Rhinoplasty, or nose surgery, may involve correction of cosmetic concerns, functional nasal concerns, or a combination of functional and aesthetic issues. Rhinoplasty surgery can help relieve breathing problems, reduce or increase the size of the nose, change the shape of the tip or the bridge of the nose, straighten the nose, change the shape of the nostrils, and may correct deformities caused by previous rhinoplasty surgery (revision rhinoplasty). Additionally, there are many changes possible, and each surgical plan depends on the patient’s specific concerns.
The appearance of the nose, and how it fits into overall facial harmony, is very important in facial aesthetics. A nose that is disproportionate, malformed, crooked, or prominent can become distressing for many people. Creating a more harmonious facial appearance through nasal surgery can allow a patient to have a better sense of self, an increased quality of psychological health, and more self-confidence. It is true that undergoing elective surgery requires an investment in terms of time, courage, and money. But once a patient understands what surgery can accomplish, and what surgery entails, he or she often feels reassured, and realizes that they can do it. The goal is to make you look better and more natural each and every day for the rest of your life.
Tiny incisions are made, allowing the surgeon to access the underlying nasal structure. Once the skin is opened, the cartilage and bones may be reshaped according to the patient’s wishes. Two basic methods are utilized for performing nose surgery: the ‘open’ and the ‘closed’ techniques. There are advantages and disadvantages of each technique. Dr. Warner will discuss the techniques during the initial consultation and help decide what is best for you. If functional surgery is also indicated, it will be performed during the same operation to maximize your outcome and take advantage of a combined recovery period.
In the vast majority of cases, insurance does not cover surgery on the nose if it simply to change the appearance. If rhinoplasty is being utilized to correct a breathing problem, the procedure may be covered under the patient’s insurance policy. Your surgeon will discuss this with you during your consultation and explore your options.
Anesthesia
General or local. Typically, general is safer than “twilight” if major work must performed.
Length of surgery
1 to 4 hours
Length of stay
Outpatient (home the same day)
Back to work
1-2 weeks
Exercise
May be resumed in 3 weeks
Discomfort
Mild to moderate (anticipate 1-4 days of prescription pain medication)
Swelling
Mild to moderate (should anticipate being “sociable” by 2 weeks)
Bruising
Will decrease within 2 weeks
Bandages
A splint will be removed within one week
Final result
Swelling will be minimized and results visible 1 to 2 weeks following surgery, although appearance will improve over the course of the first year
I’ve heard that I can have rhinoplasty without surgery – is this true?
Non-surgical rhinoplasty does exist. But the ability to change the appearance of the nose using this technique is extremely limited. Non-surgical, or “liquid,” rhinoplasty involves injecting a filler material, like hyaluronic acid, into your nose. This type of material is frequently used to correct wrinkles and provide volume enhancement in the face (like plumping up the lips). It can be used to fill in minor depressions on the nose, but will not provide any significant change to the nose and should not be considered a substitute for surgery in the majority of cases. It is also not permanent and will need to be repeated frequently.
Is my rhinoplasty surgery covered by insurance?
This is a common question and the answer is varied. This exists because insurance companies vary on coverage guidelines. Therefore, you will need to check with your specific insurance company regarding their policy. It is helpful for you to review your coverage policy prior to your consultation. For the most part, surgery related only to correcting the functional aspect of your breathing may likely be covered by insurance. Any surgery to correct the appearance of your nose will likely not be covered by insurance. Many patients have both a functional and an aesthetic component to their nasal concerns, and payment for surgery will likely be a combination of insurance coverage for the functional aspect and out-of-pocket expense for the remainder of the aesthetic component. You will need to discuss this with both your surgeon and your insurance company to understand what will and will not be covered.
Will I be awake or asleep for surgery?
This is dependent on your preference and also your surgeon’s preference. Some patients want to be under “twilight” because they feel it’s safer than general anesthesia, and other patients prefer general anesthesia because they just “want to be out” and not know what’s going on. It is important to keep in mind that general anesthesia is very safe for those patients who are generally healthy. Additionally, some surgeons have a very strong preference and will only perform your rhinoplasty surgery one way or the other. Regardless, both types of anesthesia are acceptable and you will need to develop a plan with your surgeon prior to surgery.
Will I have to stay in the hospital after surgery?
