There are as many shapes and sizes of noses in the world as there are faces. No two are alike, although similarities of faces and their noses exist. The ideal nose surgery procedure maintains or improves the flow of air through the nose and creates a nasal shape which harmoniously blends with and complements the rest of the face.
At times this may mean also altering the shape of other parts of the face, such as the chin, cheekbones, or jaws and teeth, and the plastic surgeon may decide you are best to be treated by a combined, team approach with other health professionals.
Surgery to alter the appearance of the nose has been at the centre of plastic surgery since its earliest days. In a continuous search for more long-lasting, dependable and predictable results, plastic surgeons are constantly re-evaluating known techniques and working with new ones.
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Consequences of Nose Surgery
It takes many months or longer for the consequences of surgery to become clear, and what may look good two or three weeks after surgery may not last over time. Although you may feel one area or your whole nose is too large, the is a complex three dimensional structure which needs to balance with the rest of your face. No one operation is right for every patient. The surgery must be carefully planned to respect the need for balance and proportion in each patient. Operations which routinely involve reduction of cartilage, shaving off and narrowing the bones, and shortening the nose may produce an over done look, with thicker skin and not very much definition. Most of our patients want a nose which is proportionate but with more graceful lines and good definition.
The results of a satisfactory Vancouver nose surgery can be transformative. This effect has been known to plastic surgeons for generations and is partly why rhinoplasty became one of the earliest cosmetic surgery operations to be widely accepted.
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Although most patients who request rhinoplasty are concerned with the shape of their nose and usually feel one area or the whole nose is too large, the nose must be viewed as a complex structure made up of many three dimensional structures which need to blend together with the rest of the face in a harmonious whole. No one operation is right for every patient. The surgery must be carefully planned to respect the need for balance and proportion in each patient. Because of this, the rhinoplasties which were done in earlier years and which are still done by some surgeons which routinely involve reduction of cartilage, shaving off and narrowing the bones, and shortening the nose, will often produce a nose that eventually looks like it has been partially amputated and may even look mutilated.
Selective, subtle reduction and refinement of the bone and cartilage combined with selective augmentation with cartilage grafts usually is more successful in creating a nose which is balanced and harmonious within itself and the rest of the face.
This does not necessarily mean reducing the size of a nose which looks too large. This appearance may be an optical illusion created, for example, by a nasal bridge which is disproportionately low and wide for the tip region. Instead of reducing the tip which may result in an operated upon look, the surgeon may feel augmenting the bridge area may restore balance and maintain a natural appearance. I have often used Meryl Streep’s nose as an example of one which has grace and proportion giving an appearance of beauty without being small.
For a surgeon, deciding whether or not to operate, is probably more difficult in rhinoplastyÂ surgery than in almost any other area of esthetic surgery, for several reasons. The psychological effects of a nose which is seen to be unsightly by the patient have likely been present for many years, often since early adolescence. Among other factors, the patient may have been teased by peers, or felt rejected emotionally, or felt to be ethnically conspicuous. Expectations of the operation may run unrealistically high, and because the effects of surgery do not appear immediately, disappointment may set in and be persistent.
The surgeon must try to select the patients who can understand the aims of surgery in their individual case, along with the limits to what can be performed. A host of factors determine the outcome of surgery, only some of which are under the control of the surgeon. These include the texture and thickness of the skin, the strength and size of the underlying bone and cartilage and the age of the patient, among others. But it is not just the combination of factors involved, and the shape of the patient’s nose prior to surgery which determine the final outcome. The patient’s concern may be the most important factor, and this is often not easy to determine in pre-operative discussions. Concern with small details may be either the warning of a patient who will never be satisfied, or may indicate one who will appreciate a good result. Obsession with detail, on the contrary, indicates the patient will likely not be satisfied, given that small imperfections result from nearly every operation. If definite, relatively predictable surgical maneuvers will likely give the kind of shape the patient desires, and if the patient expresses these desires clearly and without obsessiveness, there is a high chance of success.
The functional aspects of the nose must also be considered. The flow of air through the nose may be unsatisfactory prior to surgery due to development or to previous injuries such as a broken nose. There may be reduced airflow due to allergies and chronic inflammation, and these will not be helped by surgery. In cocaine users, the wall running down the centre of the inside of the nose (the septum) may develop a hole, or perforation, and at an extreme, the nose may collapse due to loss of support from the septum. There are other illnesses which may cause problems with the function of the nose, and these need to be discussed with your doctor, diagnosed, and treated, if possible.
