Rhinoplasty (Nose Surgery)
Surgery of the nose is among the most common of all plastic surgery procedures, yet an extremely exacting one that demands experience and precision. Because this surgery can be subtle or more dramatic, it is important that both surgeon and patient have the same aesthetic goals and realistic awareness of what can and cannot be accomplished surgically. This is particularly true when performing revision (secondary) rhinoplasty, when previous surgery either fell short of the patient’s expectations or undesired complications marred the desired appearance and/or nasal function. Rhinoplasty is performed at Minneapolis Plastic Surgery, LTD. in our nationally-accredited (QUAD A, formerly AAAASF) on-site surgical facility by both Dr. Douglas L. Gervais and Dr. Richard H. Tholen . Our American Board of Plastic Surgery-certified plastic surgeons have performed hundreds of rhinoplasty surgeries and understand how altering the nose affects the entire facial appearance. (text continues after photos)
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Candidates for Rhinoplasty
Ideal candidates for rhinoplasty surgery are people seeking aesthetic improvement in their noses, not perfection. Rhinoplasty is a versatile operation that can change the overall size of your nose, narrow or decrease the size of the nostrils, and/or change the shape of the tip or the bridge. Hump removal, reduction of overly wide nasal appearance, and refinement, retrusion, or elevation of a bulbous, over-projecting, or dropped nasal tip are commonly-requested cosmetic changes. Of course, maintenance or improvement of breathing, especially after developmental or post-traumatic nasal injury, can (should) be part of any rhinoplasty procedure. The techniques used greatly depend on the goals as well as the nasal anatomy of the patient, so it is important to seek an experienced rhinoplasty surgeon who fully understands the result that you are trying to achieve, while also recognizing the limitations of each individual’s anatomy or prior surgery.
At Minneapolis Plastic Surgery, LTD., rhinoplasty is as an outpatient operation performed under general anesthesia (TIVA), or local anesthesia plus IV sedation, and usually takes an hour or two but can take longer, depending on the complexity of the operation. In the procedure, the skin of the nose is separated from its supporting framework of bone and cartilage. The bone and cartilage may then be accessed by the plastic surgeon who sculpts them into the desired shape. The skin is then redraped over the new bone and cartilage framework. Taping and splinting is essential to maintain these changes.
After rhinoplasty surgery is complete, tapes and a thermoformed plastic splint are applied to the nose to help maintain its new shape and minimize scar tissue. Nasal packs or soft splints may be placed in the nostrils to protect the internal incisions or to stabilize the septum, the dividing wall between the air passages. If airway surgery is necessary, the nasal packs will be left in place for several days to allow the mucous membranes to heal; otherwise, the nasal packs are removed in one to two days. The nasal splint is left in place for 7-10 days to allow the skin and soft tissues to adhere to the underlying cartilage and bone framework, to reduce swelling and scar tissue, as well as to allow the altered nasal bones to heal.
You must NOT remove the nasal splint or tapes yourself as you may damage the cosmetic result and require re-operation; it will be removed at the appropriate time by your plastic surgeon or his nursing staff. You will wear your nasal splint at night for another week or two until the healing bones and tissues are more durable.
Recovery and Results
For the first 24 hours after rhinoplasty surgery, the face will feel puffy, the nose may be sore, and the patient may experience a dull headache. Prescription medication is provided to manage any discomfort during this period. The patient should plan on sleeping with his or her head elevated above heart level for three weeks after surgery. There may be swelling and bruising around the eyes, reaching a peak after two to four days. By the end of 7-10 days, all packing, dressings, external splints, and stitches will be removed.
You should not blow your nose (at all, even “gently”) for three weeks after surgery to avoid serious infection or damage to your cosmetic result; saline nasal mist and gentle sniffling is allowed. If septal surgery is necessary, internal splints (not visible from the outside) may be left in place longer. After the external splint and tapes are removed, you will see your results, though further refinement will occur as healing progresses and swelling diminishes. The nasal skin will be numb for weeks to months after rhinoplasty surgery; it is important to avoid sunburn or frostbite during this period as protective sensation is absent. The final results may take 6-12 months to be seen.
Revision (secondary) rhinoplasty is usually not recommended until healing has completed and scar tissue softened and matured for a year after previous surgery, regardless where performed. Revision or “touch-up” surgery may sound simpler or less involved than primary, first-time rhinoplasty, but almost always is more complex, difficult, and with a higher potential for undesired scar tissue or unpredictable results. Whenever possible, the first rhinoplasty operation should be the last, because of these increased complexities, risks, and potential for unsatisfactory outcomes. Since no surgeon (or patient) is capable of perfection, choosing the surgeon most likely to achieve your goals with first-time rhinoplasty minimizes the additional time, cost, and difficulty of secondary (revision) rhinoplasty.
Cost for Rhinoplasty (Nose Surgery or “nose job”)
Total costs for “standard” rhinoplasty, including surgeon’s fee, operating room, anesthesia, and all follow-up visits are approximately $10,500. Septorhinoplasty costs start at $12000. If you require more operating time, cartilage or other grafts, Weir excisions to narrow the nostrils or nasal base, or functional (breathing) procedures, the cost is determined by the specific procedure(s) and time required. Exact cost quotes are given at the time of complimentary consultation at Minneapolis Plastic Surgery, Ltd. Financing options are available. Please contact us for a no-obligation consultation with our American Board of Plastic Surgery-certified plastic surgeons.
Because of the high demand for free consultations with our plastic surgeons, our staff will ask for a credit card number in order to schedule a consultation; there is no charge whatsoever for appointments that are kept–you will be charged $100 only if you fail to keep a scheduled appointment, or fail to cancel at least 48 hours in advance of your appointment time–for Monday appointments, you must cancel no later than noon on the previous Thursday; for Tuesday appointments, you must cancel by noon on the previous Friday.