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NASAL AND SEPTAL RECONSTRUCTION (RHINOPLASTY)

The term "rhinoplasty" means to mold or shape the rhinion, which is another word for the nose. In rhinoplasty, the deformities of the nose are corrected in a reconstructive fashion.

The operation itself consists of restoring, rearranging or removing any excess bone or cartilage to give the nose a more pleasing appearance, and preserving nasal function.

The goal of aesthetic rhinopasty is to restore or create Symmetry, Balance and Proportion:

Reasons for Rhinoplasty

Many nasal and septal reconstructions, or septorhinoplasties, are performed to improve nasal function, or to improve the movement of air through the breathing passages. In addition, and intimately related, is the patient's desire for improvement in appearance. These two parts of the operation are very naturally done at the same time. Frequently the best functioning noses are those that are symmetrical, proportional and balanced. They look good!

The patient who desires improvement in appearance may simply want a nose which is in harmony with the rest of his/her face, rather than one which is distorted. As is often the case, the nose may actually become progressively more disfigured the older the patient becomes. This is a natural part of the aging process, which can lead to further difficulties in breathing as the nose droops. A longer, drooping nose may be a tell-tale sign of aging, and a noselift can be performed to give a more youthful look.

One must note that, at times, the deformities inside the nose which impair breathing, cause headaches or sinus trouble, cannot be satisfactorily corrected without simultaneously straightening the external nose.

Revision and Reconstructive Rhinoplasty

Revision Rhinoplasty may be necessary for a variety of reasons. Some of the reasons are related to surgical factors and some are related to patient factors. Frequently revision rhinoplasty requires the use of cartilage grafts or the use of implants. Each case is highly individual and requires thorough evaluation.

After severe nasal trauma, necessary corrective surgery may be more complicated than that performed in a primary aesthetic situation. Aesthetic and functional improvements, however, are usually possible and can be approached through effective surgical planning during consultation.

Dr. Fedok Speaks to RealSelf TV About Revision Rhinoplasty

Before Surgery

Patients who have read the preceding sections of this online booklet will know that I take photographs of the face and plan how I will proceed in each individual case. Part of this planning may include video imaging, so patients can see an approximation of how the improvements may look. Because of the inherent limitations in surgery, it is often difficult to duplicate the exact idea as it was presented. No ethical physician can "guarantee" the results of any treatment.

Surgery

The surgical procedure itself can take one-and-one-half hours to three hours, depending on the extent of work that needs to be done. In general, I find that packing the nose is usually not necessary. This contributes significantly to the reduction in swelling and discoloration patients experience in the postoperative period.

After Surgery

I will place a tan, taped splint on your nose and advise you to remain out of bed, in an upright position, as much as possible. It is also advisable to sleep with the head of the bed elevated. The elevated position of your head over your heart helps reduce swelling and promotes healing. Ice cold washcloth compresses should be used throughout the day and night immediately following your surgery to further reduce swelling, slow any normal and expected oozing and reduce bruising.

Postoperative Care

If external sutures were used, they will be removed four to seven days after surgery. Then, one week following surgery, the splint dressing is removed. When the dressing is taken off, a special liquid adhesive remover may be used to remove any residue. In most cases, no further dressing need be applied. At this time, most patients return to work or school and social activities. I do not advise patients to over-exert, lift heavy objects, or blow their nose for at least two weeks, and sometimes three weeks. In addition, over the next six weeks, patients must be extremely careful not to injure the nose in any way. Once the nasal splint is removed, it is important for patients who wear glasses not to rest the glasses on the top of the nose. The glasses must be suspended from the forehead with a piece of tape or be supported with special "feet" attached to the lower rim that allow the weight of the glasses to rest on the cheeks. These small inconveniences are well worth the effort it takes to arrive at a satisfactory postoperative result and a pleasant-looking nose.

At the end of the first week following surgery, most patients will experience only a minimum amount of swelling and discoloration. Some swelling of the nose may still be present, which the patient feels more than he/she or anyone else sees. This slight swelling will diminish gradually over the following weeks and will resolve within a few months. However, some small amount of swelling persists in the skin for months, and the "final" result may not be apparent for up to one year or more after surgery. The swelling sensation will be more noticeable in the morning hours and subside during the day. Patients may experience intermittent nasal stuffiness, which will progressively decrease over the first month following surgery. It is permissible to ingest oral antihistamines and decongestants, if you desire, to help decrease the congestion.

Important Facts to Know and Understand About Rhinoplasty
  1. When the dressing is first removed from the nose, it will appear turned up because of swelling and the manner in which it was taped at the end of the surgical procedure. The patient who expects to see a perfectly shaped nose at this time will be disappointed. As I have mentioned in the preceding text, swelling does occur, but it will begin to disappear once the splint is removed. The splint will leave a light impression which will blend out within a few hours of the splint's removal. By the end of the second week, the average acquaintance would probably not notice any swelling. In the ensuring weeks, the nose will begin to assume its eventual shape. The last two or three percent of the swelling will subside over the course of a year or more as the elements of the nasal surgery come together and improve the definition of the new nose.

  2. When surgery to correct deviation of the internal nose is done to improve the breathing passage (septorhinoplasty), one can expect the nasal passes to be swollen after surgery. Therefore, it is reasonable to expect nasal blockage; this condition will usually gradually subside.

  3. In most cases, the operation is nearly painless and the patient "sleeps" through the procedure. Patients require little, if any, postoperative medication.

  4. Experience has demonstrated that the thicker the skin, the longer it takes for the nose to assume its final shape. Each case is different, and in our preoperative consultation, I will discuss the skin limitations in your case.

  5. Patients must realize that noses which have been severely traumatized as a result of a sports injury or accident, or that are crooked, are inherently more difficult to correct to obtain a perfectly straight nose. Most of the time, these noses can be corrected with one operation, but occasionally, a "memory" of the tissue tends to drift the nose back slightly to the pre-existing curvature. Then, a second stage operation or surgery is required to give the best possible result and is usually done approximately three months to one year later.

  6. The incisions made inside the nose do not leave visible scars. In order to increase the visibility of the nasal structures, these incisions may be connected with a small incision under the tip of the nose crossing the central portion between the nostrils. This incision is designed to leave an inconspicuous scar after healing is completed. When it is necessary to narrow wide nostrils, incisions are made at the base of the nostril near or in the crease, and this area will be slightly red for a few weeks.

  7. Patients should remember that there is a limit to the corrective procedures that can be completed. The surgical goals is to improve one's looks and not to match the "ideal" present in a patient's mind. Rhinoplasty surgery has limitations which include the contour and shape of the face; the texture and thickness of the skin; the inclination of the chin, lip, and forehead; the depth of the angle between the forehead and the nose; the height of the individual; and the healing powers of the person's tissues. Often, it is necessary to correct a receding chin at the time of nose surgery to bring harmony to the facial features.

Patient Example

This patient sought consultation for aesthetic rhinoplasty. On consultation she was found to be a candidate for not only corrective rhinoplasty, but also rejuvenative midfacial lift. Click here to view the Rhinoplasty gallery

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