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Rhinoplasty – an Overview of Nose Jobs

Rhinoplasty – or as it is more commonly known, a nose job – is plastic surgery to reshape or repair the nose. As such a central feature of the face, flaws in the appearance of the nose can cause an individual to become very self conscious about their appearance, which can lead to a loss of confidence. Although rhinoplasty can also be used to correct medical problems such as impaired breathing, it is the improvement of the appearance which motivates a majority of patients to seek surgery, and which makes nose jobs one of the most highly sought cosmetic surgeries.

When it comes to improving the nose aesthetically, a surgeon can improve the appearance by sculpting or filing the cartilage and adding implants to lengthen, shorten, increase the projection of the nasal tip, remove a hump or change the width of the nose. In the case of narrowing the nose the bones are commonly broken and meticulously reset. Where implants are required many surgeons prefer to use natural tissue, often taken from the patient’s septum or inner ear, as the body is less likely to reject this than an artificial implant (often made from silicone).

Rhinoplasty is gaining immense popularity among teenagers and young adults, where peer pressure and bullying can often prompt individuals to seek out plastic surgery at a young age. If the nasal flaws are minor, most surgeons prefer to wait until the patient is older and growth is complete. However, in girls the procedure has been performed as young as 13 and in boys, who generally mature more slowly, at the age of 15. Having surgery at this age can be extremely beneficial in terms of self esteem, but additional risks need to be taken into consideration, for instance if it is performed before growth has ceased then complications may arise that necessitate revision rhinoplasty later in life.

There are two methods of surgery for rhinoplasty. The first is closed rhinoplasty, where incisions are made inside the nose. This method means less trauma to the nose, with the beneficial result of less bruising and swelling post-operatively. Because the surgery is performed ‘blindly’ it is best suited to nose jobs where little work is required, such as straightening the bridge of the nose, but the overall shape of the nose and nasal tip is good. However, in the hands of a highly skilled and experienced surgeon, closed rhinoplasty can sometimes produce outstanding results in more complex procedures too.

The second method is open rhinoplasty, which is well suited to more complicated surgery. A small incision is made in the columella (the fleshy column between the nostrils) and the skin is carefully lifted back to expose the cartilage. This allows surgeons to carry out more intricate work. Once work is complete, the skin is pulled back down and stitched back into position. The disadvantage of this technique is that it leaves a scar, although this is usually barely visible. The swelling will also be more severe and will take longer to heal.

Rhinoplasty is often performed under IV sedation (light sleep), although general anaesthetic may be used for more complex procedures. On average, surgery takes around 90 minutes. After surgery a splint and dressing will be applied. Nasal pads may also be required for a few days.

As is the case with all surgery, rhinoplasty carries inherent risks. Some of these are general to all surgical procedures, such as having a reaction to the anaesthetic. Other risks and side effects are more specific to nose jobs and can range from the banal such as excess mucus production (which can last several months) to more serious complications such as the nose healing in an abnormal shape. The latter is commonly caused by the patient either bumping their nose before healing is complete or even seemingly minor factors as the patient favouring a particular side when sleeping, causing the nose to heal with a bias to that side. Revision rhinoplasty may be required to remedy this.

A successful rhinoplasty can be extremely beneficial to your appearance and self esteem. Therefore, it is imperative to find a highly qualified and experienced surgeon to carry out the nose job. The initial consultation at a clinic is usually free so it is beneficial to visit several to find the one most suited to your needs. Researching thoroughly to find a good surgeon will be time well spent.

How to Select Your Botox Doctor?

Credentials: Selected surgeons should be certified by the American Board of Plastic Surgery (ABPS). Any doctor (even one from a nonsurgical specialty) can legally perform surgery.

On the other hand, certification by the ABPS ensures at least five years of surgical training, including two years of training specifically in plastic surgery.

Patients undergoing a cosmetic procedure should select a member of the American Society for Aesthetic Plastic Surgery (ASAPS) to help ensure that their surgeon has extensive cosmetic surgical experience and has met ASAPS requirements for continuing cosmetic surgery education.

Hospital privileges: Cosmetic plastic surgery is often performed outside the hospital in an office-based surgical facility. Wherever the surgery is to be performed, selected surgeons should have hospital privileges to perform the specific procedure in an acute care hospital.

Facilities: Published data show that accredited office-based facilities have a safety record comparable to that of hospital ambulatory surgery settings.

Ambulatory or office-based facilities should be accredited by a nationally or state-recognized accrediting agency, or be state licensed or Medicare certified.

Health: Candidates for cosmetic surgery should be in generally good physical health and must be candid with their physician about any drugs they are taking.

The medical history should include hormones (oral contraceptives and estrogen replacement) and even aspirin, vitamins, and herbal medications since these substances can interfere with blood clotting or interact with medications used during surgery and could increase surgical risk.
Patient education: Before surgery, patients should be educated about all aspects of the planned surgery, including whether to discontinue certain medications and stop smoking. Postoperative care should be thoroughly discussed with the surgeon, as surgery is not truly over until the patient is ambulatory and has returned to a relatively normal routine.
Risks: Most cosmetic surgery is extremely safe in the hands of surgeons certified by the American Board of Plastic Surgery. However, even with the highest level of care, every surgery carries risks as well as benefits, and these should be discussed thoroughly before surgery is undertaken.

For example, multiple procedures performed at the same time may increase the risks of surgery. There are risks associated with anesthesia, analgesics and antibiotics. Smokers are at greater risk of complications including delayed wound healing, skin loss, scarring, and poor surgical outcome.

Other risks include deep vein thrombosis (DVT) [formulation of blood clots in the veins] and pulmonary embolism (PE) [a blood clot that goes to the lungs preventing the lungs from exchanging air].

Factors such as general anesthesia and prolonged operating time appear to increase the risk of DVT. Both DVT and PE are unpredictable and can occur outside the surgical setting, as the result of certain medical conditions or from immobilization; for example, individuals have developed DVT following long airplane trips.

Postoperative monitoring and home care: In the immediate postoperative period, any patient undergoing cosmetic surgery should be monitored by qualified medical personnel and discharged from the surgical facility only after evaluation by the surgeon.