Rhinoplasty Surgery: How is it Performed?

A rhinoplasty surgery can take anywhere from 1 hour to 2.5 hours, depending upon the type of work being done and how much of an alteration is desired. Your rhinoplasty surgery can be combined with other types of cosmetic surgery, such as a brow lift, face lift, or liposuction, which would increase the total time for surgery. It can be performed in a hospital, in a freestanding surgical clinic, or in a surgical suite in the surgeon's office.

After you are brought into the operating room, you will have an intravenous line inserted into a vein in your arm. This will be used to administer fluids and medications during surgery.

You will be sedated and your face will be washed with an antibacterial solution. The surgeon will make the appropriate incisions for access to the inner structure of the nose. In an open rhinoplasty, the incision will be made across the columella, the bit of skin between your two nostrils, under your nose. This incision will be in the shape of a Z or a shallow W. In a closed rhinoplasty, the incisions will be hidden within your nostrils.

Rhinoplasty Techniques

If your surgery is for thinning the tip of the nose, which is sometimes called a tiplasty, you may have incisions at the base of the septum on the columella. If you are having your nostrils narrowed, you may have an incision on each side of the nose in the crease where the nose meets the face. The surgeon will normally take care to make any scars as inconspicuous as possible.

If your nasal bone structure needs thinning, another rhinoplasty technique is to have incisions lead up from the initial incisions through the cartilage into the bridge of the nose. The surgeon will insert a chisel-like tool, called an osteotome, tap it manually with a rubber hammer. This is very precisely done, and the surgeon does not just clumsily break your nose with a hammer. However, it may take a few taps to break the nasal/facial bones precisely. If a hump is present, may be filed down with a special rasp. You may feel some pressure and perhaps even hear the noise from this as it happens, but you will be sedated and very calm.

After the bones are broken, they are moved together to form a narrower bridge as well as give the nose a little more projection, if needed. This process of breaking the bone and resetting it to narrow the nose is called an infracture. If the nose is being widened after the nasal bones are broken, it is called an outfracture. After all the reshaping or infracture/outfracture methods have been carried out, the incisions are then sutured and you may have packing inserted into your nose to hold the shape and reduce swelling and bleeding.

Your nose is then taped and a cast made from plaster, metal, or plastic is applied to protect your nose and help it retain its new shape during the first few days of the healing phase. The bones fuse together quite rapidly, but you must refrain from exercise and sports until you receive the 'okay' from your doctor.

After the rhinoplasty surgery is complete, you will be awakened from anesthesia. Your recovery from anesthesia depends on the type you received for the operation. You may feel very cold as you come out of anesthesia. You may also feel emotional and start crying. These reactions are both normal. Some people become nauseated after anesthesia, so alert one of the nurses if you feel sick. He or she can give you a few sips of cool water to help stave off the nausea or at least provide you with a receptacle in which to vomit. You can also ask for blankets, if you are cold.

Usually, you will not be released until you are completely awake. This may take up to 2 hours. You will not be allowed to drive yourself home. A responsible adult must take you home. Don't even think about driving yourself home.