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RHINOPLASTY: TO DO OR NOT TO DO

Do you look at your nose everyday and think that it does not suit you or your face? There are many people who do, and suffer the consequences of social discomfort. Such feelings of nasal disharmony frequently begin in the early teens, and will persist throughout life if not addressed.

The procedure to re-shape a nose that is too large or small, too wide or thin, too crooked or generally mismatched for the face, is called a rhinoplasty (“rhino” – nose, “plasty” – shape). If a crooked midline wall of the nose is also straightened to improve breathing, the procedure is called a “septorhinoplasty”.

The nose re-shaping is done through small incisions, inside or between the nostrils, that allow elevation of the skin from the underlying bone and cartilage structure. The walls, nasal bridge and tip of the nose are sculpted to refine the nose appropriately for a given person. Such factors as sex, age, racial features, skin thickness and desired appearance are all considered in creating the most ideal aesthetic and functional result. The nasal sculpting can be very detailed and exacting, making rhinoplasty the most complex of all facial cosmetic procedures. Skin healing also affects the final result, and so the goal must always be substantial improvement, and not necessarily perfection.

Complications are uncommon, but include bleeding and infection. Revision or touch-up procedures may sometimes be required. Most importantly is that the patient and surgeon both agree pre-operatively on the desired outcome so that their aesthetic goals are aligned.

You are a good candidate for a rhinoplasty if you have specific deformities that you can identify, your concerns are long-standing and confirmed, you have reasonable expectations for the result, and you are agreeable to accepting the small but real risk of surgery. And of course you must be medically and psychologically healthy. You should not have rhinoplasty if you require a perfect result to be happy, if you expect it to change your life in any magical way, or you do not feel perfectly comfortable with your decision to proceed.

Studies show that young people, from early teens to twenties, are often excellent candidates if they dislike their nose. This is because they readily incorporate a new body image - everything else about their appearance is changing, too - and the nose has not yet become a focus for other real or imagined problems in life.

Young people heal quickly, and tend to be optimistic. But we have also performed rhinoplasty on many seniors, who for one reason or another always wanted it done but just hadn’t gotten around to it!

Usually rhinoplasty is performed as day surgery, under local intravenous or general anaesthesia. It can vary from one and a half to three hours in length. A small cast is placed on the bridge for protection, and cool compresses used to minimize bruising and swelling. The good news – usually there is minimal or no pain, just the feel of nasal congestion. The cast is off in one week and most patients are back to normal activities except for contact sports within two weeks. The nose looks better by two weeks and is mostly healed by six weeks, but can take a full year for the final refinement to be seen.

Each person has a unique feeling about their own nose, regardless of what it looks like to others. So if you feel that your nose does not reflect your own sense of self, you may be a good candidate for rhinoplasty. People who have reasonable expectations and are medically and psychologically healthy have a high rate of satisfaction following rhinoplasty. The procedure can be complex, so be sure to consult a surgeon who specializes in rhinoplasty.

Peter A. Adamson, M.D.,F.R.C.S.C., F.A.C.S.