Rhinoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

Rhinoplasty surgery is a procedure that reshapes the nose or enhances the appearance of the nose while restoring or improving its function. It is one of the most commonly-performed surgical procedure in the US. This procedure is also known as “nose job” or nose reshaping.¹Sean T. Massa MD, Scott G. Walen MD. Evidence-Based Clinical Practice in Otolaryngology, 2018, 59-71.

Rhinoplasty Surgery Procedure Steps

The steps that are followed during a rhinoplasty surgery procedure are:²American Society of Plastic Surgeons.

step 1

Based on the patient’s preference and complexity of the case, local or general anesthesia is given to the patient to numb the nose.

step 2

Using a blade, incisions are marked either internally on the inner skin of the nose (closed procedure) or externally on the skin separating two nostrils (open procedure).

step 3

Following this, skin covering the nasal bone and cartilage is lifted.

step 4

The nose is reshaped by removing bone and cartilage. Occasionally, cartilage graft is added to enhance the shape of the nose.

step 5

Any deviation present in the septum is corrected simultaneously.

step 6

The soft tissue is again stitched back on the nose. Splints or nasal packing may be placed within the nose to give support.

Effectiveness of Rhinoplasty Surgery

Studies show there is significant improvement in the appearance and function of the nose after rhinoplasty. Individuals reported improvement in the quality of life and satisfaction with the results of rhinoplasty upon evaluation at the end of 3 and 6 months.³Esteves SS, Gonçalves Ferreira M, Almeida JC, Abrunhosa J. Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study. Brazilian Journal of Otorhinolaryngology. 2017 Oct;83(5):552-7

What to Expect After Rhinoplasty Surgery?

After the rhinoplasty procedure, patients can expect the following:⁴Cochran, C. S., Ducic, Y., & DeFatta, R. J. (2008). Current Concepts in the Postoperative Care of the Rhinoplasty Patient. Southern Medical Journal, 101(9), 935–939.

Post-surgery, the patient may have discomfort or congestion in the nose due to the presence of nasal splint or packing. The nasal packing is given to stop post-surgery bleeding, while nasal splints help to stabilize the septum and prevent adhesions (fusion between septum and adjacent structures in the nose).
Post-surgery dressing will be placed over the nose. This provides comfort to the patient as it allows only a partial view of the post-operative changes and prevents anxiousness or depression that may be caused by looking at the nose.
Mild bleeding from the nose can be expected for a very short duration.
Pain or tenderness will be present for up to 48 hours. In case of severe pain contact the doctor.
Swelling at the operated site can be seen for 2-3 days which subsides gradually.
The doctor will document the patient’s satisfaction with the appearance and function of the nose for at least a year.

Rhinoplasty Surgery Recovery

To recover from a rhinoplasty surgery, patients are advised to:⁵Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694

Apply cold pack or ice intermittently for 20 minutes for 3 post-operative days to reduce pain, swelling, and discoloration of skin.
Use medications (antibiotic and painkillers), as prescribed.
Perform nasal saline irrigation once or twice daily for 1-2 weeks after the surgery as it helps in clearing the accumulated mucus and reducing the patient’s discomfort.
Use Arnica montana, an herbal supplement that helps in treating the postoperative swelling and discoloration, and fastens the recovery.
Use cotton buds or Q-tips with antibiotic ointment to gently clean scabs in the nostrils.
Visit the doctor for regular follow ups and assessment of the symptoms.

Precautions After Rhinoplasty Surgery

After the rhinoplasty procedure, patients should follow these precautions:⁶Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Avoid blowing of nose at least for a week post surgery.
Avoid lifting weights or performing vigorous workout.
While sleeping, keep the head elevated (by ~30 degrees) by using 2-3 pillows.
Avoid sneezing with the mouth closed. Keep the mouth open while sneezing.
Avoid smoking tobacco and drinking alcohol.
Avoid biting on hard food for 1 week after surgery.
Avoid visiting crowded places.

