Nose Surgery (Rhinoplasty)

Background

Before

After

The nose constitutes the central third of your face. As such, it is the center of attention when others are conversing with you or looking at you. What is an attractive nose?

An attractive nose is one that looks natural and achieves a harmonious balance with your other facial features. Plastic surgery on the nose or rhinoplasty can enhance the shape, size and overall appearance of your nose. Rhinoplasty can be performed on any age group. It is recommended that young people wait until facial growth is complete – about age 13 to 14 for girls and 14 or 15 for boys. If you are a teenager, having the procedure should be your own desire and preference.

Any of the conditions listed below can be addressed by a rhinoplasty:

• A nose which is too large for your face
• There is a bump or depression on the nasal bridge when viewed in profile
• Your nose seems too wide when viewed from the front
• The nasal tip droops or plunges
• The tip is thickened or enlarged
• Your nostrils are excessively flared or wide
• Your nose is off-center or crooked
• A previous surgery or trauma has made your nose asymmetrical on unbalanced
• You have an airway obstruction that impairs breathing

To enhance results, you may consider improving your facial balance with concurrent procedures. A facial rejuvenation procedure can augment the results of your rhinoplasty. Your chin size and projection have remarkable influence on the appearance of your entire face, especially your nose. You may choose to make your chin more or less prominent. A chin implant can augment your chin to achieve a smaller appearing nose. In contrast, procedures to make an excessively large chin smaller can make your nose more proportional for your face. Please refer to the list of Dr. Sayah’s specialties for other procedures you may benefit from.

Procedure

Rhinoplasty procedures are performed based on your nose’s particular needs. No two noses are alike, and procedures on the nose should therefore be individualized based on your nose’s appearance and the desired effect. Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, reshape and improve the definition of your nasal tip, or change the angle between the nose and the upper lip.

Two approaches are possible in a rhinoplasty. The first is called the closed rhinoplasty in which the procedure is performed through the inside of the nose via small incisions inside the nostrils. The second approach is termed open rhinoplasty. In this technique, a small incision is made across the vertical strip of tissue separating the nostrils (columella). Open rhinoplasties offer a more clear view of the nasal structures and may be an appropriate choice in some patients.

Working through the open or closed rhinoplasty approaches, the nose framework of bone and cartilage is sculpted to the desired shape. Dr. Sayah may reshape or reposition the bones in your nose as necessary. He can build-up certain areas, using either nasal cartilage or bones and cartilage from other parts of your body in order to sculpt a well-balanced nose. The skin and soft tissues are then redraped over the reshaped framework. Large or wide nostrils are corrected by Dr. Sayah by excising small wedges of skin and subcutaneous tissue at the base of the nostrils. The resulting scars are hidden in the nose’s natural creases.

To correct breathing problems, Dr. Sayah may perform a turbinectomy procedure. Turbinates are prominences in the nasal passage which are involved in warming and humidifying the air we breathe in. In certain instances, the turbinates are enlarged and obstruct the passage of air. In such cases, a turbinectomy can open the nasal air passage reducing the size of the turbinates.

The nasal septum is a midline dividing wall within the nose that separates the right side of the nose from the left. If the septum, made of cartilage, shifts from the midline to either side it can obstruct air passage. Such sepal deviation can result naturally, genetically, or due to trauma. A septoplasty corrects a deviated septum and its associated airway obstruction.

Dr. Sayah strives to achieve perfection in all of his procedures, but this endeavor requires your participation for excellent results.

After Procedure

Day of Surgery: You are to go directly home and into bed. Rest on your back, and avoid any pressure on your nose. Maintain your head elevated at all times with 2 to 3 pillows under your back. Avoid extreme bending and striking or bumping nose for the first 10 days. Drink only cold clear liquids (7-Up, clear apple juice) the day of your surgery. Do not eat any solid foods. Take your medications as prescribed. Do not consume any of the prohibitive substances on the list provided to you by Dr. Sayah.

Change the gauze dressing beneath your nose as necessary to catch drainage. Gentle oozing from the nose is normal and anticipated during the first 72 hours. If uncontrollable bleeding occurs, call Dr. Sayah at once. You may remove it if there is no drainage. Ice compress on your eyes will reduce swelling and soothe the eyes. The perfect substitute for an ice compress is a bag of frozen peas wrapped in a small towel. Avoid any showers or baths on this day.

