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Rhinoplasty Washington DC

Rhinoplasty (Nose Surgery) Washington DC

The goal of a rhinoplasty is to improve the external appearance of the nose by removing a hump, narrowing the upper portion of the nose and/or tip, changing the tip position, or correcting any asymmetries. Through manipulation of the bone and cartilage, placing of sutures and possibly grafts, nasal deformities may be altered to provide a more pleasing nose that fits the individual’s facial proportions. This procedure can also be performed to correct irregularities resulting from previous nasal surgery, termed a secondary rhinoplasty.

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Rhinoplasty (Nose Surgery) Procedure

The procedure is performed on an outpatient basis typically under local anesthesia with sedation or general anesthesia. The surgery involves cuts inside the nostrils and possibly an external cut on the exposed portion under the nose, the columella. Through these incisions, the excess bone (hump) is shaved down, the excess cartilage trimmed, and the tip cartilages modified to define and/or reposition the tip. The nasal bones may also be broken to narrow the nose.

If a patient has had previous surgery, there may be deficiencies present in the nose that can be addressed by the addition of cartilage or an implant. An implant is a synthetic material that is placed to fill a deficiency. In this case, it may be either a silicone implant or a sheet of Gore-Tex®. The final step of the procedure involves evaluating the width of the base of the nose. This can be narrowed by making wedge skin excisions (Weir excisions) of the outer portion of the nostrils. Upon the completion of the procedure, nasal packing is inserted in each nostril and a plastic splint is placed on the outside of the nose. A “moustache dressing” made out of a folded piece of gauze is applied under the nose to catch any nasal drainage.

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Recovery from Rhinoplasty (Nose Surgery)

Patients rarely complain of pain after this operation. The two most common complaints are a stuffy nose due to the nasal packing that forces the patient to breathe out of his/her mouth and the resulting dry mouth. Drinking plenty of liquids and applying Vaseline to the lips help to alleviate this. The nasal packing is removed 1-2 days after surgery. However, the patient may still not be able to breathe out of his/her nose due to internal swelling. At approximately 4-5 days after surgery, the external splint is removed along with any external sutures. The patient will then see a difference in his/her nose but, will not appreciate the full effects of the surgery for 6-12 months as the swelling continues to decrease. The internal sutures dissolve. Bruising is rare and if present, will resolve over 7-10 days. The nose is considered “broken” for 4 weeks and must be protected during that time. Exercise can be resumed at 2 weeks in the form of walking on a treadmill or stationary bike and without restriction at 4 weeks.

Rhinoplasty (Nose Surgery) Risks and complications

Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, scars, sensory changes of the overlying skin, and need for revision in the future.

Procedures that may Complement Rhinoplasty (Nose Surgery)

If there is a deviation in the nasal septum or enlargement of the inferior turbinates that causes nasal airway obstruction or difficulty breathing, this can be addressed at the time of rhinoplasty. These are internal nasal deformities that may affect one or both sides of the nose and may be seasonal.

In addition, if chin augmentation (genioplasty) is required to improve the balance between the nose and chin, this can also be performed at the same time. This can be performed with placement of an implant or by cutting the bone of the chin and advancing it forward.

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