Rhinoplasty is the surgical reshaping of the nose and is one of the most common procedures performed in ENT and plastic and cosmetic surgery. Rhinoplasty can increase or decrease the size of the nose; change the shape of the dorsum or tip of the nose; reduce 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 it is performed and the results expected from the procedure. However, it does not answer all the questions, because there are many factors affecting the results of rhinoplasty, which include both patient and surgeon factors. If you have any questions that you do not understand, you can consult an experienced rhinologist or plastic surgeon in detail. Rhinoplasty can improve the appearance of your nose and increase your self-confidence, but it can’t completely change your entire appearance so that others will 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 experienced in rhinoplasty. The best candidates for rhinoplasty are those who want to make her/his appearance improved, rather than demanding perfection. If you are physically healthy, mentally normal, and your expectations are realistic, then you may be a best candidate for rhinoplasty. Age is another factor the surgeon takes into consideration. 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/he has developed to a more stable age. All surgeries have risks and uncertainties There are hundreds of rhinoplasties performed each year in hospital plastic surgery departments, and when the surgery is performed by a surgeon who is well trained in rhinoplasty, the results are generally quite satisfactory. But no matter what, there are always certain risks and complications associated with surgery. Post-operative complications such as infections, nose bleeds or reactions to implants are very rare, but can occur. By choosing a surgeon experienced in rhinoplasty and carefully following your surgeon’s instructions before and after surgery will reduce the risk of complications. If the rhinoplasty is performed through an incision in the nostril, there is no visible scar at all; if a nostril reduction is performed, there is a less visible scar at the base of the nose. Almost 1 in 10 rhinoplasty patients will need a second minor surgery to correct minor defects, and even the most experienced cosmetic surgeons can have unexpected problems. The second surgery is usually minor and can be done in an outpatient operating room. Third, Plan Your Surgery Your communication with your doctor is very important. During your first visit to the doctor, the cosmetic surgeon will ask you what you would like your nose to look like; examine the contour structure of your nose and face; discuss possibilities with you, etc. The surgeon will also explain to you how your nose will affect the outcome of your surgery. The doctor will also explain to you some of the factors that will affect the process and outcome of your surgery. These factors include the structure of your nasal bones and cartilages, the shape of your face, the thickness of your skin, your age and your expectations. The surgeon will also explain the several surgical options he will use and the choice of anesthesia, whether the surgery will be done in an inpatient or outpatient operating room, the costs and risks of the surgery; and then let you make your own choices. Be sure to tell your 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 problems, if you are taking medications (including vitamin-based medications), and if you smoke. Be undepressed to ask your doctor all your questions, especially those related to your expectations and results after surgery. The doctor will tell you how to prepare for your surgery, 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 surgery if possible. V. Choice of Anesthesia Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the surgery. If the doctor chooses general anesthesia, then you will be in a sleep state during the whole procedure and will not feel anything. If you choose local anesthesia, you will be awake during the operation, your nose and the surrounding tissues will feel numb and no feeling, but occasionally feel some discomfort, you just need to relax. VI. Surgical Procedure Rhinoplasty usually takes 1-2 hours, although there are some complex surgeries that may take longer. During the surgery, the surgeon will lift the skin of the nose from the nasal bone and cartilage underneath it, and then according to your requirements and the surgeon’s skill, he or she will do the sculpting of the nasal bone and cartilage, or directly implant the nasal scaffolding which has already been sculpted in order to achieve your desired effect. Finally, the skin is sutured back into place from new. Most plastic and cosmetic surgeons who perform rhinoplasty prefer to make incisions inside the nostrils so that there is no scarring after the procedure. However, some more complex surgery often need to make an incision in the nasal columella, which will leave an