Nasal plastic surgery include rhinoplasty and septoplasty. Rhinoplasty is a surgical procedure which is usually performed by either an Otolaryngologist, Maxillofacial Surgeon, or Plastic Surgeon in order to improve the function (reconstructive surgery) and/or the appearance (cosmetic surgery) of a person's nose. Rhinoplasty is also commonly called a "nose reshaping" or "nose job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. It can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.
Septoplasty is a corrective surgical procedure done to straighten the nasal septum, the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Nasal obstructions caused by serious deviations frequently lead to chronic sinus problems. Turbinate reduction may also be advised to further enlarge the nasal cavities. If turbinate resection is indicated special care should be taken to avoid over-resection leading to Empty nose syndrome. Most surgeries are completed in 90 minutes or less, not including recovery time.
Rhinoplasty
Rhinoplasty can be performed under a general anesthetic or with local anesthetic. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, a tiny, inconspicuous incision is also made across the columella, the bit of skin that separates the nostrils (open rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone. Most people remain at home for a week. If there are external sutures, they are usually removed 4 to 5 days after surgery. The external cast is removed at one week. If there are internal stents, they are usually removed at one to two weeks. The periorbital bruising usually lasts two weeks. Due to wound healing, there are minor and subtle shifting and settling of the nose over the first year.
In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone to strengthen or change the structure of the nose. Usually the cartilage is harvested from the septum although if there isn't enough which can often occur in revision rhinoplasty, cartilage can be taken from the concha of the ear or rarely the ribs. In the rare case, again usually revision rhinoplasty, where bone is required, it is harvested from the cranium or ribs. Sometimes a synthetic implant may be used to reconstruct the nose. This is most common when augmenting the bridge of Asian noses.
To improve nasal breathing function, a septoplasty may also be performed. If there is turbinate hypertrophy, an inferior turbinectomy can be done.
There are several complications that can arise in rhinoplasty, although it is usually considered to be safe and successful. Post operative bleeding is uncommon and often resolves without needing treatment. Infection is rare and can occasionally progress to an abscess that requires surgical drainage under general anesthetic. Adhesions, which are scars that form to bridge across the nasal cavity from the septum to the turbinates, are also rare but cause nasal obstruction to breathing and usually need to be cut away. A hole can be inadvertently made at the time of surgery in the septum, called a septal perforation. This can cause chronic nose bleeding, crusting, difficult breathing and whistling with breathing.
If too much of the underlying structure of the nose (cartilage and/or bone) is removed, this can cause the overlying nasal skin to have little shape resulting in a 'polly beak' deformity. Likewise if the septum is not supported, the bridge of the nose can sink resulting in a "saddle nose" deformity. The tip of the nose can be over-rotated causing the nostrils to be too visible and creating a "Miss piggy" look. If the cartilages of the tip of the nose are over-resected, this can cause a pinched look to the tip. If an incision is made across the collumella (open approach rhinoplasty) there can be variable degree of numbness to the nose that may take months to resolve.
The cost of rhinoplasty varies regionally and between surgeons. If it is for functional reasons, like breathing correction, it can be covered by many health plans. For example in 2006 in Ontario, Canada the provincial health insurance carrier paid $480, while the cost for cosmetic rhinoplasty varied between $1000 and $10,000.
Septoplasty
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ecause the deviation is a result of a cartilage and/or bone surplus, the procedure usually involves an excision of a portion of those tissues. Under general or local anesthesia, the surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage targeted in the operation. Often an "L" strut of cartilage in the dorsal and caudal areas (1cm width or more) is preserved for structural support. After excess cartilage and bone have been taken out, the septum may then be stabilized with small plastic tubes, splints, or sutures. Considerable swelling and bruising can be expected. The nasal cavities may or may not be packed, and a piece of gauze is taped underneath the nose to absorb blood. Postoperative care includes frequent changing of this gauze (roughly every hour or so) and after 1 to 2 days, the excess bleeding normally stops and the inner nasal packing may be removed. The following day, saline irrigations of the nasal cavities are often advised, and it is only now that a patient is allowed to gently blow his/her nose. After 1 to 2 weeks, patients are allowed to blow their nose normally.
Patients typically regain about 80% of their energy one week after surgery, and make a full recovery after one month
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