Department of Otolaryngology

Rhinoplasty

Rhinoplasty is a facial plastic surgical procedure that is employed to refine the external appearance of one's nose. Rhinoplasty is the most commonly performed plastic surgery procedure in the United States and is perhaps one of the most technically challenging procedures in plastic surgery. Various factors including the patient's ethnicity, skin thickness, and the size, and shape and strength of the supporting cartilages must be taken into account to ensure a pleasing result. Some individuals may experience difficulty breathing through the nose due to obstruction from a deviated septum. Surgery that corrects both internal and external nasal deformity is known as septorhinoplasty.

In addition to the wide diversity and highly individualized surgical technique that a rhinoplastic surgeon faces, there are grades of complexity seen with different types of rhinoplasty. Secondary or revision rhinoplasty is generally more complex than primary rhinoplasty. This type of surgery may be indicated if a previous rhinoplasty was not entirely successful. Usually, this results from having too much or too little tissue removed by the previous surgeon. Dr. Mark Armeni, our fellowship trained facial cosmetic surgeon, performs the majority of rhinoplasties done by our department. Approximately one third of Dr. Armeni's nasal surgery practice is devoted to secondary rhinoplasty. Dr. Armeni is also interested and trained in the treatment of the cleft-lip nose. This surgery, for individuals who have had their cleft lip/palate repaired as an infant, can be performed secondarily as early as age 15 or 16 to help improve the nasal function and appearance, and thus, self-esteem.

Planning for Surgery
The planning of nasal plastic surgery involves a careful review of the patient's attitudes and expectations regarding surgery. This type of surgery is usually elective, and is something one must desire for themselves, rather than to please others. As with other types of surgery, rhinoplasty has risks that should be thoroughly considered. During consultation with Dr. Armeni, patients are encouraged to point out features that they like or dislike about their noses. Time is spent using video-imaging, a technique that uses video images to project the appearance of one's nose both before and after making alterations.

Surgery and Postoperative Care
Rhinoplasty is usually performed under intravenous sedation or general anesthesia. If one feels particularly nervous or anxious about surgery, then Dr. Armeni may recommend general anesthesia. This type of surgery is most often performed on an outpatient basis. Surgical incisions are made just inside the nostril rim. However, in more complex cases, an additional incision may be made on the skin between the nostrils. At the completion of surgery a small cast is secured to the outside skin of the nose with tape; this remains in place for 5-7 days. A small amount of packing is inserted in the nose to help control/prevent bleeding; this packing is usually removed on the day after surgery, helping to optimize patient comfort. The amount of swelling, bruising, and discomfort in the postoperative period varies from person to person. Pain medication helps to alleviate the discomfort that one may have. The swelling and bruising are usually resolved at one week following surgery (when the splint comes off). After this, makeup can be applied (ladies) to help conceal any remaining bruising. Depending on the amount of physical activity required for one's job, a person may return to work or school one week following surgery.