Dr. De Fazio Plastic Surgeon :: Procedures :: Face :: Rhinoplasty in Italy

Rhinoplasty (Nose Surgery)

rinoplastica.jpgRhynoplasty or Nose Surgery is a surgical procedure whose purpose is to improve the appearance and proportion of your nose, enhancing facial harmony. This improvement is achieved by reducing and reshaping the bone and cartilaginous nasal framework. The degree of improvement is different from person to person and it depends on both the skin condition and the dimension of the underlying bone structure.

1 to 2 hours
1 day / day surgery
1 to 2 weeks

The procedure

Cosmetic Rhynoplasty is a surgical procedure performed in a surgery room, under either general anesthesia or neuroleptanalgesia, which consists of intravenous sedation by an injection of medications making the patient calm and relaxed. In addition, local anesthetic is injected when the patient is sleeping, in order to avoid any discomfort from the shot. 

The procedure is painless both during and after surgery. The choice of anesthesia can be discussed with the anesthetist. In any case, the surgical team will always use the appropriate methods and tools in order to ensure the highest safety for the patient.
Rhynoplasty is performed either using a closed procedure, where incisions are made inside the nose, in the nasal vestibule (the nostrils), or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. The skin that covers the nose is gently raised, allowing access to reshape the structure of the nose. The hump, if present, is removed and the nasal bones are cut from the base in order to put them together and reshape the nasal dorsum (bridge of the nose). If the septum is deviated, the septum cartilages are detached, while the paired alar cartilages and the triangular fibrocartilage complex are reduced as much as necessary to reshape the tip of the nose. No swabs are placed inside the nose, while a splint is applied externally on the nasal dorsum to keep the nasal bones in place. Sometimes it might be necessary to combine rhynoplasty with a correction of deviated septum. This surgical procedure is carried out through the same incisions made for the cosmetic correction of the nose.

Preoperative Preparation

The patient will be asked not to take aspirin, or other drugs containing it, 2 weeks before and 2 weeks after surgery. Aspirin can cause bleeding and, as a consequence, increase the risk of complications. No make-up product should be used on the day of surgery.

It is recommended to female patients taking oral contraceptives to stop taking them one month before surgery.

Post-operative care

When the procedure is completed and then for 24 hours after surgery, a soft dressing, as well as cold compresses are applied. The compresses need to be changed often during this time. The day after surgery, the patient can be dismissed, but he/she must continue the application of cold compresses for another 12 hours at home. The stitches will be removed 5 to 7 days after surgery.

After the procedure

The splint will be removed 7 days later and, at that point, the nose will look presentable, even though the final result will take some more time. During the first 24 hours after surgery, some edema (swelling) might occur, in the face, the eyelids and the nose, together with some ecchymosis; real pain does not normally arise.

Watery eyes might occur also during the first 24 hours, but they will disappear quite quickly. Edema and ecchymosis will gradually disappear within 4-5 days.

Possible complications

Any surgical procedure implies some level of risk. 
Specific risks related to rhynoplasty are limited and as a rule rare. The most common complication consists of infections, which, however, respond very quickly to antibiotics therapy, with no influence on the final result.

In some cases, since no swab is used, epistaxis (nosebleed) might occur, but it normally stops quickly and gives no special problems. If this occurs, it is recommended to inform the surgeon.
Some irregularities might appear once the nose has recovered and the patient's condition has stabilized. These can be corrected with a minor secondary surgery under local anesthesia achieving very good results.

The final and permanent result will be achieved 6 to 12 months after surgery, when also the edema will be completely gone. During this period the patient might feel reduced skin sensitivity in the nose, but it gradually comes back.
When a correction of deviated septum is combined with rhynoplasty, the patient also needs to learn how to breathe through the nose again. This functional rehabilitation requires proper training for a long time. In some cases, a complete correction of deviated septum cannot be achieved due to a particular cartilaginous nasal framework. For the same reason, in a small percentage of cases, a partial recurrent nasal septum deviation might occur.

Recovery time (back to social life)

On the surgery day, the patient can stand up and walk. One week after surgery, when the edema has disappeared, he/she can gradually resume normal physical activity. Hair can be washed 3-4 days after surgery
Driving can be resumed one day after surgery, as well as sexual activity (within reasonable limits).
As well known, sun exposure is very dangerous for the skin, particularly after surgery. As a consequence, it must be avoided for at least 3 months after surgery. Using a hat/cap might also help in protecting the face and the nose from the sun. Sun exposure might cause redness and, consequently, make the skin color on the nose more intense than in the rest of the face. This condition might stay even when the tan is gone.
Sports like jogging, dancing and yoga can be resumed 2 weeks after surgery, while more intense sports like skiing, tennis, football, basketball, surfing, swimming and diving should be avoided for at least 4 weeks.