What Is Rhinoplasty?
While many people refer to the procedure as a "nose job," Rhinoplasty, as it's known in medical terms, is a surgical procedure intended to change the structure of the nose. This may be performed for purely aesthetic reasons (to look more appealing) or for functional reasons (to breathe more easily).
Efforts to reshape the nose can be traced back hundreds, even thousands of years. The American Rhinologic Society reports that the earliest recorded rhinoplasty was some 1700 years ago in Egypt, long before the advent of anything we would consider modern medicine. Then, doctors would attempt to repair nasal fracture damage with "plugs of linen, soaked in grease." According to a 2015 article in The Atlantic magazine, nasal reconstruction goes back even further, to around 600 B.C., when Indian healers would repurpose a flap of skin from the patient's cheek to form a new nose.
There are two primary reasons that surgeons perform rhinoplasty:
The purpose of cosmetic rhinoplasty, as the name implies, is to improve the outward appearance of the nose. It's a very common surgery - more than 200,000 rhinoplasty procedures were performed in 2017, according to American Society of Plastic Surgeons.
Procedure - The procedure is relatively simple and can be performed in an office-based surgical facility, an ambulatory surgical center or a hospital.
Anesthesia - Depending on the exact nature of the changes to be made, your doctor might recommend intravenous sedation, or general anesthesia.
Incision - Again depending on the individual case, the procedure can involve closed incisions, hidden inside your nose, or an external approach, with a small incision across the narrow strip (known as the columella) that divides the nostrils. Next, the skin is gently lifted to allow access to the underlying structure of nasal bones and cartilage. Additional incisions may be placed in the natural creases of the nostrils to alter their size.
Reshaping - The surgeon may remove small amounts of bone and cartilage to reduce the size of the nose. In some cases the surgeon adds grafted bone or cartilage from the nose (or even the ear or rib) to improve the line of the nose. The size and shape of the nostrils, the bridge of the nose, and the tip of the nose may all be altered by the surgeon, depending on the patient. In cases where breathing is obstructed by a deviated septum, the surgeon may also correct this during the cosmetic operation. The combined procedure is known as "septorhinoplasty."
Closing the incision - Once the desired resculpting is complete, the nasal tissue is re-draped, and the incisions are closed.
Splints and packing - The surgeon may support the reshaped nose with splints and packing, which will be remove with a period of a few days.
Functional rhinoplasty is a procedure whose primary goal is to improve or restore the ability to breathe through the nose. In most purely functional procedures, the goal is to alter the nasal airway to achieve better air flow, without changing the outer appearance of the nose.
Procedure: The relatively simple procedure is performed in an office-based surgical facility, an ambulatory surgical center or a hospital. A functional rhinoplasty typically involves repair of the nasal valves, the internal cartilage valves in the lower portion of the nostrils. Some people are born with narrow nasal valves that obstruct breathing. In other cases, age, injury or previous surgery can cause collapse of the nasal valves. Until recently, nasal valve rhinoplasty has involved cutting away excess tissue, or dissolving it with radiofrequency ablation. A more recent procedure involves insertion of thin plastic supports that hold open the nasal passage from the inside, in the way that over-the-counter nasal strips pull open the airway from the outside. These approaches come with the risk of alteration to the appearance of the nose. More recently a lower-temperature radiofrequency procedure has become available, which eliminates the need for cutting or inserted supports, reduces recovery time, and is much less likely to alter the shape of your nose.
Anesthesia: As with cosmetic procedures, your doctor will make a recommendation on whether to use sedation or general anesthesia. The latest techniques require only local anesthetic.
Splints and packing: These post-operative supports are common with cutting or high-temperature procedures, and are typically not needed for inserted supports and low-temperature procedures. Recovery takes anywhere from a maximum of a few days down to a few hours, depending on the procedure.
If you're considering either a cosmetic procedure to improve the shape of your nose, or a functional one to relive persistent nasal congestion that's not due to cold or allergy, begin by speaking with your family doctor about your situation and your own goals for improvement. That way, you'll be the best position to choose the appropriate specialist to diagnose and treat your condition.