Plastic and Craniofacial Surgery
Rhinoplasty, commonly known as a “nose job,” is an operation to change the shape of the nose. It is an operation that can address common complaints with the nose, such as a nose that is bent toward one side, a hump on the bridge of the nose, a drooping nose or a tip that is too large. The nose is a key aesthetic feature of our faces, so any difference between the two sides is easy to notice, and any dissatisfaction with the shape or features of the nose can lead to significant psychosocial problems.
Rhinoplasty is one operation in which small differences at the time of surgery can have large effects on the shape of the nose, and at Children’s Health℠, all of the pediatric plastic surgeons are faculty of the UT Southwestern Department of Plastic Surgery, a world renowned center for rhinoplasty. The nose changes dramatically during puberty and early adulthood so any surgery to the nose needs to be considered in terms of not only the best operation to achieve the individual’s goals, but also the ideal timing to give the best immediate and long-term results.
Patients can consider rhinoplasty for a variety of reasons. Often an injury earlier in life can cause the nose to be bent to one side, which is obvious to see as the nose is so central in its position on the face. When the nose is asymmetrical on the outside, there is also likely to be asymmetry of the air passages within the nose, and people can have difficulty breathing through one or both nostrils. Other patients considering rhinoplasty are unhappy with certain aspects of their nose, often that the bridge of the nose has a hump; that the nose, especially the tip, is too big; or that the nose looks droopy. The psychosocial consequences of these issues can have a dramatic effect on some people’s lives with poor self-esteem, sensitivity to comments made by or teasing by peers and difficulty with relationships.
Rhinoplasty is one operation, but within that, there are multiple procedures. The set of procedures undertaken needs to be chosen for the individual and is usually decided during the planning stage. Planning rhinoplasty is done after a combination of clinical examination and clinical photographs in multiple views. Procedures can include removing excess bone and cartilage either in the bridge of the nose or in the tip, reinforcing or reshaping part of the underlying nasal structure with cartilage taken either from within the nose or from elsewhere, molding and suturing techniques to reshape the underlying structure of the nose and techniques to create a controlled break of the nasal bones so they can be moved into a new position.
Before undertaking rhinoplasty, it is important to have a thorough analysis of your nose taking your age and ethnicity into account. You will be asked about the features of your nose that are of concern and the impact these concerns are causing on your life, whether you have ever had any injuries to your nose and whether you have undergone any previous operations on your nose. There is no test or formal diagnosis, but following the analysis, your surgeon will discuss what is realistic to achieve with surgery and whether that is likely to meet your expectations from the operation.
The main decisions about rhinoplasty are whether the operation will achieve your expectations, the best age for you to undergo rhinoplasty so that you can maintain a good long-term outcome and which of the procedures you will need in order to create the nose you are looking for.
In terms of scarring from rhinoplasty, there are two main techniques: open-tip rhinoplasty and closed rhinoplasty. In open-tip rhinoplasty, an incision is made inside both nostrils and in the skin between the two nostrils below the nose. This technique gives good access to all parts of the underlying structure of the nose that we recommend in most cases. In closed rhinoplasty, incisions are made within both nostrils but not in the skin between them. This means that there is no scarring visible on the skin, but it means that vision of the underlying nasal structures is not as good, and results can be more unpredictable.
You may be recommended to see our team of developmental psychologists to give you support with any issues you may be facing because of your nose. This helps prepare you to undergo surgery and for any complications from it that you may encounter. A psychologist can also provide support during the post-operative phase, where there is likely to be bruising and swelling.
Aftercare is very important following rhinoplasty as the nose naturally continues to change for a year following surgery. Changes in the size and shape of your nose in early adulthood are common. After the operation, you should expect to have a dressing or a splint over your nose for a week, and you may have internal splints within your nostrils.