Rhinoplasty (Nose Surgery)

Cosmetic Nose Surgery
Unlike rhinoplasty performed years ago, modern rhinoplasty takes into consideration personal preferences, familial traits, and ethnic backgrounds. When considering a rhinoplasty, it’s important to be realistic about the desired outcome. While every nose is different, there are common traits that people seek to correct through rhinoplasty:

• A hump on the bridge of the nose (this is called the dorsum)
• A drooping or bulbous tip
• Irregular angles and asymmetries
• Nostril irregularities and disproportions in width 

For the most part, these concerns can be corrected by an experienced rhinoplasty surgeon by modifying the cartilage and bone that comprise the nose’s framework. The goal is to create a cosmetically pleasing sized and shaped nose with results that last a lifetime.

Revision rhinoplasty may correct concerns that arise after a previous rhinoplasty, such as a cosmetic imperfection or a resulting breathing problem. It is typically not done until one year following the original surgery. This gives the nose time to heal completely.

Revision rhinoplasty is challenging because it must address the original concern as well as the outcome of the prior surgery.  Duke rhinoplasty surgeons are skilled in revision rhinoplasty and provide an honest assessment of what can and cannot be achieved.

Before coming to visit us for revision rhinoplasty, it would be helpful to obtain operative records from your previous surgeon. We realize this is sometimes very difficult or not possible if your surgery was many years ago but it can help our surgeons plan your surgery.

Nose surgery may be needed to correct a medical condition such as nasal obstruction or breathing problems. The following functional problems may benefit from nose surgery.

Deviated Septum
The septum is a cartilaginous sheet that separates the right and left sides of the nose. It is rarely perfectly straight. When the septum bends significantly (this is a deviation), it can block the air passage on one or both sides, making it difficult to breathe.

Swollen, Enlarged Turbinates
Considered the humidifiers of the nose, the turbinates are comprised mostly of the nasal mucosa. They periodically swell in response to the environment (as with allergies) or to position. For example, lying on one side may make it more difficult to breathe through the nostril on the lower side. This is the effect of normal turbinate swelling. Sometimes, chronic enlargement of the turbinates obstructs one or both sides. This condition may be treatable medically or may require surgery for relief.

Middle Vault Narrowing or Collapse
A weakness of the middle vaults (side walls) of the nose can cause them to fall inward with a deep inhalation. Adhesive strips worn on the nose by athletes can actually be used to prevent this. Weakened or collapsed middle vaults can be corrected surgically using cartilage grafts to support the nose’s framework. These grafts are usually obtained from your own septum, but if you’ve had prior septal surgery, other sources can be used.

Initial Consultation
An initial visit with your plastic surgeon may take place via video or in person. During your consultation, your plastic surgeon will want to know more about your motivation to pursue rhinoplasty. You will discuss:

• What bothers you about your nose
• How long have you been concerned about this issue
• Your aesthetic goal

Your surgeon will review your medical history including previous surgeries, medications you are taking, and any conditions that put you at risk for surgery. They will examine your nose, discuss desired outcomes, and determine whether rhinoplasty will give you the results you seek. Bringing photos of noses you admire can sometimes help our surgeons understand your goals from rhinoplasty. If your first consultation takes place by video, you will have an in-person visit before your surgery. 

Understanding the Risks
Rhinoplasty carries the same risks as any other standard surgery. These include the risk of bleeding, blood clots, infection, and risks associated with anesthesia. Complications specific to rhinoplasty are rare but can happen. Your doctor will discuss these risks with you.

Rhinoplasty Cost
A rhinoplasty performed for cosmetic reasons is not covered by insurance. If there are functional concerns in addition to aesthetic concerns, a portion of the procedure may be covered by insurance. Our financial counselor will discuss this with you and provide an estimate. 

Presurgical Testing
Once your surgery has been scheduled, you will talk with an anesthesia specialist to ensure you are in good health. You may be scheduled for pre-surgical testing, which can include blood work, an EKG, or other tests to ensure you are healthy and ready for surgery.

On the Day of Surgery
Rhinoplasty typically takes from one to four hours. The length depends on the extent of the nose surgery and whether it includes a functional correction or revision. It is usually an out-patient procedure, meaning you will go home the same day. If you live one or more hours from Duke, our team can recommend lodging if you wish to stay nearby overnight.

Rhinoplasty Recovery
Discomfort following surgery usually lasts about five to seven days, with improvement happening each day. Much of this depends on the extent of the surgery. Over-the-counter pain relief medications can limit your need for prescription pain medications. Your doctor will recommend a timeline for returning to work, school, and exercise.

Swelling is a normal part of healing from surgery and will gradually subside during the first four to six weeks. While you may be happy with the results early in the healing process, your best final result may not be apparent until one year has passed, as it can take that long for all swelling to fade. Postoperative visits will be scheduled to remove stitches and splints and to track your progress throughout the first year.