I Don’t Like The Hump On My Nose
Rhinoplasty is a procedure designed to improve the appearance of the nose. Patients inquiring about rhinoplasties hope to address a hump, a curvature, their nose being too long, short, wide or thin, breathing issues and/or revisions need after previous surgery.
Consultation
At the initial visit, patients are asked to voice their concerns. The plastic surgeon will then evaluate the nose both externally and internally by looking at the airway and the internal components that affect the appearance and ease of breathing.
After goals are discussed and examination is complete, the patient and the surgeon have an in-depth conversation to explain the recommended procedure, answer any questions and address concerns.
At Plastic Surgery Institute of Washington, our patients are able to conceptualize optimal outcomes through the use of software that allows the surgeon to digitally simulate results using the patient’s own photos.
Seeing these simulations allows the patient and surgeon to achieve a greater understanding, and appreciation of the goals of the surgery.
Analysis
The upper third portion of the nose consists of nasal bone, the lower two thirds consists of lateral cartilages and the tip cartilages. The tip cartilage is addressed when patients are concerned by a bulbous or boxy tip of their nose. This appearance is often caused by the presence of large or excessive cartilage. This is addressed by trimming and suturing the cartilage to narrow the tip and offering a more delicate appearance.
Patients with thickness of the overlying skin require greater support from the cartilage in the tip of the nose, which limits the degree of narrowing that can be accomplished. In these cases, a cartilage graft from the septum can be placed to correct this.
Factors affecting breathing:
The Septum can be deviated to one side, which can affect and limit airflow.
The Turbinates are structures that moisten the air we breathe. The lining of the turbinates, called mucosa, may enlarge due to allergies. The mucosa can be reduced, consequently treating symptoms of allergies.
The Middle Vault is the cartilage below the nasal bone. If this is collapsed, the airway is narrowed. This is addressed by the use of spreader grafts, or pieces of cartilage borrowed from the septum and placed to widen the middle vault to improve the airway.
The cartilage within the nostril rim can become weak, causing the nostril to collapse when taking deep breaths. Placing an additional piece of cartilage in the rim will add rigidity and help to prevent the collapse. If there is insufficient cartilage in the septum, cartilage from the bowl of the ear can be used as well. This cartilage is truly a spare part and is approached from the backside of the ear to avoid visible scarring.
Procedure
The procedure is performed on an outpatient basis typically under general anesthesia. On average, the procedure lasts two hours. Rhinoplasties are referred to as an open or closed procedure. Open rhinoplasty is more common and involves an incision across the narrow part of the nose between the nostrils. This provides a more accurate exposure of the underlying structures.
Recovery
A plastic splint is placed on the nose at the time of surgery. This is left in place for four days. At four days, the splint is removed and you can take a full shower. Prior to that time, you are bathing from the neck down keeping your splint dry.
For the first two weeks after the procedure, exercise is limited to casual walks. After two weeks, if you’re feeling good the day after exercising, activity level can be gradually increased. ‘I feel good’ – do more. ‘I am sore’ – you overdid it, and should slow down.
The nose is considered broken for 4 weeks from the date of surgery.
Balance
There is a balance between nose and chin. On occasion, a patient will state their nose is too large. This may be due to a large nose and a receding, retrognathic chin. If present, this can be addressed with a chin implant at the time of surgery. The implant is made of silicone and can either be placed through the mouth or under the chin to provide more chin projection and achieving balance.
Risks
Risks of rhinoplasty surgery can include infection, bleeding scar, sensory changes and swelling. Swelling is the biggest issue as it will delay the appreciating of the final result for 6-12 months. On a rare occasion, a hump may partially come back after surgery. This is unusual but can occur. If this happens, revisions may be done to file it down.
NOTE: Most recently there has been enthusiasm around non-surgical rhinoplasty using dermal fillers, like Juvederm or Restylane. While filler can be used to temporarily “fill in” valleys and help camouflage humps, adding filler adds volume. Therefore, making your nose bigger, not smaller. Decreasing the size of your nose can only be accomplished by surgery.
