Breathing Issues
Nasal breathing problems present a serious concern that may be dealt with through various surgical procedures such as septoplasty, turbinate reduction, or other functional nasal procedures. These procedures need not alter the outward appearance of the nose. A septoplasty can straighten a crooked septum and improve nasal airways through repositioning the internal structures of the nose.
Often referred to as a nose job, rhinoplasty is the technical term describing a surgical procedure that alters the shape, structure and appearance of the nose. A rhinoplasty may be performed for either aesthetic or functional reasons or even a combination of the two. It has become the second most common cosmetic procedure and is also a viable treatment option for those suffering from chronic nasal breathing issues.
Nasal reconstruction has been around for thousands of years in a variety of cultures. Though an ancient procedure, modern technology and techniques have highly refined the art of rhinoplasty.
Indications
The American Academy of Otolaryngology-Head & Neck Surgery provides the following non-exhaustive list of potential indications that warrant a rhinoplasty.
• Obstructed breathing
• Nasal injury
• Nasal birth defect
• Acquired deformity resulting from an infection, tumor, or other trauma
Improvement in both the look and function of the nose are the key benefits of a rhinoplasty.
Dr. Daniel J. Hall, MD, FACS
Surgery Time Table
Preoperative
All patients must undergo a medical evaluation prior to surgery. Certain prescription medications, especially blood thinners, are contraindicated during the surgery and healing period. It is also recommended that patients quit smoking during the weeks leading up to and after the procedure.
Surgery
Rhinoplasty can be performed using a variety of anesthetic measures, depending on the preference of the physician and/or patient. Anesthetic options include a local anesthetic that is administered via an injection, intravenous sedation, also called twilight sedation, or general anesthesia, in which the patient is put completely under. With a local anesthetic, the patient remains fully awake. Intravenous sedation means that the patient is sedated but not unconscious.
After anesthesia has been administered, small incisions are made to allow access to the cartilage and bone underneath the nose. If the incisions are hidden inside the nostrils, this is referred to as a closed rhinoplasty. An open rhinoplasty involves a small incision at the base of the nose to allow for larger exposure.
Depending on the individual anatomy of the nose, bone and cartilage may need to be added, removed, or rearranged. It is quite common for pieces of bone and cartilage to be taken from one location and placed in another.
The surgical shift toward cartilage augmentation, which means adding cartilage rather than merely taking away, has resulted in a more natural appearance, improved breathing ability and greater degree of satisfaction than the previous method of cartilage reduction.
If a patient is undergoing a primary rhinoplasty, in other words, this is his or her first nose surgery, cartilage is most often taken from the nasal septum. However, in the case of a revision rhinoplasty, cartilage may be taken from another area, such as a rib, ear, or even bone obtained from the skull. Further reshaping may be required through a number of measures, including sutures or intentional fracturing.
Recovery
Once the procedure is complete, the external surface of the nose is taped and a type of cast is applied. Additionally, nasal packing may be placed inside of the nose temporarily, but that is up to the discretion of the surgeon. Dr. Hall rarely needs to do this in his surgeries.
Swelling and bruising are expected anywhere from a few days up to two weeks. Pain medicine may be prescribed as needed. Sutures will be removed at a follow-up appointment.
Overall recovery length varies from person to person and also depends on the extent of the surgery.
Postoperative
It is vital that patients follow all of the doctor’s directives, which include taking medications as prescribed and changing bandages and dressings as instructed.
Open versus Closed
Ultimately this decision is between the patient and doctor. However, there are key factors to consider. Open rhinoplasty allows for a larger field of vision in the presence of a distorted nasal anatomy or if the patient’s nose is extremely crooked. It is also much better suited for performing a complex revision rhinoplasty.
Though the incisions are not inside the nostrils, they are tiny and only visible to a trained eye. With proper postoperative care and protection from the sun, incision scars will fade until they are virtually invisible.
That being said, an experienced surgeon can perform a rhinoplasty without an incision along the bottom of the nose, giving a patient equal if not better results with a closed rhinoplasty. Again, the decision rests between the patient and doctor.
Dr. Hall is trained and experienced in open and closed rhinoplasty techniques, and routinely performs both of these procedures. The selection of rhinoplasty approach is tailored to the specific needs of each patient, and will be discussed with the patient prior to surgery.
Risks
The vast majority of rhinoplasties heal without complications or adverse reactions. The rate of patient satisfaction is quite high. However, as with all surgical procedures, potential risks do exist, and patients should be aware of all risk factors before undergoing any type of surgery.
• Abnormal scarring
• Anesthesia issues or complications
• Asymmetry
• Epistaxis (nosebleed)
• Infection
• Nasal obstruction
• Need for revision rhinoplasty
• Over-removal or under-removal of cartilage
• Septal perforation (hole in the internal wall of the nose)
• Unsatisfactory appearance
Results
As the nose heals, patients can expect to see marked improvement right away. Results are intended to be permanent. However, future injuries or other unforeseen traumas can impact both the appearance and function of the nose. Due to the natural aging process, the flexible cartilage of the nose may move or shift over time as well.
If you have any questions or need to reach us for another reason, please send us a message and we will follow up as soon as possible.
You may also request a consultation online, or call us at (352) 372-9414 to schedule an appointment at Dr. Daniel Hall’s rhinoplasty surgery practice in Gainesville, FL.
Consultation
During a consultation, Dr. Hall will discuss the patient’s goals, anatomic issues, risks, benefits and surgical preferences. The inside of the nose will be examined to look for any of the following symptoms.
- Deviated septum
- Inflammation of the turbinates
- Stenosis of the internal valve
Computer imaging is available prior to surgery in order to help patients communicate their vision of what they would like their nose to look like after the procedure. It also helps to set up realistic and mutual expectations as well as eliminate any potential shock factor that could result if a patient did not have a clear idea of what he or she was hoping to achieve with the surgery.