1. At what age can rhinoplasty be performed?

A rhinoplasty or surgery to correct the appearance or function of the nose can be performed at any age as long as the bones and cartilage of the nose have completed growth. Typically, this is after age 16.


2. What does a typical rhinoplasty consultation entail?

A typical rhinoplasty consult entails a complete history and physical examination by your surgeon. S/he will want to know what you don' t like about the appearance of your nose as well as such important items as whether you have ever had trauma to the nose such as a fracture, whether you have problems breathing out of either side and if you do, under what circumstances (i.e. at night, when breathing in forcefully, all the time or only occasionally) and whether you have a history of such things as sinus attacks or allergies. S/he may also want to know about any pertinent family history such as problems breathing and also about your general health. Once the history has been taken, s/he will do a complete examination of the nose, both externally and internally to see what the anatomy entails. Only then can s/he discuss what is possible. For example, it is not possible to take someone else' s nose and put it on you, but it may be possible to reduce a large hump or shorten a long nose or make a nose less wide. Any anatomy that interferes with breathing will have to be addressed because if not, the problem can become worse. Sometimes the surgeon will indicate that s/he cannot change the nose without adding some bone/cartilage to it. For example, some long noses can be difficult to shorten without causing breathing issues but by adding cartilage to raise the bridge of the nose between the eyes, the surgeon can create an optical illusion that the nose is shorter! S/he will discuss all these issues including the care you need post-operatively and how long it will take to recover.


3. What should I expect postoperatively?

Post-operatively, what you can expect will depend on the type of operation you have as well as other factors such as your health and ability to follow instructions. If you are having minor cartilage work, there may be very little in the way of swelling/bruising and restrictions. Even if you need the nasal bones fractured, it is not usually as painful as it sounds. There maybe black eyes and some swelling but most people do not feel it is as painful as surgeries such as hernia repairs. If the bones are worked on, you may need to wear a nasal splint of aluminum or plaster until the bones have gotten sticky, usually within a week. You will then need to protect the nose from trauma for the next month but most people get back to regular activities quickly. Most surgeons will want you to take it easy for a week so as not to stir up bleeding or to blow your nose. Some surgeons require packing in the nose to control bleeding; others do not. You surgeon will discuss his/her usual procedures with you before surgery.


4. What is a "hanging columella"?

A columnella is the central strut of the nose which is visible when you look up someone' s nose. Normally when you look at someone' s profile, the columnella is even with the edge of the nostrils or just slightly below them. In the condition known as a hanging columnella, it is pretty far below that level or "hanging" down. This is unattractive but can be repaired surgically by shortening that part of the septum (the middle cartilage which supports the nose) at the end toward the feet.


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

Usually dissolving sutures are placed inside the nose to close incisions made for the rhinoplasty surgery(many surgeons place the incisions inside the nose). Occasionally someone will develop an inflammatory reaction to the suture and there will be a lot of pus and redness around the stitch. People mistake this for an allergy to the suture but it is not a true allergy. If you have had this reaction, please let your surgeon know. S/he may want to avoid these type of sutures in your surgery.


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

As long as there is surgery, there will be new techniques in surgery. Some surgeons are experimenting with techniques such as laser-assisted surgery but most surgeons are fixing a deviated septum the old fashioned way, by removing the curved portion which is causing blockages and leaving the lining which covers the cartilage and enough cartilage to give support to the nose so it does not collapse. Cautery is frequently used because the nose has a rich supply of blood vessels which means it heals quickly and very rarely gets infected but also increases the risk of bleeding. Cautery lessens that risk. It is not always necessary to pack. Many doctors perform packing to try to keep pressure on incisions so they do not bleed but one study showed that packing did not prevent bleeding and patients were more comfortable when packing was not used. Packing certainly makes it hard to breathe! I like to use packing to support the bones internally when I fracture them but I now use much more stream-lined packs that do not interfere so much with breathing. The packs come out in one to two days.


7. Which approach is preferred? Internal or external?

The approach to surgery on the nose, internal (using incisions inside the nostrils), versus external (using those same incisions and joining them across the columnella so the skin on the tip of the nose can be peeled back, thus exposing the bones and cartilage to view), is often dependent on the training of the surgeon. Many feel comfortable performing the approach their surgical teacher taught them. Others, such as myself, may vary the approach depending on the patient. For straight-forward rhinoplasties I will generally do the internal approach as there is no visible scar but for complicated noses, particularly re-do surgeries or those noses with significant asymmetry, I may do the external approach so that I can really see as opposed to feel what I am doing. And for some ethnic noses such as a broad, wide nose, some of the nostril may need to be resected, therefore resulting in external scars at the junction of the nostril with the cheek (Weir incisions). Be sure you understand what type of incision your surgeon will use before the surgery so there will be no surprises.