Nose Job

What Is Rhinoplasty (Nose Job)?

Rhinoplasty is a surgical procedure that is done to correct, reconstruct, or alter the shape of the nose.

Alternate names

• Nose Job

Is this procedure an elective or an emergency procedure?

Rhinoplasty is an elective procedure.

Types of procedure

Rhinoplasty can be of the following types:

• Reconstructive Rhinoplasty: Done to restore the form and the function of the nose
• Cosmetic Rhinoplasty: Done to improve the appearance of the nose

It may also be classified as:

• Primary Rhinoplasty: It is the first procedure that is done to correct the function, form, or appearance of the nose.
  • Open rhinoplasty
  • Closed rhinoplasty
• Secondary rhinoplasty or Revision Rhinoplasty: It is done as a revision procedure on a previously failed primary rhinoplasty.
• Filler Rhinoplasty
• Ultrasonic Rhinoplasty

Indications of rhinoplasty

The following are some of the main indications for a nose job:

• Diseases affecting the nose
• Unsatisfactory aesthetic appearance (such as disproportionate size, etc.)
• A failed primary rhinoplasty
• Obstructed airway
• Congenital deformities and defects of the nose

Some common conditions that may require a nose job include:

• Trauma: Blunt, penetrating, or blast trauma leading to broken and displaced nasal bones
• Disrupted and displaced nasal cartilages
• Congenital defects:
  • Cleft lip and cleft palate
  • Genetically derived ethnic nose abnormalities
• Allergic and vasomotor rhinitis related deformities
• Autoimmune disorder related deformities
• Bites: Animal or human
• Burns
• Tumors: Both non-cancerous and cancerous
• Septal hematoma: A large blood clot in the nasal septum
• Damage due to toxins: Such as cocaine, aerosol antihistamine medications
• Sexually transmitted diseases: Syphilis
• Connective tissue diseases

Contraindications and risk factors for rhinoplasty

The following are the contraindications for a nose job:

• The poor perioperative risk profile
• Previous rhinoplasty within the last 9-12 months
• History of too many previous nose surgery procedures, resulting in an atrophic skin–soft tissue envelope and significant scarring
• Altered mental status (eg, unstable patient with schizophrenia)
• Unrealistic patient expectations
• Nasal cocaine users

Investigations before the procedure

The following investigations are done before a nose job are:

• Laboratory tests-
  • CBP & ESR
  • Coagulation profile and blood group
  • Liver function tests
  • Renal function tests
  • Metabolic profile
• Imaging tests-
  • High-resolution photography
  • X-ray
  • CT scan

Preoperative advice

Preoperatively before performing a rhinoplasty procedure is:

• Risks and benefits of the procedure are discussed before the surgery
• Alternative treatment options are discussed
• Smoking should be discontinued before surgery as it may increase the risk of complications
• Blood-thinning medications should be stopped at least 2 weeks before surgery
• Any medication allergies are reviewed
• Oral intake is discontinued after midnight the night before surgery

Intraoperative details

Duration: The duration of a nose job may last from 1 – 5 hours or more, depending on the complexity of the procedure that is being done.

Anesthesia: A nose job may be done under local anesthesia or general anesthesia.

Procedure: A nose job may involve operating via an incision inside the nose if it is a closed rhinoplasty, or via an external incision between the nostrils if it is an open rhinoplasty. Once the cartilage and bones are reached, either excess cartilage is removed or added as required, in addition to the repositioning of the bones, to achieve the required shape.

Postoperative details

Postoperatively after a nose job is:

• The patient is kept under observation until stabilized
• The incision site is observed for any signs of infection
• Advised to sleep with head raised to reduce bleeding and swelling
• Internal dressings and splints are kept in place for a period of up to 7 days
• A drip pad may be placed under the nose to absorb drainage

Commonly seen normal postoperative conditions are:

• Slight bleeding and discharge
• Pain at the site of surgery
• Swelling and discoloration of the face and eyelids

Medication: Such as antibiotics and pain relievers may be prescribed.

Discharge: This is usually done after a period of 3 – 7 days depending on the procedure that was done.

Review: After 1 week for the removal of the internal splints and dressing.

Resumption of normal activities: With certain restrictions can be done 1 -2 weeks after the procedures.

Role of diet/exercise/lifestyle changes

The following measures are advised after a rhinoplasty procedure:

• Avoid strenuous activities such as jogging, aerobics
• Avoid injuries to the nose
• Avoid showers washing hair for at least 1 week, and take baths instead until the dressing is removed
• Avoid blowing the nose
• Eat a high fiber diet to avoid constipation
• Avoid extreme facial expressions such as laughing, smiling, screaming, etc
• Brush teeth gently to avoid moving the upper lip too much
• Avoid clothes that need to be worn from over the head: Such as t-shirts, or sweaters
• Avoid wearing regular glasses or sunglasses that rest on the bridge of the nose for at least 4 weeks
• Avoid food that required prolonged chewing

Complications of rhinoplasty

Complications are not very common after a nose job but may include the following:

• Bleeding
• Infections at the site of surgery

Prognosis of rhinoplasty

The prognosis for the nose job is generally excellent, although the outcome and patient satisfaction are dependent on the skill of the surgeon performing the procedure.

Indications for hospitalization if required

Hospitalization is required for rhinoplasty, and it may extend from a day to a week, depending on the complexity of the procedure.

Suggested clinical specialists/Departments to consult for the procedure

Nose Job is performed by specialists from the Department of Plastic Surgery, and Otorhinolaryngology.