In cases of pure plastic surgery of the nose (rhinoplasty), the patient’s goals will be to acquire a different appearance. Another group of patients seeking correction of the nose for injury, deformity and dysfunction may be eligible for insurance coverage under the umbrella of septorhinoplasty, septoplasty, nasal fracture repair and nasal valve obstruction repair.
Although this group of patients seeks improvement in nasal function (blockage of nasal airways / valve collapse / internal nasal septum deformities), special attention is paid to the cosmetic appearance of the outside of the nose (nasal hump / nasal fractures / crooked nose) for a uniform functional and cosmetic correction (septorhinoplasty) to be performed to restore the patient’s nose to facial harmony and adequate internal airflow.
Some cases only require correction of a “deviated nasal septum”, with or without correction of nasal valve dysfunction (reconstruction of the nasal septum with or without repair of vestibular stenosis).
Functional rhinoplasty is similar to cosmetic rhinoplasty in surgery and recovery time. The surgery takes one day, lasting two to four hours, with minimal incisions, usually without wrapping, with soft splints inside the nose and a splint on the outside, removed five to seven days after surgery. Most of the time, the stitches are absorbable.
Pain during recovery is minimal to moderate, and some bruising around the eyes can be expected. Patients are advised to use cold compresses for two days and then warm, non-hot compresses around the eyes. After the splint is removed, the patient can shower. It is possible to return to activities in one to two weeks.
It is noteworthy that patients will immediately see that the nose is straighter, and gradually that breathing is better. It is important that patients follow the instructions of the facial plastic surgeon on the care of the inside of the nose, avoiding sunburn and injuries.
For functional nasal surgery, improvement is expected to follow this timeline: 40% cure at six weeks / 60% cure at six months. It is noteworthy that the patient’s nasal airway function should continue to improve for a period thereafter. In the case of “rhinoplasty for function,” your facial plastic surgeon’s goal is committed to excellence in restoring appearance as well as improving nasal airway function.
The term rhinoplasty is derived from the German “rhinoplastik”, which means “to change the shape of the nose”. The technique involves first accessing the bony and cartilaginous elements of the upper part of the nose, which is achieved through incisions made inside, where they are invisible (closed rhinoplasty). In some cases, an incision is made in the area of skin that separates the nostrils (open rhinoplasty). Then the bone and underlying cartilage are reduced, enlarged, or rearranged to create a new structure. For example, if the bridge of the nose has a prominence, this can be reduced to create a nicer profile. If any part of the nose appears disproportionately small, cartilage or soft tissue grafts can be placed to create better harmony. This is sometimes called augmentation rhinoplasty, which is more common in some ethnic groups who tend to have smaller structures in their nose. Nasal tip surgery is also often considered to further improve the overall appearance of the nose. The angles of the nose relative to the upper lip or forehead and the width of the tip of the nose can be changed by further sculpting the support structure of the nasal tip.
The tissues are then redrawn over the new structure, and the incisions are closed. A small plastic splint is applied to the outside of the nose to minimize swelling and help maintain the new shape while the nose heals. Soft, absorbent material can be worn inside the nose to maintain stability along the dividing wall of air passages called the septum. Alternatively, soft nasal supports can be placed that allow for post-operative nasal breathing.
Most patients report little or no pain after nasal surgery, and any discomfort is easily controlled with mild pain medication.
After the surgery is complete, you will be monitored in the post-anesthesia recovery area until you feel well enough to be discharged. Most patients do not experience significant pain; however, analgesic medications may be administered as needed for postoperative discomfort. Whether the pack is placed in the nose or not, most patients report that their nasal breathing is limited in the first few days after surgery. This is a result of internal swelling and gets better as it goes down. Some patients develop swelling and/or bruising around the eyes, especially on the first day, but this usually begins to subside within the first two to five days after surgery. Cold compresses will help to minimize and reduce bruising and any discomfort. Absorbable sutures are usually worn inside the nose and do not need to be removed. Any external sutures, if necessary, are removed within five to eight days. Dressings and nasal splints are also removed between five and ten days after surgery.
It is essential that you follow your surgeon’s post-operative instructions. Keeping your head elevated will minimize swelling. It is important not to blow your nose and to avoid any impact while the internal and external structures are healing. Activities such as weight lifting, overexertion, sun exposure and any activity that increases the risk of injury should be avoided. If you wear glasses, be careful not to put excessive pressure on the bridge of your nose. Tape and other devices are sometimes used to allow wearing glasses without straining the area as it heals. Ask your surgeon how long these restrictions will be in place so that you are well prepared for your recovery period.
Follow-up is crucial for successful rhinoplasty. Any concerns related to your post-operative course such as excessive bleeding, unexpected swelling, fever or significant pain should be reported to your surgeon immediately. It is essential that you keep your follow-up appointments with your surgeon. While your healing is being monitored, there may be techniques such as massage, use of nasal sprays or even small injections of cortisone as medications that can further improve the desired result.
Insurance generally does not cover surgery purely for cosmetic reasons. Any component of the surgery aimed at improving nasal function or correcting any traumatic nasal deformity may be partially or fully charged to insurance. Discussion with the surgeon’s team and your insurance carrier will help determine your eligibility.
With proper analysis, realistic patient expectations, and the skills of a qualified facial plastic surgeon, rhinoplasty is a very rewarding procedure for both the patient and the surgeon.
