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.
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.
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.
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.