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Candidates: Girls
should be at least 14 or 15, boys 16 to 17 before they can have nose surgery, because
the structures of the face change with growing and it is better to wait until full
development of the face is achieved to perform the surgery. Younger patients should
be advised carefully, to understand the reasons that motivate to want to change
their noses. It is important to realize the change should satisfy the patient, avoiding
influences from relatives and friends. The upper age limit for rhinoplasty depends
on health conditions and psychological motivations that provoke the need for the
change. A classical reason for nose surgery in older patients is the rejuvenating
effect that can be produced to correct a drooping tip, when performed together with
a facelift. Breathing problems can be corrected at the same time. A computer consultation
is the best way to evaluate the change that can be obtained through plastic surgery
of the nose. If the nose has a "ball" at the tip, if it is too large for
the face, if there is a hump in profile, or if it is too wide, crooked or asymmetrical.
Objectives: Reshape the nose by reducing or increasing size, removing a hump,
changing shape of tip or bridge, narrowing the nostrils, or changing the angle between
nose and upper lip. It may also relieve some breathing problems. The skin quality
and the size and shape of the nose in relationship to the face are studied. Sometimes
correction of the chin can be done together with nose surgery to balance the face.
Incisions and technique: Results from rhinoplasty will vary according to
several factors, type of skin, shape of the nose, etc. Results are individual and
should not be compared with others. The nose can be increased or decreased, nostrils
can be narrowed, the tip reshaped and elevated. Usually all of the incisions will
be placed inside the nose. To reduce the base of the nose or the nostrils small
incisions are placed at base of the nostrils, hidden in the natural crease. Sometimes
a small incision is made in the columella, the tissue that separates the nostrils.
This can be used in more difficult cases or in re-operations. Though the small incisions
cartilage and bone are treated to narrow and straight the nose. To augment the nose
cartilage from the septum or the ear can be used.
Length: 1 to 2 hours or more.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary swelling, bruising around eyes and nose. Some bleeding.
Risks: Serious complications from rhinoplasty are not common. Potential complications
include hematoma (an accumulation of blood under the skin which may require removal),
infection and reactions to anesthesia. Numbness of the skin following rhinoplasty
may occur but is usually temporary. Occasionally, further improvement can be obtained
through a second procedure.
Recovery: Bruising around the eyes and cheeks can appear three days after
surgery and should disappear around the second week. Cover-up makeup can be used
to conceal the discolored skin. Most of the swelling disappears on the first month,
but there can be residual swelling up to the sixth month. Usually the final result
of rhinoplasty is obtained around the eighteenth month. Packing can be used in the
first 24 hours to avoid bleeding although it is not absolutely necessary in every
case. A nasal splint, when used is usually removed between the 5th and 7th day after
surgery. Back to work: 1 to 2 weeks. Strenuous activities: 2 to 3 weeks. Sun exposure:
one to two months.
Duration of Results: Permanent.
Details: There should be no pain after rhinoplasty. Dressings usually stay
for seven days. Stitches usually reabsorb and do not have to be removed. During
the first two days after surgery it is necessary to sleep with the head elevated
to reduce swelling and the possibility of minor bleeding. A small amount of bleeding
on the dressing is not uncommon on the first two days.
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