1. At what age can rhinoplasty be performed?

Rhinoplasty is usually performed no sooner than the end of the adolescent growth spurt. This can be as young as 14 or 15 in teenage girls and usually 16 to 18 in teenage boys. There are certain circumstances which dictate that part or all of the procedure would be performed at an earlier age, such as a cleft lip nose deformity, severe trauma, or functional airway problems. The goal is to avoid interfering with growth centers in the nose as much as possible to allow full development of the nose in the adolescent and post-adolescent years.


2. What does a typical rhinoplasty consultation entail?

The consultation involves complete examination of the head, face and neck, and the nose itself. This includes intranasal evaluation for deviated septum, polyps, turbinate hypertrophy, nasal valve dysfunction, and other potentially significant problems that would need to be addressed at the time of surgery. In addition, an analysis of the external nose from different angles is performed. This is both photographic analysis, as well as 3-dimensional analysis, including assessment of the profile. This is because it is clinically important to balance the profile when considering changing the shape or size of the nose. Such considerations as correcting a retrusive chin along with reducing the size of the nose often creates a more harmonious profile than simply reducing the size of the nose alone. In addition, there are gender differences in the shape and size of the nose between men and women which must be considered to achieve an optimal result.


3. What I should I expect postoperatively?

There is usually an external tape and splint dressing on the nose for five to seven days. Little or no intranasal packing is usually necessary, although sometimes soft intranasal splints are utilized. Most all of the sutures are absorbable with the possible exception of columellar sutures if an open rhinoplasty approach is utilized. These are easily removed between five and seven days. There will be moderate swelling and possibly some periorbital bruising, although this is usually minimal. The nose may feel a bit stiff and numb for awhile postoperatively. Improvement in terms of appearance is progressive and depending upon the thickness of the nasal skin, may be fully evident in four to six months or considerably longer in patients who have thicker skin. Regular postoperative visits with the surgeon during this time are important to assess the healing progress.


4. What is a hanging columella?

Quite simply, the hanging columella is an excessive rounding of the middle part of the base of the nose which can result in excess columellar show. This can be aggravated if the lateral alar margins are retracted as well. A skilled rhinoplasty surgeon can easily address the problem hanging columella and correct that with incisions which are completely hidden intranasally.


5. Is it possible for someone to be allergic to dissolvable stitches? If so, what is the reaction like?

It is possible for a patient to react to some forms of absorbable sutures. This is most common with catgut sutures rather than other synthetic absorbable sutures. The reaction is attended by swelling and redness and tenderness, but usually not an infection. Simply removing the sutures resolves the problem, although adjunctive medication such as an antibiotic or steroid may be used short term.


6. Are there any new techniques to repair deviated septum? Is cauterization used? Does the nose always have to be packed after surgery?

There are a multiplicity of techniques to repair a deviated septum, but a skilled rhinoplasty surgeon will be familiar with virtually all of these. He will utilize the technique that is optimal for each patient. Cauterization is almost never required for this purpose, but if so it is limited in scope so as not to impair healing of the mucosal lining of the nose. It is not always necessary to pack the nose after surgery, but occasionally splints may be required to maintain septal straightening or support.


7. Which approach is preferred, internal or external?

The debate over closed or endonasal rhinoplasty versus open or external rhinoplasty is never ending. In fact, both approaches continue to be utilized. Depending on the complexity of the surgery, the tendency to utilize external rhinoplasty would be increased or favored by most surgeons. This is because direct visualization during important surgical manipulations such as cartilage reshaping, grafting, etc., is possible with the external approach. The columellar incision, although visible initially, usually heals imperceptibly. Therefore, there is no downside to the external approach in the long run.