Most rhinoplasty surgery today is performed on an outpatient basis and you will be discharged home on the same day. Rarely, there may be a reason to keep you in the hospital overnight. It is reasonable to perform rhinoplasty surgery at an accredited ambulatory or office-based surgery center or hospital. Where your surgery will be performed is usually a surgeon preference. If you are coming in from out of town and would like to stay in the Chicago area, please ask our office for hotel options. You will need to stay near Chicago for 7-10 days for post-operative care.
I want my nose to be smaller, but I want to maintain my ethnic look. Is this possible?
Absolutely. The goal of rhinoplasty should be a natural appearance that maintains your overall look, but makes your nose less noticeable. The goal of rhinoplasty should not be to place the same nose on every face, which gives most people a surgical or “operated-on” look. There are ways to change the appearance of your nose to alleviate your specific concerns while maintaining the ethnic characteristic of your nose. For instance, you may want the hump on the bridge of your nose softened, but avoid the “ski-jump” or “scooped-out” rhinoplasty result. The best way to ensure that you are happy with your result is to have a discussion with your surgeon to make sure he or she is aware of your specific concerns.
Will my nose look natural after rhinoplasty? I don’t want to look like I had my nose “done.”
There are many different ideas of what the “ideal” nose should look like. However, there is no truly “ideal” nose when it comes to rhinoplasty. The goal of rhinoplasty is individual. When this is done properly, the result is a natural, un-operated look that blends the nose harmoniously into the rest of the face. Rather than notice you’ve had your nose “done,” the nose should no longer be apparent, and attention will instead be focused on the rest of your facial features (the most common of which being your eyes). When this happens, the ultimate goal has been achieved, where previous concerns disappear and facial harmony is restored.
Why is my surgeon talking about my chin during my rhinoplasty consultation?
Facial harmony is a term used to describe how all of the different components of your face fit together to create an overall pleasing appearance. Of all the structures on the face, the chin has the strongest perceptive association with the nose, especially when your nose is viewed from the side. Changing the size and position of your chin can actually make your nose look bigger or smaller, even if the nose itself is not altered at all! Therefore, your surgeon may discuss this relationship with you during your rhinoplasty consult.
What is the difference between open and closed rhinoplasty?
Open rhinoplasty refers to one approach to surgery, where a small incision is made on the underside of your nose in addition to incisions on the inside of the nose. Your nasal skin can then be lifted off the underlying bony and cartilaginous framework, enabling the surgeon to see the structures of the nose directly. In closed rhinoplasty, no external incision is made and the work is done completely through incisions inside the nose. Surgeons who use the closed approach believe that it eliminates the external scar, which indeed it does. However, the closed approach limits the surgical view of the underlying nasal structure where the majority of the work needs to be done. Additionally, the external scars uniformly heal exceptionally well and are typically of no concern.
Regardless of the differences, both approaches are acceptable. The approach your surgeon chooses is completely dependent on his or her comfort with that particular technique. The vast majority of rhinoplasty surgery is done through the open approach, a testament to the fact that the external scar created with this approach heals extremely well in almost every patient. In fact, much of the time this scar heals so well that it can even be hard to find. Even surgeons who use the open approach most of the time may elect to perform a closed rhinoplasty for purely functional surgeries or smaller revisions when indicated.
What are the limitations of rhinoplasty surgery?
The two major limitations with rhinoplasty surgery are the thickness of the nasal skin and post-operative scar formation. The thickness of your skin is determined by the time you are born and it is very difficult to change. Therefore, if you have very thick skin, there are limitations as to how small and well-defined the nose can be made. Conversely, if you have very thin skin, the nose can be made small and well-defined, but any abnormalities under the skin may become more apparent as the swelling subsides.
Scar formation is another element that is controlled by the nature of the healing process. Once surgery is completed, scar tissue begins to form. If an excessive amount forms under the skin, it can prevent the nose from getting as small and well-defined as you might like.
There can be no guarantee that your nose will be perfectly straight after surgery, especially if it was crooked before surgery. Additionally, there will likely be some degree of asymmetry with your nose, albeit small. Fortunately, asymmetry is completely normal and almost everyone has some degree of asymmetry in their facial features naturally.
Despite these limitations, as long as you feel that your surgeon understands your concerns, and as long as you feel comfortable with what can be done to surgically address your concerns, you can expect a high degree of satisfaction following surgery.
