Rhinoplasty: What Is It, | Risks, Results, Options and Cost

Rhinoplasty is the facial aesthetic surgery technique that improves the appearance of the nose, its proportion, and harmony with the rest of the face.

When the objective of the surgical intervention is to improve respiratory function, it is called a septoplasty if only the nasal septum is intervened. However, if aesthetic and functional purposes are combined, the term is rhinoplasty or functional rhinoplasty.

The intervention allows the profile and morphology of the nose to be more balanced and proportionate in itself, but also with the face in general, especially if it is combined with mentoplasty (chin surgery), otoplasty (ear surgery), or lip-lift (lip shortening surgery).

The motivations that can push a person to undergo this surgery can be different and include:

• Reduce the size of an oversized nose
• Remove the hump or trestle
• Change the tip of the nose
• Correct deviations in the nasal septum
• Reduce the nostrils
• Change the angles between the nose and lips
• Change the angles between the forehead and the nose

The operation consists of remodeling or reducing the cartilage and/or the bone skeleton according to the characteristics of each patient. The result may vary from one patient to another depending on their anatomy, skin, or race.

To obtain a proportionate and harmonious result, the experts of the SECPF (Spanish Society of Facial Plastic Surgery) and SECURE (Spanish Society of Reconstructive and Aesthetic Plastic Surgery) warn that it is important to choose the appropriate specialist and adjust expectations to reality. Specialties such as maxillofacial surgery, plastic surgery, and otorhinolaryngology are trained to perform this type of intervention with natural and satisfactory results.

Rohrich RJ and Mohan R in an abstract published in PubMed comment that “Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Male characteristics must be preserved and the nose must not be overly feminized or sculpted.”

Who is a good candidate?

Rhinoplasty is indicated for patients who wish to correct congenital or acquired deformities after trauma. As in any other surgical intervention, the surgeon must first verify through a physical examination and a thorough anamnesis that the patient is in good health, and there are no contraindications that may affect the surgery.

The ideal candidate for rhinoplasty is the patient who is not satisfied with the aesthetics or function of his nose, even turning into a psychological or functional problem. However, it is important that the patient have realistic expectations regarding the outcome of the surgery.

There are no specific age limits to perform a rhinoplasty but the SECPF and SECURE indicate that most surgeons prefer to wait until the patient is 16 years old to ensure that development has been completed and that they are emotionally and socially ready for the operation. Also to verify that they are the ones who want to perform the rhinoplasty and not their parents. The preferable as a general rule is to wait until the age of 18.

How do I choose the specialist surgeon?

The first step to follow before undergoing rhinoplasty is to choose the most appropriate doctor for your case. In Spain, surgeons who perform rhinoseptoplasty surgeries are maxillofacial surgeons, plastic surgeons, and specialists in otorhinolaryngology , preferably registered in at least one of the scientific societies or professional associations of the sector, such as the SECPF, SECURE, or the SEORL .

It is essential to verify the branch of specialization of the chosen surgeon and to verify his career and studies in facial plastic surgery and specifically in rhinoplasty. The second step will be to request a first visit with two or three specialists to find the professional who inspires you the most confidence and who makes you feel better. In this phase, it is advisable to ask the surgeon to let you see some photos of the results obtained in previous interventions.

What will the first visit be like?

The first visit with the surgeon is the most important as it gives the patient the opportunity to express all their doubts, fears, and expectations regarding the rhinoplasty procedure and the results that can be obtained.

During the first visit, the objectives of the patient (aesthetic and/or functional) are exposed and their general state of health will be evaluated, including respiratory function, any pathology, familiarity, and clinical history.

Subsequently, the doctor will examine the internal structure of the nose, the shape, and the dimensions, also as the rest of the face.

An instrument that can be used to get a first idea of how the final effect of rhinoplasty will result is that of simulation through an image made by the specialist with the help of a computer. According to  “these simulations are not intended to guarantee 100% the final result, but they are a very useful tool to facilitate doctor-patient communication. It is the way to graphically capture the expectations of the patient, the surgeon being able to explain the expected or possible results in his case. This is so since not all nasal anatomies allow the same results. In this way, greater satisfaction with the result is achieved. ”

Once the objectives and risk factors have been established, the doctor will explain to the candidate all the details related to the surgical procedure: techniques and methods of intervention, anesthesia, preliminary preparation for the operation, postoperative, possible complications and, finally, the costs.

