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Nose Surgery

Aesthetic Nose Reshaping
Functional Nose Surgery

rhino side

Aesthetic Nose Reshaping (Rhinoplasty)
Because reshaping the nose can so dramatically improve a person’s overall appearance, rhinoplasty (also called nose reshaping or a nose job) is one of the most common facial plastic procedures.  Dr. Sykes has performed thousands of rhinoplasties to correct the effects of an injury or to address patients’ personal dissatisfaction with their nose shape or size.  While the procedure is quite common, rhinoplasty is also among the more technically challenging procedures and is, without question, the most highly individualized. 

The nose you were meant to have…
Patients generally elect nose reshaping to eliminate a hump or indentation, narrow the bridge, raise and/or refine the nasal tip, or lengthen, shorten or straighten the nose.  Dr. Sykes performs rhinoplasty with the goal of creating an attractive, naturally shaped nose that best fits the patient’s face. 

Reshaping a patient’s nose to achieve the ideal composition requires careful assessment and planning in advance of the actual procedure.  UCDMC surgeons take into account several factors, including a careful study of each patient’s facial geometry to arrive at the best possible proportions and alignment to other facial features.  In addition, they select the surgical technique that will achieve the desired result, accommodating the wide variety of structural differences in the nasal bones and cartilage, as well as skin texture and other physical characteristics that affect healing and the final result. 

Experience: The best teacher
The single most important factor in choosing a rhinoplasty surgeon is experience.  As with any skill, the longer a person successfully performs a craft, the more likely you are to achieve the result you desire.  Dr. Sykes brings his patients the benefit of knowledge gained over 20 years and approximately 3,000 rhinoplasty procedures.  In addition to using his experience in planning and performing your procedure, he will give you a list of things to do in advance that have proven helpful in ensuring your best outcome.  By following the instructions on the pre- and post-surgery care lists, you contribute your efforts to the final result. 

Revision Rhinoplasty
It may be a testament to the complexity of the procedure that about 15 to 20 percent of patients who schedule a rhinoplasty consultation with our clinic have already undergone one or more operations by other surgeons.  Sometimes patients need a second surgery to correct problems from an earlier rhinoplasty procedure.  In a few patients, scar tissue development or other healing peculiarities affect the outcome of even an ideally executed procedure.  More often, rhinoplasty revision surgeries are necessary to correct the result of a less-than-ideal procedure.  In those cases, even greater skill is required to repair possible structural damage and achieve an attractive, natural result. 

Choices in technique
There is no single technique that will accomplish the best result for all patients.  For about half of his patients, Dr. Sykes performs a closed or endonasal surgery where all incisions are made inside the nose.  For the remaining patients, an open or external approach that requires a small incision on the skin between the nostrils (columella) is more appropriate.  The surgeon makes the choice based on the issues and complexities of each individual patient’s nasal structure. 

The highly customized nature of each surgery brings in many additional factors.  A patient may require reduction of the bridge bone and cartilage only, while others may also need tip refinement.  The thickness of a patient’s skin may guide the surgeon to operate slightly differently than they would on an identical nose with thinner skin on the nasal tip.  In addition, some patients may inherently have strong tip support, while others may require cartilage grafting to provide necessary reinforcement.  Just as no two noses are alike, no two rhinoplasty procedures can be either. 

What to expect
You can expect to look worse than you feel during the week following rhinoplasty.  In fact, most patients are surprised to experience relatively little pain.  The procedure is done under light sedation so that you go to sleep before surgery and wake up after it’s completed.  You will have small, medicated sponges in the nostrils (not traditional packing) for the first 24 hours following surgery, which can be uncomfortable and will require you to breathe through your mouth.  For the first couple of days, you can expect to sleep a great deal and to feel generalized pain or a dull headache.  After the affects of anesthesia wear off, discomfort caused by swollen nasal tissues and internal and external incisions is common for the first week, as is bruising around the eyes.  Swelling and bruising typically peak on day three and largely resolve in 10 to 14 days, though about 30 percent of swelling resolves more gradually over the following year. 

Patients often say one of the most challenging aspects of rhinoplasty is wearing an external splint for a week following surgery.  This is a critical step in ensuring a good final outcome, because it holds the bones firmly in place during the initial mending stage.  The frustration comes from the inability to hide the fact of surgery, so that even when you feel better, you may be reluctant to go out in public.  The splint also covers all signs of change that you’re undoubtedly anxious to see.  As one patient said, “It’s like wearing a gift-wrapped present on your face.  You’re dying of curiosity, and you can’t help but see it constantly – but you can’t open it for seven days!” 

Once the splint is removed, typically after one week, you will get an initial idea of your results, which will continue to develop over the next year as residual swelling decreases.  It’s tempting to jump back into life as usual once the splint is off and bruising is gone, but healing is still very active and you need to continue taking it easy for another week before gradually resuming your normal pace.  It’s important not to let your blood pressure rise for the first two weeks, so you should refrain from exercising and not lift anything heavier than a phone book.  After two weeks, mild exercise is okay, but you’ll need to wait six weeks before doing anything strenuous or resuming your normal exercise routine. 

Final results take time
In the weeks and months that follow, you will slowly see the final shape of your nose appear.  The remaining third of your swelling, especially in the tip of your nose, will take a year or longer to completely go away.  Be patient and enjoy the process! 

Rhinoplasty Fast Facts
The following are general guidelines only.  Variations are common.

