction (changes the height of the bridge of the nose), -nasal tip augmentation or reduction (changes the shape of the tip, change the angle between nose and upper lip)
-alar plasty (reduction of width of the nasal base to narrow the span of the nostrils).
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Are you a good candidate for rhinoplasty?
To be a good candidate for rhinoplasty, you should be physically healthy, psychologically stable, and realistic in your expectations.

You may think having rhinoplasty will make you look like your ideal or give you perfect looks. You may think that people will treat you differently or that you will be a happier person after your rhinoplasty. These are unrealistic expectations. Good results will help you increase your self-confidence but you won't necessarily look like your ideal.

Your age is also a consideration. You should be at least 14 or 15 years old for girls and a little later for boys because it is best to have rhinoplasty after you've completed your growth spurt. Having the surgery should be something you want and not something other people want for you. Your social and emotional adjustment is also important to consider especially if you are a teenager.
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Selecting a Surgeon
Although rhinoplasty is generally safe, the discerning patient should consider some factors to ensure safety, minimize the risks involved, and get a good result.

Oftentimes, patients choose their surgeon on the basis of price. However, the success of the procedure is largely dependent on your choice of surgeon. There are no laws in the Philippines that regulate who can perform rhinoplasty. Thus, to avoid unsatisfactory results, it is best to choose a surgeon who has had accredited training in plastic surgery and extensive experience in rhinoplasty. This delicate operation also requires aesthetic judgement, sense of beauty, and the ability to visualize the end result.

Your surgeon's skill can make all the difference between a good result and one which will require correction and additional expense. Specially since he will be working on a very prominent feature on your face, select your surgeon on the basis of his professional qualifications and experience and not on the price.

The patient must also be able to trust the surgeon for proper evaluation and advice.

More on How to Select a Qualified Plastic Surgeon
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Consultation
Cosmetic surgery of the nose is one of the most delicate plastic surgery operations. There is so much artistry involved in the planning and execution of this operation. Everyone has a different nose and there are many techniques that the surgeon can use to achieve the desired results.

When you first consult with your surgeon, he will ask you what your expectations are and what you would like your nose to look like. He will also evaluate the structure of your nasal bones and cartilage, the shape of your face, your skin, and your age since these factors influence his decisions about what techniques to use for the surgery to get the desired result.

Your surgeon will explain what he plans to do and what anesthesia he plans to use, considering your preferences. He will discuss where the surgery will be performed, as well as the risks and costs involved. You can also ask him any questions you may have, especially those regarding your expectations about the results.

He will also ask you if you've previously had nose surgery or have had an injury to your nose. If you have allergies, breathing difficulties, if you smoke, or take medications, vitamins, or other drugs, you should also inform your surgeon.

Before you undergo your operation, your surgeon will ask you to have blood tests done to ensure that you will not have any bleeding problems as a result of the operation. If you are 40 years of age or older, you will also be requested to have an electrocardiogram done and to visit your internist or cardiologist for cardiovascular clearance. This is to ensure that you are physically fit to undergo the surgery.

If you are planning to have a nasal bridge augmentation (noselift), it is ideal to have a mold of your nose done before the operation. This nasal mold will help the plastic surgeon carve or sculpt a silicone implant that will be specially appropriate for your face. It is important that the silicone implant blends harmoniously with your existing nasal framework so that the surgical result will look natural.
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Planning the Surgery
After evaluating the patient, the plastic surgeon plans the operation and determines whether incisions can be hidden inside the nose, (a "closed" rhinoplasty) or if incisions on the outside skin have to be made (an "open" rhinoplasty).

The shape and position of the incisions are carefully planned so that the resulting scars are practically invisible after healing. It is rare for a patient to have visible scars if her surgeon is competent. However, if the operation isn't performed skillfully, incisions that are made randomly and haphazardly will result in visible scars and an unnatural new nose. Thus, you have to be very careful in your selection of your surgeon. The most important factor in the success of your surgery is your surgeon's training, skill and experience.
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Preparing for your Surgery
To avoid any complications and risks, your surgeon will give you specific guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Follow these instructions carefully.
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The Risks of Surgery
All surgery has some uncertainty and risk involved but complications are infrequent and usually minor when rhinoplasty is performed by a qualified plastic surgeon, since he has the necessary training, skill and experience. If you follow your surgeon's instructions closely both before and after surgery, you can also reduce your risks of complications such as infections, nosebleeds, or reactions to the anesthesia.
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Anesthesia
Rhinoplasty can be performed under local or general anesthesia, depending on the complexity of the procedure and on what you and your surgeon prefer.

With general anesthesia, you'll be sleeping during the operation and wake up after it is finished. With local anesthesia, you'll be awake during the surgery, but in a relaxed state, since you will be lightly sedated. You will be insensitive to pain and your nose and the surrounding area will be numb. There is less risk when the operation is done under local anesthesia.
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The surgery
Rhinoplasty is usually done on an outpatient basis, for convenience and more affordable costs. It may be performed in a surgeon's office-based operating room. More complex procedures may require a short inpatient stay.