How it is performed?

It must be performed in an equipped operating room within an accredited clinic. The operation is performed under general anesthesia, or local anesthesia with sedation, so the patient will not feel any pain during the operation. The choice of anesthesia will depend on the characteristics of the patient, following the indications considered safest and most appropriate by the surgeon.

Depending on the doctor and patient preference and technique used, it can be performed as an outpatient procedure (discharge from the hospital shortly after the operation) or with an overnight stay and observation period.

Rhinoplasty can be open or closed and its duration can vary greatly depending on the case and can last from 1 to 3 hours.

“Rhinoseptoplasty has changed a lot in the last 10 years, forcing surgeons who dedicate ourselves to it to be in continuous renewal. We have achieved a much safer surgery, with a faster recovery compared to classical techniques, and with aesthetic results that can be previously designed using simulation systems, allowing in many cases to be able to operate a nose under local anesthesia and sedation. The main advantage of this type of anesthesia is that the surgeon can assess intraoperative nasal ventilation ”, explains.

Aesthetic or functional

Below we will detail the differences between an aesthetic rhinoplasty and a functional rhinoplasty.

• Functional rhinoplasty: Also called septoplasty or deviated nasal septum correction. The deviation of the nasal septum can have congenital causes or be due to trauma (the latter is associated with an alteration of the turbinates). It can cause breathing difficulties, headaches, hearing disorders, sinusitis, and pharyngitis. According to Dr Morera: “Septorhinoplasty or rhinoseptoplasty is the surgical intervention that modifies the shape of the nasal skeleton, both in its internal structure and in its external appearance. As such it has a double aesthetic and functional aspect that, in most cases, are inseparable: any change in the external shape of the nose will have an impact on nasal patency and almost any change with a functional reason of the nasal skeleton will produce a modification of its external form. Contemporary septorhinoplasty is an extremely careful surgery of the tissues that make up the nasal pyramid. The cartilaginous skeleton is worked with techniques of change of shape and reinforcement, instead of the aggressive classic techniques of resection. The current rhinoseptoplasty results are optimal.”

• Aesthetic rhinoplasty: this operation is used to correct the different aesthetic defects of the nose, such as a projected tip or marked humps that create noses with aquiline profiles. This intervention can be performed through an open or closed approach, with practically imperceptible scars. Once the defect to be corrected has been identified, it will be the surgeon’s responsibility, through preoperative simulations, to establish a new proportional and balanced shape concerning the rest of the face, without taking as a model an ideal of a perfect nose. In the case of: “I look for harmonious and natural results with the rest of the facial profile. We must not forget that the nose should not be assessed independently but rather associated with the rest of the facial proportions. Also, in my case, I perform ultrasonic rhinoplasty, the results obtained are much more precise, with less edema and bruising. “

Rhinoplasty techniques

The surgical techniques to perform rhinoplasty are mainly two:

• Closed rhinoplasty: It is performed through the nostrils so it does not require external incisions. At the end of the operation, the incisions are closed with absorbable stitches that will remove themselves after a few days and the scars are not visible. This rhinoplasty is indicated for a reduction or narrowing of the nasal appendix without major modifications in the shape since it is not possible to perform all of the possible rhinoplasty techniques.
• Open rhinoplasty: The same incisions are made as in the closed one, as well as a small incision in the colon of the nose. It is used to fully visualize all nasal structures. The scar after months is practically imperceptible. It is the first choice in patients who have already performed an operation and must undergo a secondary rhinoplasty, or in cases of large nasal deviations or corrections. The postoperative period does not vary in terms of closed and open significantly.
• Ultrasonic rhinoplasty: The novelty of this technique lies in the use of a special piezoelectric scalpel, which emits micro-vibrations made by a low-frequency ultrasound so it only can cut the bone without affecting the rest of the nasal tissues. “The arrival of the piezoelectric has been a before and after in rhinoplasty. Currently we can work on the nasal structures with great precision, reducing edema and bruising to a minimum, and avoiding the use of nasal packing. This makes the postoperative period practically painless and with a slight sensation of nasal congestion during the first week ”, explains

Is there a less invasive alternative?