inconspicuous scar on the nasal columella after surgery. VII. Post-operative care Within 24 hours after surgery, your face will be swollen, you will feel pain in your nose and a dull headache, and your doctor will control these discomforts with medication. For the first day after surgery, it is best to lie in bed (except for going to the bathroom) and keep your head elevated. You will notice swelling and bruising around your eyes on day 1, peaking on day 2-3. A cold compress will reduce some of the swelling and make you feel better. The swelling usually fades away 2-3 weeks after surgery. A little bleeding is common in the first few days after surgery, and you will feel congested for a couple of weeks after surgery, and your doctor will ask you not to blow your nose during this time. VIII. Return to Normal Most rhinoplasty patients are able to get down to the floor the day after surgery and return to school a week after surgery, but it does take 3-4 weeks to fully return to normal. You should resume your normal activities gradually, and your surgeon recommends that you refrain from strenuous exercise, such as running, swimming, and other sports that raise blood pressure, for 2-3 weeks after surgery. For two months, do not traumatize or bruise your nose and do not expose it to excessive sunlight. Wash your face, comb your hair and use make-up gently. You can wear contact lenses after surgery, but wearing glasses is usually not allowed until 3-4 weeks after surgery. Nine: A brand new nose shape The swelling and bruising of the first few days after surgery may make you forget that your nose will look good. In fact, many plastic surgery patients are frustrated during the first few days after surgery, which is perfectly normal and understandable. Rest will 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, you will look as if you have not had surgery. However, healing from surgery is a slow and gradual process. Swelling at the tip of the nose may last for several months. Sometimes it takes a year or more to see the final results. In the meantime, you may experience unusual reactions from your family or friends; he or she may say that your nose hasn’t changed much before or after surgery, or someone may even resent you for changing the way your family or friends see you. If any of this happens, it is important to remember what you were planning to have the surgery for in the first place, and if the surgery itself has catered to your heart’s desire, then your surgery has been a success. Cosmetic Surgery of the Nose The nose is located at the center of the mid-face and its shape is very important to the overall facial appearance. A low nose gives the impression that the face is sunken and lacks definition. Nose reshaping includes nose dorsum, nose tip, nose wing, nose septum and nose base reshaping. Generally speaking, you can consider repairing the relevant parts of the nose in terms of its height (dorsum, tip) and width (dorsum, septum, and base of the nose). The height of the nose can be changed mainly through rhinoplasty, nasal cartilage revision and nasal columella lengthening. The width of the nose can be changed by narrowing the nasal bone, narrowing the base of the nose, and repairing the tip of the nose. Indications of rhinoplasty Low nose: Generally, the height of the nose at the root of the nose is less than 9 mm, and the nasal angle (i.e., the angle between the forehead to incisal line and forehead to dorsal line) is <30° for males and <25° for females as a low nose. Saddle nose without nasal strut and intranasal injury: the destruction of the nasal bone and septum that constitute the nasal strut. Nasal collapse due to nasal bone fracture. Preoperative preparation 1.X-ray cephalometric lateral radiographs: When taking cephalometric lateral radiographs, the soft tissue morphology of the nose should be shown. 2.X-ray projection measurement: Draw the lateral cephalometric projection to observe the morphology of the nasal bridge and also draw the predicted height of the nasal bridge. Between the original dorsal soft tissue line and the predicted line is the thickness of the prosthesis to be injected. It is generally believed that: the nasal surface angle should be 25-30 °, nasal dorsum, nasal column angle of 85-95 °, nasolabial angle of 90-105 °; lateral observation: the lower lip edge in the tip of the nose to the apex of the chin on the line, the front edge of the upper lip is located in the line after, that is, the Rickeffs aesthetic plane. Selection of prosthesis Rhinoplasty implants can choose between autologous bone tissue and artificial prosthesis. Autologous bone tissue can cause damage to other parts of the body when it is taken, and bone tissue has a poor feel and hard texture after implantation; in addition, it is difficult to shape the bone tissue. Therefore, nowadays most of them use artificial prosthesis. Artificial prosthesis is mainly silicone products and expanded body (TPFE).