Rhinoplasty, commonly known as a “nose job”, is a plastic surgery procedure performed to change the shape or improve the function of the nose. The nose is central to facial balance and many people opt for its surgical reshaping in an effort to find a more harmonious alignment of their features. The goal of rhinoplasty is to revise the nose to the patient’s desired appearance and the procedure might therefore include removal of the nasal hump, reshaping of the nose tip, reshaping or resizing of the nostrils, or increasing or decreasing the nose’s overall size and projection. Because both breathing and the nose’s shape are interrelated, a rhinoplasty may sometimes be performed not only to change the way the nose looks but also to improve breathing. By straightening the wall inside the nose that divides the nasal passages into a right and a left side (nasal septum), breathing can be improved. In fact, when the septum is crooked, it can make it harder to breathe through the nose and a septoplasty might therefore be combined with a rhinoplasty.
While surgical techniques are advanced, there are limitations as to how much the nose can be altered. Like any cosmetic procedure, rhinoplasty is prone to certain pitfalls, most of which involve having unrealistic expectations or unworkable goals. As an experienced rhinoplasty specialist, Dr. Montemurro lets you know if your goals are practical or even possible. He’ll also offer guidance to help put any unworkable expectations you may have into perspective and explain exactly why he recommends a specific treatment approach. Although rhinoplasty is a surgical procedure, it should always provide natural-looking results. Patients are best served when they realize the procedure should make the nose harmonize with the rest of the face rather than perfecting that feature.
In general, candidates for rhinoplasty should be in good overall health and should be done growing. In fact, facial growth in teens and young adults can affect the look and function of the nose over time. A nose job is usually done as an outpatient procedure, meaning there is no overnight stay. The operation is performed in general anesthesia and it usually takes 1 to 1.5 hours. The exact surgical technique is uniquely tailored by the plastic surgeon for each patient but most of the time, all incisions are made internally and there are no visible scars on the nose (closed rhinoplasty).
In a few selected cases, an incision is made at the base of the nostrils, leaving a thin scar which is barely visible (open rhinoplasty). The surgeon then reshapes the inner bone and cartilage to produce a more pleasing appearance and applies fine absorbable stitches inside the nostrils, meaning they’ll dissolve and won’t require removal.
Following surgery, most patients experience mild to moderate discomfort that can be controlled with medication and that will usually last for only 36 to 72 hours. Often the most common complaint is actually not pain but rather that the nose is congested, which can affect sleep. At the end of the procedure, a cast is placed on the nose to help it retain its new shape while it heals.
Cast removal after one week is not painful, the cast is gently peeled off and patients won’t feel anything aside from a slight tugging sensation as the glue that holds the cast to the nose pulls away. Tape is then applied for the first week to reduce swelling and promote healing.
Every patient bruises and swells differently. Some patients present no signs of having had surgery already after one week. Others may have really swollen noses and bruising below the eyes. Unfortunately, there isn’t much one can do about bruising and swelling aside from letting it go away on its own. The majority of patients see all their bruising go away by 10-14 days after the operation and the majority of swelling is gone by 2-3 weeks after the procedure (a small amount of residual swelling that only the patient can notice can stay around for up to a year after surgery). Patients should plan to take a week off from work, school or other obligations. They will feel progressively better each day during the first week and may return to normal social activities as soon as within two to three weeks without any recognizable signs that the procedure was done. Patients are usually back to performing all activities after three to four weeks. Although rhinoplasty is a safe procedure, healing from it can take a while. The tip of the nose is especially sensitive and can remain numb and swollen for months.