During surgery, incisions are made to provide access to cartilage and bone. The skin of the nose is separated from its supporting framework and depending on your problem and your surgeon's preferred technique, the new nose is sculpted to the desired shape. Finally, the skin is redraped over the new framework.

Whenever possible, incisions are made inside the nostrils but for more complicated cases, a small incision is made across the columella, the vertical strip of tissue separating the nostrils. If the nostrils are too wide, incisions are made at the base of the nose.

When the surgery is complete, a splint may be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

Although rhinoplasty usually takes only an hour or two, this operation is difficult to learn and difficult to perform well. A skillful surgeon knows where to make incisions so that they will be practically invisible after healing. With proper technique, scar tissue doesn't interfere with achieving the desired results. A skillful surgeon also knows where to make incisions to minimize the amount of bleeding during the operation. The surgeon can have better results when there is less bleeding because he can clearly see what needs to be done. An experienced surgeon also knows how to minimize intraoperative swelling. Swelling can make it hard for the surgeon to see what the nose's final shape will be and what needs to be done during surgery.
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Rhinoplasty for Asians
Rhinoplasty performed on Asians has the same goal as rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. Usually, Asians require augmentation of the nose, while Caucasians usually require reduction. Southeast Asians (Filipino, Malay, southern Chinese) typically require the most augmentation.

In Filipinos and other Asians, the nasal bridge is often low. The nasal tip is also low and thick, and the base of the nose is wide. Hence the most commonly requested nasal surgery in the Philippines is the "noselift." Most Filipino plastic surgeons use solid silicone L-shaped implants in order to increase the height of the nasal bridge and to increase the projection of the nasal tip. The bend of the L forms the new tip. The skillful surgeon takes great care in creating the look and feel that is most suitable to your face and features. Implants are individually sculpted to personally suit the shape of your face, resulting in a more "natural" look.

American plastic surgeons generally prefer the use of cartilage grafts or bone grafts to augment the nasal bridge and tip. However these kinds of grafts have been known to resorb and decrease in size over a period of time. Filipino patients also do not want an extra operation on another part of their body in order to harvest cartilage or bone. Also, most American patients request reduction rhinoplasty for large noses and hence American plastic surgeons have less experience performing noselifts.

Many Asian patients will also need an alar plasty operation to decrease the wide nasal base. A skillful surgeon will use a technique to remove small wedges of skin to bring the nostrils closer together and which will result in natural looking nostrils.
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Your new nose
The challenge in rhinoplasty is in creating a new nose that will look natural. Your surgeon must have a fine aesthetic sense such that the surgical results of your nose operation will appear natural and unnoticeable. The new nose should look like it "fits" together with the rest of your features. The nose should be symmetrical and nostrils should have a natural curve.

A poorly done noselift can be easily detected by an observer because of the visible outlines of the silicone implant under the skin. The nose is also overly prominent and does not blend in harmony with the contours of the rest of the patient's face. In a poorly done alarplasty, nostrils look unnaturally narrow when compared to the rest of the nose.

When incisions are inside the nose, there is no visible scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of wide nostrils, the small scars on the base of the nose are usually not visible.
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After surgery
After surgery, your surgeon will instruct you to stay in bed with your head elevated during the first twenty-four hours. Your face will feel puffy and you may have a headache. Your nose may also ache. Take the pain medication prescribed by your surgeon to control whatever discomfort you feel.

It is common to have a little bleeding during the first few days after surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal.

It is normal to have some swelling and bruising around your eyes specially after two or three days. Applying cold compresses will reduce this swelling and relieve some of the discomfort. Most of the swelling and bruising should disappear within two weeks or so.

In the days following surgery, many patients feel depressed because of their bruised and swollen faces. This stage will pass and your spirits will improve as your nose heals.

If you have nasal packing, it will be removed after a few days. Dressings, stitches and splints are usually removed after one week and you can usually return to school or sedentary work within this period.

Although you will feel much better after two days, it may take several weeks before you're back to normal. Your surgeon will give you guidelines about when you can resume your normal activities. Usually, for two to three weeks after surgery, he will ask you to avoid strenuous activities such as sports or sexual relations as these will increase your blood pressure.

You will also have to be gentle with your new nose. If you wear glasses, you will have to make sure they don't rest on your new nose until it is completely healed. This will take about six to seven weeks. You should also avoid hitting or rubbing your nose or getting it sunburned.
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Follow-up
In the months after surgery, your surgeon will schedule frequent follow-up visits to check on the progress of your healing. In between visits to your surgeon, if you notice anything unusual or have any questions about symptoms, or what you are allowed to do, don't hesitate to call him.