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Face Rhinoplasty

1. OVERVIEW

Cosmetic nasal surgery, or rhinoplasty, can significantly enhance the appearance and proportions of your nose, while also improving the overall balance of your facial features.

In general, a rhinoplasty can be used to correct:

  • The size/proportion of your nose in relation to the other features of your face
  • The width of your nose at the bridge
  • The size and position of your nostrils
  • Your nasal profile (i.e. if a visible hump or depression is present near the bridge of the nose)
  • An enlarged, drooping, upturned, or hooked nasal tip
  • A deviated septum (with or without associated impaired breathing)
  • Impaired breathing caused by structural defects not involving the nasal septum
  • Nasal asymmetry

2. IDEAL CANDIDATES

Ideal candidates for a rhinoplasty procedure are healthy, non-smoking adults who:
  • Have completed facial growth (≥ 18 years of age)
  • Are bothered by the appearance, proportion, and/or symmetry of their nose
  • Have realistic expectations with regards to how surgery can improve their concerns about their nose

3. THE PROCEDURE

3.1. ANAESTHESIA

  • The procedure can either be performed under general anaesthesia or under local anaesthesia with intravenous sedation.

3.2. APPROACHES/INCISIONS

  • A rhinoplasty can be performed using either a closed or open approach.

3.2.1. CLOSED RHINOPLASTY

  • A closed procedure uses incisions that are hidden inside the nose.
  • This approach is commonly used for minor nose reshaping procedures.

3.2.2. OPEN RHINOPLASTY

  • In addition to the incisions used to perform a closed rhinoplasty, an open procedure uses an incision across the columella (the narrow strip of tissue that separates the nostrils).
  • This approach is most often used for more intricate nose reshaping procedures.

3.3. TECHNIQUE

  • Once the incisions are made, the skin and subcutaneous tissue are carefully separated from the underlying bones and cartilage, which form the supporting framework of the nose.
  • The nose can be reshaped by either reducing or augmenting the supporting structures.
  • The nasal framework can be reduced or narrowed by removing/altering the bones and cartilage.
  • Alternatively, the nasal framework can be augmented with cartilage taken from various areas of your nose, or if necessary, from other areas of your body. Typically, cartilage can be taken from the septum (the central dividing structure within the nose) and used for this purpose. Occasionally, a piece of cartilage from the ear, or rarely, a small piece of rib cartilage may be necessary.
  • If there is a hump near the bridge of the nose, it can be reduced to create a smooth and natural profile.
  • If the septum of the nose is deviated, it can be corrected.
  • Projections of tissue inside the nose can also be reduced to improve breathing.

3.4. CLOSURE OF INCISIONS

  • Once the underlying structures of the nose have been sculpted to the desired shape, the nasal skin and soft tissue is redraped and incisions are closed with sutures.
  • If necessary, additional incisions can be made within the natural creases in the nostrils to reduce their size.

4. ADDITIONAL RHINOPLASTY TERMS

4.1. PRIMARY RHINOPLASTY

4.2. SECONDARY RHINOPLASTY (“REVISION RHINOPLASTY”)

  • This type of rhinoplasty is performed to address issues that persist or develop after a previous nose surgery.
  • For a given issue, secondary rhinoplasties are generally more complex since the normal anatomy of the nose, as well as its blood supply have been altered by previous surgery. However, the majority of issues requiring a secondary rhinoplasty are minor and can be corrected.
  • Secondary rhinoplasties are also performed using either a closed or open approach.

5. OTHER TYPES OF RHINOPLASTY

5.1. FILLER (OR “NON-SURGICAL”) RHINOPLASTY

  • A filler rhinoplasty can correct shape and/or contour irregularities of the nose by using injectable fillers to “fill" depressions, soften sharp angles, or alter the projection of the nasal tip.
  • While effective, the results of a filler rhinoplasty are only temporary and require periodic repeats or touch ups.
  • Please refer to the section on “Injectable fillers” for more information.

6. PREOPERATIVE CONSULTATION

Dr. Lee will perform a thorough medical evaluation during your consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.

After carefully evaluating the unique characteristics of your nose, analyzing the proportions of your facial features, and assessing your aesthetic goals, Dr. Lee will review your available options and help you choose a treatment plan for your desired results.

Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively .

Depending on your age, pre-existing medical conditions, overall health status, and the type of anaesthesia required for your procedure, you may be scheduled for routine pre-operative blood testing and possibly an electrocardiogram approximately 1-2 weeks before surgery. If necessary, additional recommendations will be made once the results of these tests have been reviewed.

7. RECOVERY

The operation is performed on an outpatient basis and most patients are allowed to go home a few hours after surgery.

There may be splints placed within your nostrils at the end of your rhinoplasty procedure if your septum was addressed during the operation. These serve to prevent fluid from accumulating beneath the septal mucosa and also support the nose for the first couple of days following surgery as it begins to heal. In the absence of an internal nasal splint, the nose may be lightly packed with a medicated gauze. You will also have a splint over your nose if the nasal bones have been narrowed/altered. Although the nasal packing will be removed on the 2nd or 3rd postoperative day, the external nasal splint will have to be worn for 10-14 days to support and protect the shape of your new nose. Generally, all sutures, apart from those used to close the incision across the columella (if an open approach was used) are absorbable.

Some discomfort, swelling, and bruising (especially around the eyes), and stuffiness are expected. You will be given a prescription for pain medication to help manage your discomfort throughout your recovery, as well as an antibiotic to minimize the risk of infection while the internal nasal splints or nasal packing is in place. Bruising will usually resolve after 3-4 weeks; and although swelling will have considerably decreased in this same time frame, it may take up to 6-12 months for it to completely resolve, and for you to see your final results. Before leaving our facilities, you will be given detailed instructions to follow throughout your recovery in order to optimize your healing, minimize the appearance of your scars, and to ultimately achieve your best possible results. These include:

  • Keep your head elevated when lying down
  • Rest and avoid strenuous activities
  • Avoid situations where there is a risk of direct contact to your nose
  • Take baths instead of showers until your external nasal splint has been removed
  • Avoid wearing sunglasses or eyeglasses for at least 6 weeks after surgery
  • Do not place ice or cold packs on your nose
  • Do not blow your nose

Most patients are able to resume light activities after a few days; however, regular activities and exercise should be avoided for at least 6 weeks following surgery.

8. RISKS AND COMPLICATIONS

As with any surgery, there are risks associated with a rhinoplasty procedure. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.

Risks/complications include:

  • Risks associated with anesthesia
  • Bleeding (hematoma)
  • Infection
  • Altered skin sensation
  • Scarring
  • Difficulty breathing
  • Skin discolouration
  • Prolonged/persistent postoperative swelling
  • Possible need for revision surgery
  • Nasal septal perforation (a hole in the nasal septum), although rare

Post-operative scarring

Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.

It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.

Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery. 

Office of Dr. James Lee:

  • 2540 Daniel Johnson, Suite 905 Laval, QC,
  • Tel: 1(514) 664-2076

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