Surgery length:

1 to 2 hours

Location:

Office or hospital outpatient surgery suite

Anesthesia:

Light sedation or general anesthesia, patient is asleep during surgery

Dressings:

External nose splint and occasional internal splints, typically removed in one week 

Pain & discomfort:

Minor pain for the first couple of days, most often dull and generalized.  Discomfort from nasal stuffiness and breathing through the mouth.  

Swelling & bruising:

Moderate, generally peaking by day three.  Bruising typically fades in 10 to 14 days.  Seventy percent of swelling resolves within the first week.  The remaining 30 percent, especially in the tip area, resolves over the following year or longer. 

Suture removal:

Typically at one week, when splint is removed

Return to work:

One to two weeks

Resume exercise:

Two weeks for gentle exercise, six weeks for strenuous exercise

Initial results:

One week following surgery, when splint is removed 

Final results:  

One year or longer

Permanence: 

Permanent, affected by ongoing aging and post-surgery injuries

 

Functional Nasal Surgery (Septoplasty)
Between the two nostrils is a bone and cartilage structure called the septum.  Though most adults do not have a perfectly straight nasal septum, a significant bend due to a birth defect, injury or the aging process creates breathing difficulties.  A deviated septum can lead to snoring, sleep apnea and recurrent or chronic infections, as well as causing discomfort, a loss of smell or taste, and a sense of having a chronically plugged nose.  A septoplasty procedure straightens the septum so that air passes freely and equally through both nostrils, alleviating troublesome symptoms.   

Occasionally, people who do not have typical septal deviation undergo functional nasal surgery to remove bone spurs, benign tumors called polyps, cancerous tumors, and other growths that obstruct air flow.  Functional nasal surgery is also commonly performed during reconstruction following facial trauma or tumor surgery.  As facial plastic and reconstruction surgeons, Dr. Sykes has performed hundreds of nasal surgeries to treat diseases or improve function.  Functional nasal surgery can be performed alone or in combination with aesthetic nasal shaping (rhinoplasty).   

In your case
The type of procedure you have depends entirely on the condition that brought you in for a consultation.  For breathing obstruction caused by a deviated septum, the doctors typically perform septoplasty through the nostrils so there is no visible incision.  During the procedure, the doctor will remove the excess septal cartilage, straightening the remaining cartilage and attaching it to the bone.  Other conditions may require different techniques, but most functional nasal procedures can be performed without an external incision. 

What to expect
When performed alone, septoplasty for deviated cartilage is a fairly short procedure, typically performed in an outpatient surgical center.  You will be given light sedation, so you are asleep during the procedure and awakened when it is complete.  To prevent normal bleeding from your nose, the doctor will place small, medicated sponges in the nostrils (not traditional packing) for the first 24 hours, requiring you to breathe through your mouth.  You will come into the office the day following your surgery so the doctor can check your progress and remove the sponges. 

Many patients are surprised that there is little pain following a simple septoplasty, generally a dull headache that can be alleviated with pain medication.  Lingering effects of the sedation will make you sleepy for the first 24 to 48 hours, and you can expect swelling and some bruising around the eyes, typically peaking at about three days following surgery before gradually fading away.  If septoplasty has been performed in combination with a rhinoplasty or other procedure, swelling and bruising may last longer.  The doctors may place a splint inside your nose to maintain the septum’s proper position and they typically place an external splint over your nose to prevent any trauma from affecting your results.  Both internal and external splints are commonly removed at your one-week follow-up visit. 

The most important consideration for the first two weeks following septoplasty is for you to avoid sneezing through your nose or blowing your nose.  In cases where septoplasty includes removal of bone spurs, polyps, or other causes of nasal obstruction, you may experience more pain, swelling or bruising, but you should call your doctor if pain or bleeding is excessive. 

Recovery
After the first week, you should feel good enough to resume most normal activities.  Swelling and bruising varies by individual, so it may be a little longer before you feel completely comfortable going out in public.  As soon as the internal swelling begins to subside, you should start breathing better than before the surgery and experience a sense of relief.  During the six weeks following septoplasty, it’s important to limit physical activity to keep your heart rate down to prevent pressure in your nasal area and to avoid any chance of trauma.  After six weeks, you can resume all normal activities—with a renewed ability to breathe freely. 

Septoplasty Fast Facts
The following are general guidelines only.  Variations are common.

Surgery length:

1 to 2 hours

Location:

Office or hospital outpatient surgery suite

Anesthesia:

Light sedation, patient is asleep during surgery

Dressings:

External nose splint and occasional internal splints, typically removed in one week 

Pain & discomfort:

Minor pain for the first couple of days, most often dull and generalized.  Discomfort from nasal stuffiness and breathing through the mouth.  

Swelling & bruising:

Moderate, generally peaking by day three.  Bruising typically fades in 10 to 14 days.  

Suture removal:

Dissolvable sutures are commonly used, requiring no removal.

Return to work:

One to two weeks

Resume exercise:

Two weeks for gentle exercise, six weeks for strenuous exercise

Initial results:

One week following surgery, when splint is removed 

Final results:  

Within a few weeks, though internal healing will continue for some time.

Permanence: 

Permanent, affected by ongoing aging and post-surgery injuries

 

Jonathan M. Sykes, MD
Professor/Director of Facial Plastic and Reconstructive Surgery
UCDavis Medical Group
2521 Stockton Blvd., Suite 6206
Sacramento, CA 95817
(916) 734-2347
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