Rhinoplasty, which is the surgical reshaping of the nose, is one of the most common procedures in plastic and cosmetic surgery. Rhinoplasty can reduce or increase the size of the nose; change the shape of the dorsum or tip of the nose; narrow the nostrils and change the angle of the nose to the upper lip, etc. Rhinoplasty can also correct certain congenital or post-traumatic deformities. If you are considering rhinoplasty, the following will be a basic introduction to the procedure, such as the timing of the surgery, how the surgery is performed and the expected results of the surgery. However, not all questions can be answered because there are many factors that affect the outcome of rhinoplasty, including patient and surgeon factors. If you have questions that you do not understand, you can consult an experienced plastic surgeon in detail. Rhinoplasty can improve the appearance of your nose and increase your self-confidence, but it cannot completely change your entire appearance and make others treat you differently. Before you decide to have rhinoplasty, make sure you think carefully about what you want most and discuss it with a plastic surgeon who has experience in rhinoplasty. The best candidates for rhinoplasty are those who want to make improvements in her/his appearance and are not asking for perfection. If you are physically healthy, mentally normal, and your expectations are realistic, then you may be a good candidate for rhinoplasty. Age is another factor that doctors consider. Plastic and cosmetic surgeons generally do not perform rhinoplasty on adolescents (14-15 years old for girls and 16-17 years old for boys) until she or he has developed to a more stable age. All surgeries have risks and some uncertainties When the surgery is performed by a surgeon who is well trained in rhinoplasty surgery, the results are generally quite satisfactory. But no matter what, there are always certain risks and complications associated with the surgery. Post-operative complications such as infection, nose bleeding or reaction to the implants are very rare but can occur. The risk of complications is reduced by choosing a surgeon with experience in rhinoplasty and carefully following the surgeon’s instructions before and after surgery. If the rhinoplasty is performed with an incision inside the nostril, there will be no visible scar at all after the surgery; if a nostril reduction is performed, a less visible scar will be left at the base of the nose after the surgery. Nearly 1 in 10 rhinoplasty patients require a second minor surgery to correct minor defects, and even the most experienced cosmetic surgeon may experience some unexpected problems. The second surgery is usually minor and can be done in an outpatient operating room. Planning Your Surgery Your communication with your doctor is very important. During your first visit to the surgeon, the cosmetic plastic surgeon will ask you what you like your nose to look like; examine the structure of your nose and facial contours; discuss possibilities with you, etc. The doctor will also explain to you some of the factors that affect the procedure and the outcome. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. The doctor will also explain the several surgical approaches he will use and the choice of anesthesia, whether the surgery will be done inpatient or in an outpatient operating room, the cost and risks of the procedure; and then let you make your own choice. Be sure to tell the doctor if you have had previous nose surgery and if you have had any trauma to your nose, no matter how many years ago. You should also tell your doctor if you have any allergies, breathing difficulties, if you are taking medications (including vitamin-based medications), and if you smoke. Do not hesitate to ask your doctor all your questions, especially those related to your expectations and the outcome after surgery. The doctor will tell you how to prepare for the procedure, including your diet and certain medications, smoking and facial cleansing methods. Following the doctor’s instructions carefully will make your rhinoplasty go very smoothly. You should arrange for another person to be able to take you home or stay with you in the hospital for 1 – 2 days after the surgery if possible. Place of surgery Rhinoplasty can be done inpatient or in an outpatient operating room. Usually, it will be done in an outpatient operating room for cost and convenience reasons, but more complex procedures will still require a short hospital stay. Choice of Anesthesia Rhinoplasty can be performed under local or general anesthesia, depending largely on the extent of the procedure and your preference with your surgeon. By choosing local anesthesia, you will remain awake during the procedure and your nose and surrounding tissues will feel numb and insensitive, but occasionally there will be some discomfort and you will just need to relax. If you choose general anesthesia, then you will be asleep throughout the procedure and will not feel anything. If The procedure Rhinoplasty usually takes 1-2 hours, although there are some complex procedures that may take longer. During the procedure, the surgeon will lift the skin of the nose from its underlying nasal bones and cartilage, and then either sculpt the nasal bones and cartilage according to your requirements and the surgeon’s skill, or directly implant an already sculpted nasal scaffold to achieve your desired result. Finally, the skin is sutured back into place. Most plastic and cosmetic surgeons who perform rhinoplasty prefer to make incisions inside the nostrils so that there will be no scarring after the procedure. However, some more complex procedures often require an incision in the nasal columella, which will leave an inconspicuous scar on the nasal columella after surgery. After surgery, a splint is placed on the back of the nose to maintain the new shape and a soft plastic splint is placed inside the nostril to stabilize the septum. Post-operative care For 24 hours after surgery, your face will be swollen and you will feel pain in your nose and a dull headache. It is best for you to lie in bed (except to go to the bathroom) and keep your head elevated for the first day after surgery. You will notice swelling and bruising around your eyes on the first day after surgery, which will peak on the second or third day after surgery. The swelling usually goes away gradually 2-3 weeks after surgery. It is common to have a little bleeding for the first few days after surgery, and you will feel a stuffy nose for several weeks after surgery. Your surgeon will ask you not to blow your nose during this time, as the tissue is healing. Return to normal Most rhinoplasty patients are able to be on the floor the day after surgery and can return to study a week after surgery, but it does take 3-4 weeks to return to full normalcy. You should gradually resume your normal activities after surgery, and your surgeon recommends that you refrain from strenuous exercise, such as running and swimming, that can raise your blood pressure for 2-3 weeks after surgery. For two months, you should avoid trauma or bruising of the nose and excessive exposure to sunlight. When washing your face, combing your hair and using cosmetics, be gentle. Contact lenses can be worn after surgery, but wearing glasses is usually not allowed until 3-4 weeks after surgery. A New Nose Shape The swelling and bruising of the first few days after surgery may make you forget that your nose will look great. In fact, many plastic surgery patients feel frustrated during the first few days after surgery, which is perfectly normal and understandable. Rest can smooth out this unpleasant period of frustration. Your nose will look better day by day, your spirits will gradually improve, and after 1-2 weeks, it will be as if you never had surgery. However, healing from surgery is a slow and gradual process. The swelling at the tip of the nose may last for several months. Sometimes the final result takes a year or more to be seen. In the meantime, you may experience unusual reactions from your family or friends. He/she may say that your nose has not changed much before and after the surgery, or someone may even resent you because you have changed the way your family or friends see you. If this happens, it is important to remember what you intended to have the surgery for in the first place, and if the surgery itself has catered to your heart’s desire, then your surgery was a success.