For less complicated cases and those with only minor defects, such as a small hump, for example, it is possible to resort to non-surgical alternatives to classic rhinoplasty with scalpels and hammers.

• Rhinoplasty with tension threads: This technique can be used to intervene on the tip of the nose, lift it or narrow it, thus correcting the tip of the nose that is too wide or too low. It is a quick outpatient procedure that is performed under local anesthesia and does not require hospitalization, allowing the patient to immediately return to normal daily activities. PDO yarns can be composed of different materials, such as polylactic acid, polydioxanone, or caprolactone. The threads are fed through a very small hole made at the base of the nose: if you want to lift the tip, the wires will pass through the back of the nose, whereas if the nose has to be restricted, the threads will be they will pass from one nasal wing to the other horizontally. The advantage is that, unlike the surgical technique, The procedure is quick and will produce only slight swelling or bruising at the injection level, which will be reabsorbed within a few days. The downside is that the result will only be temporary and will last for about 12 months, up to 17 months.

• Rinofiller or rhinomodelation: the fillers for the nose are formulated with hyaluronic acid, a natural substance already present in our body and, therefore, practically free of contraindications and usable for all types of patients. Hyaluronic acid infiltration can be used to remove some cosmetic defects on the nose, especially small humps. Each case must be evaluated in a personalized way since not everyone is a candidate for rhino modeling. People who are, get great results. ” The advantage of ring filler is its speed of execution (30 minutes on an outpatient basis) and immediate recovery). However, the disadvantages of the rhinofiller are that the result is temporary (maximum 12 months) and cannot be used to correct large noses or major defects.

How to prepare for the day of the operation?

Rhinoplasty is an intervention that often causes concern in patients. The SEC and SECPF experts advise following these guidelines to better prepare for this cosmetic surgery operation :

• Carry out a preoperative study.
• Avoid taking anticoagulant drugs days before the intervention, as indicated by your surgeon and/or anesthetist.
• Avoid using vasoconstrictor nasal sprays for at least three weeks before the procedure.
• Avoid smoking and consuming alcoholic beverages the month before the intervention.
• Do not put on makeup on the day of the operation.
• Fasting of at least 8 hours before surgery.
• Go to the clinic with a family member or friend.

It is important to sign an informed consent before performing any operation. In this case, the reference website PubMed recommends in an abstract published by several authors that “certain complications such as dissatisfaction and revision surgery should be included in each consent process. These data help provide a contextual framework as well as valuable information. in preoperative counseling for patients and doctors about nose surgery and its possible complications ”

Postoperative and recovery

Rhinoplasty surgery can be done on an outpatient basis or with an overnight stay. Typically, a splint is placed that will need to be worn for a week and some surgeons will place nasal plugs for 4-5 days. However, with ultrasonic rhinoplasty, the use of nasal packing is not necessary.

During the first week, it is normal for there to be edema and hematoma in the eye area and around the nose, being minimal in the case of ultrasonic rhinoplasty. There may be pain, discomfort, or a feeling of nasal congestion in the operated area. The swelling of the nose will last for several months, but already at the moment of the extraction of the splint, it will be possible to glimpse the new shape.

In general, it is possible to return to work after 7 days of the operation, while physical and sports activity should be interrupted for at least 2-3 weeks, avoiding any situation that may cause damage or trauma to the nose until the surgeon deems it more appropriate. (usually at least a couple of months). In addition, it is very important to protect the nose from sun exposure with an SPF +50 cream for the first 2 months.

• Do not blow your nose for the first 4 weeks.
• Follow the surgeon’s instructions regarding cleaning and caring for the nose.
• Avoid lowering your head the first few days (to bend you must bend your knees and keep your neck straight).
• Do not wear contact lenses for the first few weeks.
• Do not consume very hot food or drinks for at least 2 weeks.
• Avoid strenuous physical exertion and trauma, especially during the first few weeks.
• Do not wear glasses for at least 1 month.