Rhinoplasty Pain After Surgery

Most patients report minimal to moderate pain for 36-72 hours after rhinoplasty surgery. Patients rarely complain of severe pain. However, the nose may remain sensitive to touch until 3 months. The pain can be managed using painkillers, cold packs, herbal supplement Arnica montana, or by keeping the head elevated while sleeping using pillows. In case of severe pain even 48 hours after the surgery, the patient should contact the doctor.⁷Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.

Rhinoplasty Surgery Side Effects

Complications are observed in 1.7-18% of rhinoplasty surgeries. The most common side effects of the surgery include presence of infection (~15%), delayed wound healing (~5%), and postoperative bleeding (~2%).

Other complications include septal hematoma (collection of blood between nostrils), numbness in skin of the nose, over correction of the nose, perforation of the nasal septum, nasal obstruction, and requirement of revisional surgery.⁸Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: analysis of 4978 patients. Aesthetic surgery journal. 2017 Jul 1;37(7):757-67.

Pros and Cons of Rhinoplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:⁹Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694

Pros of Rhinoplasty Surgery:

It restores aesthetics and the function of the nose.
Enhanced aesthetics improve the confidence and self-esteem of the patient.

Cons of Rhinoplasty Surgery:

The results of the surgery can be unpredictable at times.
It is a technique-sensitive procedure due to high aesthetic demands of the patient.
The surgery is quite expensive. The patient may require to undergo multiple surgeries to achieve satisfactory results.

Rhinoplasty Surgery Pictures

Here are some excellent photos that show the rhinoplasty procedure:

source

Rhinoplasty Surgery Videos

Here are some excellent videos that show the rhinoplasty procedure:

Frequently Asked Questions – Rhinoplasty Surgery

Here are answers to the most commonly asked questions related to rhinoplasty surgery:

Is rhinoplasty a major surgery?

The short answer is yes.

Rhinoplasty involves intricate procedures which can impact the overall facial balance. As a result, the surgery is artistically most challenging of all aesthetic surgeries.¹⁰Daniel RK, Pálházi P. Rhinoplasty: an anatomical and clinical atlas. Springer; 2018 Mar 6.

How long does rhinoplasty surgery take?

Rhinoplasty surgery takes an average time of 1.45- 2.15 hours.¹¹ Foda, H. M. T. (2003). External rhinoplasty: a critical analysis of 500 cases. The Journal of Laryngology & Otology, 117(06)

What is the recovery time for rhinoplasty surgery?

The swelling after rhinoplasty surgery subsides within a few weeks. While it may take a year for permanent changes in the nasal contour to become evident.¹²American Society of Plastic Surgeons.

What is the cost of rhinoplasty surgery in the USA?

The average rhinoplasty procedure typically exceeds $4,000, excluding cost incurred for anesthesia, operating room facilities, and other expenses.¹³Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.

Sources:

1
Sean T. Massa MD, Scott G. Walen MD. Evidence-Based Clinical Practice in Otolaryngology, 2018, 59-71.
2
American Society of Plastic Surgeons.
3
Esteves SS, Gonçalves Ferreira M, Almeida JC, Abrunhosa J. Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study. Brazilian Journal of Otorhinolaryngology. 2017 Oct;83(5):552-7
4
Cochran, C. S., Ducic, Y., & DeFatta, R. J. (2008). Current Concepts in the Postoperative Care of the Rhinoplasty Patient. Southern Medical Journal, 101(9), 935–939.
5
Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694
6
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
7
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.
8
Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: analysis of 4978 patients. Aesthetic surgery journal. 2017 Jul 1;37(7):757-67.
9
Daniel RK, Pálházi P. Rhinoplasty: an anatomical and clinical atlas. Springer; 2018 Mar 6.
10
Foda, H. M. T. (2003). External rhinoplasty: a critical analysis of 500 cases. The Journal of Laryngology & Otology, 117(06)