Nose Reconstruction (Rhinoplasty)

What is rhinoplasty?

Rhinoplasty is an operation that changes the shape of your nose.

When is it used?

This operation may be done to improve the appearance, size, or angle of your nose. For example, it may make your nose smaller or larger. It can also be used to correct deformities and blockages caused by injury, disease, or birth defects. Sometimes it may be done to make it easier for you to breathe.

Your provider will talk to you about why you want the surgery and the results you can expect.

How do I prepare for this procedure?

Your healthcare provider will take photographs of your face and nose to help plan the operation.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you are taking daily aspirin for a medical condition, ask your provider if you need to stop it before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a local or general anesthetic to keep you from feeling pain during the operation. A local anesthetic is a drug that numbs the part of your body where you will have the surgery. A general anesthetic will relax your muscles and put you to sleep. You may be given a sedative and a narcotic before you receive a local or general anesthetic. This will help you be more relaxed, and you will have less pain right after the procedure.

Your surgeon will reshape the cartilage and bone inside your nose. Most of the cuts are made inside your nose to limit noticeable scars. Sometimes a small cut is made on the bottom of the nose, where it attaches to the upper lip. This cut is not usually noticeable after you heal.

Sometimes bone or cartilage is removed from the nose, and sometimes bone and cartilage grafts are added. Grafts can be taken from another part of your body, or a synthetic material may be used.

The operation lasts 1 or 2 hours, depending on the amount of work that is needed.

After your nose is reshaped, the surgeon may pack thin pieces of gauze into each side of your nose to control bleeding. You will have a small protective splint taped over your nose to hold the reshaped bones and cartilage in place. You will wear the splint for 5 to 10 days. A small drip pad will be taped under your nose to catch any drainage or blood that seeps through the gauze.

What happens after the procedure?

You should sleep with your head raised. This helps decrease swelling and bleeding.

Avoid all heavy activity for at least 1 week. Don’t push on or jar the nose while it is healing. Don’t blow your nose. It is OK to draw a breath back into your nose and swallow.

If you have packing in your nose, your loss of smell will lessen your appetite. You may prefer a liquid or soft diet, but you can eat whatever you feel like eating.

You will be breathing through your mouth until the packing is taken out of your nose. This will make your mouth dry, so drink lots of fluids.

If you have packing, it will be removed in 1 to 7 days. After the packing is removed, don’t blow your nose for 48 hours. Also try not to cough too hard. Blowing your nose or coughing may start bleeding.

If you have a nosebleed, lean your head forward (so the blood does not go down your throat) and put gauze over your nostrils. If the bleeding does not stop within 10 minutes, call your healthcare provider. You may need to go to the emergency room to have the bleeding stopped.

For 1 to 2 weeks after surgery your face, nose, and eyes will be bruised, swollen, and discolored. Ice packs will help reduce the swelling, bruising, and discomfort. Your healthcare provider may prescribe medicine to reduce drainage and a mild pain reliever for pain.

After some of the swelling and bruising is gone, your healthcare provider may take pictures of your nose and face so that there is a before-and-after record of your operation. It may take weeks or months for the final improvement to be apparent.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

• You may feel better about your appearance.
• If you had a deformity that made it hard to breathe, you will be able to breathe more easily.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local anesthesia may not numb the area enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• You may have a lot of bleeding that you may not notice because it drains down the back of your throat.
• You may have recurring nosebleeds from the crusting in the area of the cut in your nose.
• You may have trouble breathing from a narrowing of the nasal passages, or you may have a reduced sense of smell.
• You may have an infection.
• You may develop a hole in the septum. The septum is the wall dividing the 2 nostrils. The hole may cause crusting or bleeding from the edge of the septum or a whistling sound when you breathe in.
• Your nose may feel or look a little different.
• Your nose may not be perfectly straight or symmetric.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (37.8°C).
• You have trouble breathing.
• You notice excessive nasal drainage or bleeding from your nose on your drip pad.
• You are spitting up or vomiting blood that has run back into the throat.
• You are swallowing often and then belching, which may be a sign of blood draining down your throat and collecting in your stomach.
• You have a nosebleed that does not stop in 10 to 15 minutes despite efforts to stop it.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.