Results

The result of a cosmetic rhinoplasty allows an improvement in both the shape of the nose and the face, and at the same time the facial characteristics will not be radically changed, but only improved. The final results will be appreciated after at least 6 months when the edema and inflammation are completely reabsorbed. “The nose may undergo small changes for months, therefore, the complete reabsorption of the inflammation will not be surpassed until the first year,” says

The results obtained are permanent and definitive, even if over the years they may undergo some changes due to the aging process, as could occur in any other part of the body. To obtain a good result the lines of the nose must be harmonious, the nostrils symmetrical and the angle between the lips and the nose well defined.

One element to take into account is the type of skin of the nose, in fact, thick skin retains more memory of the shape of the nose and does not fully adapt to the new cartilage structure obtained through surgery.

As for the scars, these are found inside the nose, except in the case of the reduction of the nostrils. If the patient is operated on with the open technique, he will notice a small scar in the narrowest part of the columella that can be straight, stepped, or V-shaped.

Secondary rhinoplasty

It is a surgery especially indicated in patients in whom the cartilage of the nasal septum cannot be obtained as a primary source due to large septum deviations, septum perforations, severe trauma, accidents or in patients previously operated on for rhinoseptoplasty in whom it has already been performed. used septal cartilage. According to  “ In these cases, it is necessary to use rib cartilage or even ear. Secondary rhinoplasty should be scheduled at least 12-15 months from the first operation, in cases where a primary rhinoplasty has been performed, and there is a deformity or asymmetry significant enough to perform this second intervention. It is not indicated for small defects since the results of a secondary rhinoplasty are somewhat more unpredictable and the risks are greater when handling already intervened tissues ”.

It is performed under local or general anesthesia depending on the type of defect or retouch, and provides postoperative recovery times similar to the first operation. The risks, however, may be greater at the level of healing, vascularization, or in the case of cartilage grafts that could undergo minimal resorption and with the consequent change in the appearance of the nose.

Therefore, the indication for a secondary rhinoplasty and its planning must be prescribed and planned by a specialist.

Risks and complications

SECPF experts indicate that possible side effects from rhinoplasty include:

• Local inflammation
• Bruises on the nose or around the eyes
• Local bleeding
• Nasal congestion
• “Red nose” effect due to dilation of capillaries
• Chronic pain
• Skin necrosis
• Unaesthetic scar
• Asymmetries
• Unsatisfactory results for the patient
• Breathing disorders and/or changes in the flow of air in the nose

frequently asked questions

• Is the surgery painful? Not at all, it is not something that our patients complain about, in fact we take great care of both the surgical technique and the anesthesia so that, as far as possible, it is as less harmful as possible for the patient.
• At what age can I undergo a rhinoplasty operation? It is not advisable to operate on any child or adolescent until they have finished their natural growth process. In girls, it usually occurs at 14 or 15 years, but in boys, it happens somewhat later.
• How long does it take to recover from the operation? In functional surgery cases, sick leave of approximately 7 days is required. If it is a functional and aesthetic surgery, the time of leave usually extends to 15 days.
• How do you ensure that the results will be appropriate for each patient? The nose should be improved but always according to the features of each person, facial beauty is a set that should not go separately. It is about knowing the patient well, perfectly understanding what he is looking for, and making a very real assessment of what his final result would be.
• What are the advantages of ultrasonic nose surgery? We manage to perform the bone cuts in a much less traumatic way for the patient, which always leads to a better recovery and less bleeding.
• What kind of anesthesia is used? It is performed under general anesthesia, from our point of view it should never be performed under local anesthesia due to the risk that this entails.
• I had a closed rhinoplasty two months ago and even though I still have the same nose, I still have a hump and the tip on the right side is still drooping. After 2 months the inflammation of the nose is still significant, I would recommend that you wait at least until 6 months so that you can consider a more permanent result. In order to advise you more we need to see photos of before and after the surgery; although it is best that you consult with the surgeon who has operated on you to clarify your doubts.

• Can I know if my healing will be correct after undergoing rhinoplasty? the visible scar remains in the nostril, but in the case of internal scarring, it depends on the postoperative period, passing it without making efforts and following the indicated precautionary measures.