Surgery may, in part, aim to improve the flow of air but in reducing the size of the nose the flow of air may be reduced and some measures may have to be taken to improve this. The nose may appear nearly straight, but a twist or bend in the septum, the wall running down the centre of the nose, may become more apparent as the bridge of the nose is reduced. Making a crooked nose perfectly straight is exceedingly difficult although much can be done to improve the alignment of the nasal architecture. Patients who want their noses reduced beyond what is likely compatible with function and those who want a perfect nose when it is slightly or completely crooked prior to surgery, should likely not undergo surgery.
Vancouver Nose Surgery: The Operation
The operation is usually general anaesthesia ( with the patient asleep but it is nearly always done on an outpatient basis. We usually use a small incision between the nostrils connected to the inside incisions, giving greater control over the way the tip can be shaped, because the complex shape of the tip cartilages can be better assessed and changed accurately this way. Structures higher up in the nose can also be seen better than they can through the traditional key-hole incisions inside the nose.
What about splints and packing?
Traditionally there was a white plaster cast on the nose extending onto the cheeks and forehead, and the inside of the nose was packed with several feet of gauze. Removal of the packing was always uncomfortable and sometimes an ordeal. External splints are now smaller, thinner and lighter, and internal thin plastic splints or stitches replaces packing in most cases, or at least limits its use to a very short period.
The external splint is usually removed at five to seven days. The external stitches are usually absorbable and don’t need to be removed. At a week after surgery there is usually still some crusting on the incision and in side the nose and this feels uncomfortable but it gradually clears. This may be aided by frequent application of antibiotic ointment to reduce drying and crusting. Sneezing through the nose should be avoided if possible.
Return to work
You can expect to be back to work in seven to ten days, by which time most bruising has resolved. Light exercise can start at ten days and full sports at six. Swelling usually takes at least six months to fully resolve, although a lot of it is gone by six weeks. It takes a lot longer for the remaining to swelling to settle so the final shape of the nose isn’t seen for many months. You will usually feel the tip being stiff and rather numb during this time.
Vancouver Nose Surgery: The Risks
As with face lift and blepharoplasty, bleeding, infection and changes of sensation are possible with rhinoplasty. Infection is highly unusual, and bleeding requiring treatment occurs in only about one per cent of cases, although it is normal to have slight post-operative bleeding for the first day or so after surgery. It is highly unusual to have any significant alteration in the sense of smell subsequent to surgery. There is always some temporary numbness of the tip of the nose and the nose will feel stiff for several months after the surgery. Some cold sensitivity during the first winter after surgery is common.
The flow of air through the nose may be altered by surgery. Any surgery to the nose can alter the flow of air, although we generally aim to improve the flow but any attempt to narrow the nose, especially, can reduce the flow. You may even feel reduced flow, strangely enough, with improved flow of air, on occasion, if you have always felt the turbulence of reduced airflow, you may now not feel anything when breathing without obstruction, and may be under the illusion there is no flow.
The most common problem from rhinoplasty surgery is dissatisfaction with the esthetic result. This may be remedied with secondary surgery, so that when the source of dissatisfaction is well-defined, and there is a clear anatomic solution, ultimate satisfaction is usually the result of secondary surgery. However, when the cartilages and other structures have been reduced and are deficient, reconstruction may be a difficult matter. All plastic surgeons see patients from time to time who have had previous rhinoplastic surgery and are dissatisfied.
Often the original surgeon is best able to do the secondary procedure, partially because he or she knows what was done previously, and knows what is available for secondary surgery.
In general, because the final shape from nose surgery is not achieved until all swelling has resolved and scar healing is complete, it is best not to contemplate revision until at least six months have passed since the original procedure.
I have seen numerous patients who expressed some initial dissatisfaction with the result at four to six weeks after surgery and were reassured that there was still significant swelling; by six months after surgery many of their concerns had resolved. If our Vancouver nose surgery clinic is not what you’re looking for, we offer a series of other plastic surgical procedures.
It is usually safe to operate when the facial bones have stopped growing, which in girls is usually between sixteen and eighteen and in boys is usually between sixteen and eighteen and, of course, when the patient is emotionally mature enough for the procedure.
This depends partly on your own response to plastic surgery, but mainly on how much bone work must be done. In most cases today there is surprisingly little bruising, which resolves quite rapidly. It is very rare for people to get black eyes lasting weeks after surgery like we used to see routinely.
This depends on your nose. Sometimes we need to cut and shift the bones ( an”osteotomy”) but we don’t “break” them. A controlled cut is less traumatic. This may be for several reasons, including as part of straightening the nose, to narrow a wide nose, and to bring the bones together after a large bump has been removed from the bridge.
To learn more please contact Broadway Cosmetic Plastic Surgery Centre.