Rhinoplasty is the plastic and aesthetic surgery of the nasal pyramid, aiming to modify its shape and size.

A nose that is too long or too wide can be modified, a hump can be reduced, a bulbous, bulbous tip can be reduced, a "droopy" nose can be corrected, a nose that is too large overall can be reduced, breathing disorders can be corrected, etc. The aim of this operation is to obtain a natural-looking nose, in harmony with the other facial structures and the patient's personality.

Rhinoplasty can be performed at the same time as other facial surgeries, such as genioplasty (beard reshaping), or eyelid surgery. If the patient wants a facelift and rhinoplasty, it is preferable that the facelift is performed about 7 days before the rhinoplasty.

The basic principle of this surgery is to modify the shape of the nasal cartilage and bones, using incisions mostly hidden inside the nostrils. The local integument is then molded to the new architecture. If there is an associated nasal obstruction, this will be treated at the same time (correction of the deviated septum and nasal turbinate hypertrophy).

Rhinoplasty can be performed any time after the completion of the growth process, when the nasal pyramid reaches the shape seen in adults, i.e. after the age of 17-18 years. There is no upper age limit at which a person in good health can undergo such an operation.

Please get in touch with a center for Rhinoplasty in Orange County if you want to know the price/cost of the intervention.

Before surgery

During the first consultation, the surgeon will make a general assessment of your health and will discuss in detail the surgical technique (inform the doctor about other surgeries you have had, other diseases, as well as allergies, including medication, you suffer from).

Inform your surgeon of all medications you are taking (including oral contraceptives, aspirin, vitamins, weight loss products). Discontinue contraceptives 4-6 weeks before surgery and aspirin-based medications at least 14 days before surgery. Do not administer preparations containing high doses of vitamin E in the days prior to surgery. It is best to avoid smoking and excessive sun exposure during this period. The operation should not be performed during or near the menstrual cycle.

On the day of the operation you will not eat or drink anything for at least 6 hours before the operation.

Type of anaesthesia and hospitalization

The operation is usually performed under general anaesthesia. Sometimes, however, intravenous sedation (without orotracheal intubation, i.e. without insertion of the intubation tube in the neck) in combination with local anaesthesia is sufficient.

In most cases, a 24-hour hospitalization is preferable (admission in the morning, discharge on the 2nd day). In rare cases, however, it is also possible to carry out the operation as an "outpatient" (same-day discharge, after a few hours of supervision).

Surgical intervention

Rhinoplasty lasts between 1 and 2 hours in most cases, depending on the surgeon's experience and the complexity of the changes made. Each surgeon adopts a technique with which he or she is familiar, but adapts it to each individual case in order to obtain the best results. However, there are some common basic principles.

The approach incisions are located, with one exception, inside the nostrils and are very well concealed. Sometimes it is necessary to make an external incision at the columella (the structure separating the two nostrils). Rarely (if the nostrils need to be narrowed) it may be necessary to make an incision in the groove separating the nasal wing from the rest of the face.

Starting from these approach incisions, the surgeon then dissects the integument and mucosa from the bony and cartilaginous skeleton underneath. The osteocartilaginous skeleton thus isolated is then modified according to the preoperative planning (bone and cartilage resections, cartilage repositioning, cartilage or bone grafts, etc.). At the end of the operation the incisions are sutured with fine, often resorbable, threads.

In most cases, tables made of absorbent material are then placed in the nasal cavity and kept there for 24-48 hours. On the outside, an adhesive bandage is made from adhesive strips, over which a metal or plastic nasal splint is applied. The splint will be removed after 10 days.

Post-operative care and final outcome

Post-rhinoplasty discomfort is surprisingly low (we can rather speak of respiratory discomfort due to the presence of the masses in the nasal cavity, rather than pain in the true sense of the word). The nasal masses are usually removed 24-48 hours after surgery, the nasal splint is maintained for 7-10 days.

Postoperative oedema becomes evident from the second day after surgery and worsens over the next 2-3 days. It is a normal reaction of the body and is most evident in the area just above the nasal flap and eyelids. It gradually disappears after approx. 7 days, but very fine traces may persist for several months postoperatively. In order to reduce the extent, sleeping with the head elevated (on 2 pillows) and using cold compresses are useful measures.

Ecchymoses (bruising) appear on the lower eyelids (usually asymmetrically) and disappear completely after 10-14 days.

Physical exertion should be avoided for the first two weeks, and intense physical exertion and weight lifting for 4 weeks. Prolonged sun exposure should be avoided for the first 8 weeks.

Glasses can be worn after 6 weeks (contact lenses can be used from the first day after the operation).

Final result

The healing process is a gradual process. It usually takes two to three months to be able to assess the outcome of the operation, but the final result will be achieved after 8 months to 1 year.

If there are any imperfections in the result, these can be corrected by a retouching operation (usually much simpler than the initial operation) a few months later.

Possible complications

A distinction must be made between complications due to anaesthesia and those due to the surgical procedure itself. Although very rare, they are still possible:

• Bleeding: it is usually reduced in quantity and appears in the first hours after the operation. In the case of larger bleeding, it may be necessary to introduce more voluminous meals in the nasal cavity.

• Infection: occurs very rarely.

• Haematomas: if they are bulky, it may be necessary to evacuate them.

• Unsightly scars: very rare.

• Erosions, wounds, even skin necrosis: usually heals spontaneously, without further scarring.