Highlighting the nose job

OP. DR. YUNUS DOĞAN

All about rhinoplasty

The line between cosmetic and reconstructive surgeries is a thin one, sometimes barely visible. By definition, cosmetic (aka aesthetic) surgery/plastic surgery enhances the patient’s appearance. All the body parts are in legitimate working order but their outward appearance needs an upgrade. It’s like a car: it might run fine but wouldn’t it look better with a nice matte-finish wrap?

Then there’s reconstructive surgery for restoring function. A patient may struggle or be incapable of using a body part to some extent, interfering with daily life. This car’s engine doesn’t turn over or there are brake pads that need replacing.

The two types of surgeries can meld together when a reconstruction also serves an aesthetic purpose. Think of upgrading a worn-out engine to a beefy one that enhances performance and looks stunning when you pop the hood.

Speaking of popping the hood, consider the breast lift, for example. Heavy, low-hanging breasts can strain back and shoulder muscles. Saggy breasts can inhibit safe and proper hygiene in the breast crease area. Reconstructive breast lift surgery lightens your load and reinstalls your shelf at a more manageable and maintainable height.

This is where the two surgeries meet: lifted breasts are considered more attractive by a majority of patients. Similarly, the history of the nose job lies in the neutral ground between aesthetic and reconstructive. Read on to see where having your nose out of joint began and how doctors kept their noses to the grindstone to find suitable solutions that were literally on the nose.

This article is the fifteenth in a series highlighting some of the most popular plastic surgery procedures. In the Highlighting series, we tell you ALL the alternative names of the surgery so you learn the medical terminology as well as develop a little street cred with slang terms. We share a little history of the procedure and describe the general process. We mention possible complications and give you an idea of the typical recovery time.

Also known as/similar or related names are:

Closed rhinoplasty, columella, nasal surgery, nose job, nose reshaping, open rhinoplasty, septoplasty, septorhinoplasty.

First recorded

Many plastic surgery specialities were born from violence. The body contouring procedure that led to the birth of liposuction permanently disfigured and disabled a dancer. The first gynecomastia surgery patients were Roman soldiers. Tummy tucks were performed on the battlefield too, to remove shrapnel and save lives.

This article would be incomplete without mentioning Indian doctor Sushruta. In addition to pioneering the eye lift, he also described using a leaf to make a template for an early form of the rhinoplasty around 600 B.C. The National Library of Medicine published some details here, explaining that Dr. Sushruta provided the remedy for the “disfiguring and brutal practice of nasal amputation,” a common war and civil punishment. In addition to the leaf template, Sushruta also stressed the importance of preparing the site for acceptance of the new skin graft - taken from the cheek - and using stents made from hollow reeds to keep nasal passages open. Give this man an award for keeping it green!

The Italians stuck their noses in this business in the 1400s, using the pedicled arm flap. This technique required the patient’s donor arm to be connected to their nose area until the donor skin had been sufficiently nourished. Eventually this method was replaced by the “Indian method” of a forehead flap.

In the late 19th century, people with their perfectly functioning noses out of joint began using rhinoplasty for aesthetic purposes. American otolaryngologist John Orlando Roe documented one of the first cases of this nasal plastic surgery. His article referenced the “deformity termed ‘pug-nose’ and its correction.” Like a Breathe Right strip on a snoring nose, German surgeon Jacques Joseph further expanded techniques for everyone’s benefit.

General process

The depth of your sleep and hospital stay depends on the type of rhinoplasty you choose. In a closed rhinoplasty, your surgeon makes incisions inside your nostrils to make smaller changes to your nasal cartilage. This surgery can be completed under local or general anesthesia.

You will be completely asleep for an open rhinoplasty, where your surgeon makes an incision across your columella - the thin piece of skin between your nostrils on the bottom of your nose. Your nose is then dissected like that frog you cut apart in middle school biology class.

Most rhinoplasties last anywhere from 1-3 hours. On the other hand, if you’re having a septoplasty to correct a deviated septum or a septorhinoplasty to fix the septum AND make you more beautiful, your time on the table could vary.

What could go wrong?

Complications that may occur include:

• Changes in skin sensation - you may have some numbness or pain, but they should subside naturally.
• Nasal septal perforation - a rare complication where a hole is punched in your septum, this can be remedied with additional surgery.
• Unsatisfactory nasal appearance - having realistic expectations and thorough communication with your surgeon regarding your outcome can help eliminate this complication.

What could go right?

Try not to look down your nose at the rest of us when you think about:

• Being proud of your side profile and silhouette.
• Selfie-ing from any angle you choose.
• Reveling in the satisfaction of following your nose to the face of your dreams.

Recovery time

You may wake up with a splint on or packing in your nose to keep everything stable. Your face could be puffy and breathing may be a little more challenging. You might have swelling that could take about three months to subside. Using ice packs within the first 72 hours after surgery can alleviate swelling.

You should rest for the first 7-10 days, avoiding any activity that could put pressure on your new proboscis. This list of snoot-stressing endeavors ranges from bending over or wearing glasses to going to the gym or engaging in sexual activity. Ask your surgeon how long you need to abstain: typically you’ll need at least two weeks of rest. Also, don’t get your nose bent out of shape but it could take up to a year to see maximum results from your rhinoplasty.

The last stitch

Plastic surgery can help with many problems, be they physical disadvantages or emotional stumbling blocks. If you’ve been broken down by the breadth of your beak and you’re ready for a change, the solution is right under your nose.