Patient education: Rhinoplasty (The Basics)

What is rhinoplasty? — 

This is surgery to change the shape of the nose. The nose is made up of bone and a rubbery material called "cartilage." Rhinoplasty is sometimes called a "nose job."

Rhinoplasty is usually done to change how the nose looks. It can make the nose smaller or bigger, or it can rebuild the nose after an injury. It can also help people breathe more easily through their nose. (This is called a "functional rhinoplasty.") Often, a rhinoplasty changes both the look and function of the nose.

The surgery can be done in 2 ways:

●Open surgery – The doctor makes a cut, or "incision," in the skin between and inside the nostrils. This lets them see directly inside the nose to do the surgery.

●Closed surgery – The doctor makes small incisions inside the nostrils. They might use a thin tube with a tiny camera on the end, called an "endoscope." They put the endoscope into the nose, and it sends pictures to a TV screen. The doctor can look at the screen to see inside the nose more clearly.

How do I prepare for rhinoplasty? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before surgery, the doctor will take pictures of your nose from different angles. They will also examine your nose to better understand its structure.

They might draw on your face to show where they plan to make incisions. They might also use markers to show certain structures of the nose. Some doctors use a computer to create an image of what your nose might look like after surgery.

Before surgery, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●Imaging tests – These create pictures of the nose.

●Nasal endoscopy – This lets the doctor look inside your nose. If you have trouble breathing, it can help your doctor figure out what is blocking the flow of air.

●Electrocardiogram ("ECG") – This measures the electrical activity in the heart.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription or "over-the-counter" medicines, plus any herbal supplements. It is especially important to tell your doctor about any inhaled medicines you take. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any procedures you had on your nose in the past – This might include a past rhinoplasty or septoplasty. (Septoplasty is a procedure to change the shape of the septum, which is the wall separating the nostrils.)

●Any recreational drugs you use – Cocaine and other drugs taken through the nose can damage the tissue inside the nose. Your doctor might not be able to do a rhinoplasty if you have damaged this tissue from cocaine use.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●What help you will need when you go home – For example, you might need someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during rhinoplasty? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Local – This numbs a small part of your body so you don't feel pain.

•Regional – This blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get "sedative" medicines to make you relax and feel sleepy.

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You will get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●They might flush the inside of your nose with fluid to decongest it.

●The surgeon will make incisions. For an open rhinoplasty, the incisions will be both outside and inside your nose. For a closed rhinoplasty, they will be inside your nose only.

●The surgeon will remove or reshape parts of bone and cartilage. They might also reshape the inside of your nose to help you breathe better.

●If they are making part of your nose bigger or need to create better support for your nose, they might use pieces of cartilage from your ear or other parts of your nose. In some cases, they might use an implant.

●They will close your incisions. They might also put on an antibiotic cream.

●They will cover your incisions with clean bandages. They might put splints inside your nose to help it heal correctly. They might cover your nose with a cast or splint to protect it while it heals. They might put gauze under your nose to catch any blood. If you have a lot of bleeding, they can pack your nose with gauze.

●Rhinoplasty usually takes 2 to 4 hours.

What happens after rhinoplasty? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Usually, you can go home the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of rhinoplasty? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding, bruising, and scarring

●Infection

●Headaches

●Changes in skin sensation

●Runny nose or watery eyes, which usually get better over time

●Blood clots forming in or around your nose in the next days or weeks

●Problems breathing through your nose

●Problems with healing

●Feeling unhappy with how your nose looks

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Rhinoplasty – Discharge instructions (The Basics)
Patient education: Septoplasty (The Basics)