1st Day after Surgery: You can enjoy a light soft breakfast today. Continue to avoid hot liquids including coffee or tea. Plenty of iced drinks are encouraged. Do not eat any foods that require chewing (steak, apples) for one week. You can begin to walk around on this day with assistance, but avoid strenuous activities including bending over, lifting heavy objects greater than 5 pounds for 2 weeks.

Do not shower yet, but wash your face gently with cold water and mild soap. Our staff will be glad to recommend the best non-irritating brand. You can enjoy a warm sponge bath without exposing your face to water. When washing your hair, do not allow the water to soak the splint. Avoid hot water for 2 days. You can gently brush your teeth, but be very gentle in the upper teeth area. If you had a concurrent chin implant, avoid the area of the lower teeth centrally.

DO NOT BLOW your nose for 2 weeks. Avoid sun exposure for 6 weeks. Do not drive for one week, or until you are no longer taking your narcotic pain medication as your reflexes are slowed. Our office will contact you daily to check on your progress. The nasal packing will be removed on this day.

2nd Day after Surgery: Continue to walk with assistance with the restrictions above. Applying ice packs will decrease any swelling and bruising. Follow the other instructions as above. Avoid strenuous activities and contact sports for 6 weeks. Avoid bumping your nose at all times.

You may start cleaning the front of the opening of your nose the second day after surgery. Proper cleansing and care of your nose will result in more comfort, less swelling and clearer breathing. Small amounts of dried mucus or blood can collect. With a cotton-tipped applicator (Q-tip) and Bacitracin ointment, gently cleanse just the edge of the opening and rim of your nose. The inside of the nose can be irrigated as often as desired with the Ocean Spray to keep it moist and help loosen any crusts. Be very gentle and do not forcibly cleanse or pull on crusts; let them loosen themselves.

3rd Day after Surgery: You can shower on this day with warm water. Avoid exposing your nasal splint to water or steam for prolonged periods as it can come off your nose. You can switch to warm compresses on this day. Soak a small hand towel in warm water, press any excess water out of the towel and place it on your eyes and nose. You can replace the towel with another warm soaked towel once the heat has dissipated. Avoid hot water as you could burn your face.

Continue walking, but adhere to your restrictions of no heavy lifting greater than 5 pounds or bending over. Sleep on your back with your head elevated.

1st Week after Surgery: Your splint will be removed this week. External sutures (if any) are removed at that time. Internal sutures are absorbed within 2-3 weeks. After the splint/tape is removed, the skin over the nose may peel as with a severe sunburn. No special care is needed. Vaseline or moisturizing cream may be helpful to keep the skin soft. If you wear glasses, do not rest your glasses on your nose for 6 weeks. You may suspend your glasses off your forehead with medical grade paper tape. You may be instructed to tape your nose to reduce swelling after the splint is removed. If glasses are worn, they should be taped to your forehead for 1 week after the splint is removed.

Warm compresses will help your bruising improve over the next week. Numbness of the skin of the nose is quite common and may continue for several weeks. Your sutures will be removed in Dr. Sayah’s office on this week. We will continue to contact you regularly during this week to assure you are progressing well. DO NOT BLOW your nose for 2-3 weeks! You may cleanse the nostrils gently with Vaseline and Q-tips after the 10th day.

2nd to 6th Week after Surgery: Continue to avoid sunlight on your face. Apply sun-block with SPF 45 or greater daily prior to leaving the house. We will be glad to recommend the best brands.

6th Week after Surgery: You may begin more active exercise at this time. Swelling of the nose and surrounding tissue may last for a few months. Your nose will continue to mature for the next 5 months to 1 year so be patient. Numbness of the skin of the nose is quite common and may continue for several weeks. Normal sensation usually returns within 4-6 months. Swelling of the nose and surrounding tissues may last for a few months. Subtle changes will occur in the contour of your nose for up to a year or more following surgery.

Avoid sun exposure for 2 months following surgery. If sun exposure is unavoidable, use sunscreen 45+SPF or zinc oxide on your nose to protect it from sunburn.