What is rhinoplasty?

Rhinoplasty surgery is performed to reshape your nose. It is commonly performed to reduce large noses that are out of proportion to the rest of the face but it can also performed on smaller noses that require augmentation to different portions such as a low nasal bridge and possible droopy, hanging nasal tip or correction of crooked noses.

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Who is a candidate?

Cosmetic rhinoplasty is performed typically when the patient is approximately sixteen years old or older.

Rhinoplasty is sometimes performed in conjunction with other procedures such as chin augmentation that yields improved proportional facial aesthetics.
Sometimes certain breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping is performed. Dr. Mezrow will help you determine whether these structures should be modified along with reshaping your nose.

Consulting with Dr. Mezrow:

During the consultation, Dr. Mezrow will ask you about your particular concerns regarding your face and nose. This will help determine your expectations and determine whether they can be realistically achieved. Because of individual factors, (skin quality, cartilage, bony structures, aging, etc.), not everyone will achieve the same results from rhinoplasty surgery. With you, Dr. Mezrow will select the surgical technique that he feels will obtain the best outcome for you.

After obtaining a comprehensive medical and surgical history, Dr. Mezrow will examine your face and nose, assessing nose size, shape and its individual components. Nasal skin thickness, nose height, width and length, nasal tip and nostrils will be assessed. An internal nasal exam will be performed to assess the airway and components that can cause deviation. The chin will also be examined to assess normal facial proportions.

The procedure is usually performed in an ambulatory surgery center. The procedure typically takes approximately 2-3 hours to perform. Most patients recover within 1 to 2 hours after surgery and are discharged home.
How is the procedure done/Where will I have scars?

Although there are many techniques in rhinoplasty surgery, generally the procedure is performed as referred to as open or closed approach. Both approaches involve intranasal incisions. The difference being that the open approach there is a small incision across the narrowest portion of the skin between your nostrils (columella). Dr. Mezrow will discuss with you which approach he prefers for your surgery

Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip.

The surgical techniques employed will depend primarily on the goals established by you and your plastic surgeon. In many instances, all of the incisions will be placed inside your nose, where they will not be visible. Sometimes a very short incision is made across the vertical strip of tissue that separates the nostrils, called the columella. This technique is called an "open rhinoplasty."

If the base of the nose is narrowed or the nostrils reduced, small wedges of skin at the base of the nostrils will be removed. Incisions are hidden in the natural crease where the nostril joins the cheek.

Depending on the surgical technique used, a splint may be placed on the bridge of the nose for the purpose of holding the tissues in place until they have stabilized.

What are the potential complications?

Fortunately, significant complications from rhinoplasty are infrequent. Every year, many thousands of people have their noses reshaped, experience no major problems and are pleased with the results. Significant complications from rhinoplasty are infrequent, however, all surgery has risks. Dr. Mezrow will discuss with you, the risks, benefits and alternatives and answer all your questions.

Some of the potential complications that may be discussed with you include bleeding, hematoma (an accumulation of blood under the skin that may require removal), infection, poor scarring, altered breathing, asymmetry and reactions to anesthesia. Numbness of the skin following rhinoplasty may occur but is usually temporary. Occasionally, if the surgical outcome needs further improvement, additional surgery may be necessary.

Complications, which delays healing and prolongs recovery, is more common in diabetic patients and those who smoke. Preoperative and postoperative instructions will be given to you by Dr. Mezrow in attempt to reduce the likelihood of complications and make you as comfortable as possible with the whole process. Smokers will be instructed to stop smoking 4-6 weeks prior to surgery and not resume smoking to reduce the risk of delayed healing, wounds, infections and compromised outcome. Aspirin, anti-inflammatory medications as well as agents that cause bleeding should be discontinued two weeks prior to surgery (or as otherwise instructed by Dr. Mezrow and your primary physician) to reduce the likelihood of bleeding.

What kind of medications will be given to me?

Medications are administered for your comfort during the surgical procedure. Typically, general or intravenous sedation is administered so you will be comfortable during the procedure.

Through the small incisions described previously, work is done on the cartilage and bone that form the framework of your nose.

Sometimes, the position of certain bones may need to be altered slightly in order to make your nose look narrower and straighter. If your nose needs to be built up in some areas, this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The skin and soft tissues then redrape themselves over this new "scaffolding."

Rhinoplasty is usually performed as an outpatient. It is important to arrange for someone to drive you home after your recovery and to stay with you for at least the next day or two.

What happens after surgery?

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication, which you may continue taking at home. Depending on the surgical technique used, a splint may have been placed on the bridge of your nose for the purpose of holding the tissues in place until they have stabilized. The splint will protect your nose while you sleep and shield it from accidental bumps. Frequently, you may also have a small triangular bandage beneath the tip of your nose. Packing or soft internal splints are sometimes used inside the nostrils, especially if work has been done to improve your breathing.

You are permitted to go home after recovery and return within approximately one week for packing and splint and suture removal.
You will be instructed keep your head elevated. Strenuous activities should be avoided for the first couple of weeks, since these activities might cause compromised results including but not limited to increase swelling or even bleeding.

You will have swelling and bruising, which will resolve with time. It is not uncommon for all swelling to take approximately one year to fully resolve.
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you may be able to return to non-strenuous work in approximately ten days after surgery. Most normal activities including exercise can usually be resumed within three weeks. During healing you may experience some mild, periodic discomfort and swelling, such feelings are normal. Severe pain should be reported to Dr. Mezrow.

Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery. Most discoloration will disappear within two weeks. A few days after surgery, you can begin to use makeup as a concealer, if desired. Noticeable swelling may last for several weeks. Minor residual swelling, most frequently affecting the nasal tip, may continue for many months, but generally this should not be apparent to others. If packing was used, it will either dissolve by itself or be removed three to seven days after surgery. Stitches may also be removed at that time. You may need

It will be a few months before you can expose your reshaped nose to direct sunlight. Your nose will be sensitive during this time, and you must be conscientious about using a sun block to protect your skin. If the bones of your nose were altered, it may be a number of weeks before you can wear glasses without special support such as tape.

How long is the healing process?

Since the healing process is gradual, you should expect to wait up to one year to see the final results of your rhinoplasty. You are likely, however, to begin enjoying your new look within weeks of your surgery.

Occasionally, a touchup may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. After surgery, you will be instructed to restrict your activities and simply relax. Elevating your head when you sleep will help to decrease swelling and bruising. It is essential not to take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to heavy secondary smoke during the healing process.

The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features. It is not uncommon for rhinoplasty surgery to make you feel more confident about your appearance.

Healing from your surgery is a process that takes up to a year for final result. You will be instructed to return to Dr. Mezrow’s office for follow-up care at prescribed intervals to monitor your progress and optimize your outcome.

If you have any questions or concerns prior to surgery or during your recovery, you should contact Dr. Mezrow.