Rhinoplasty, commonly referred to as a nose job, can correct many imperfections in the nose including a nasal hump or a deviated septum, and can also improve appearance by narrowing the tip or shortening the nose.  Rhinoplasty is performed on about 350,000 American noses annually, making it the most common cosmetic surgical procedure.

How It's Done

Rhinoplasty is usually performed as an outpatient procedure under general anesthesia or local anesthesia with a sedative.  After preparations and discussing the expected results of surgery, the surgeon begin by making incisions on the inside of the nose and in the shape of an inverted V on the middle column of tissue that separates the nostrils, called the columella.  The skin is loosened from the tissue and pulled away from the cartilage and bone.

After that the actions of the surgeon will depend upon the desired results of the patient.  To remove a nasal hump the surgeon will cut pieces of bone and cartilage from the bridge and use an instrument called a rasp to file down bone in the upper portion of the bridge.  If the nose needs to be shortened, which means moving the tip up higher on the face, then a piece of the septum is removed.  Many other aesthetic enhancements can be achieved by sculpting or removing pieces of cartilage that make up the nose.

The procedure described above is referred to as open rhinoplasty, meaning that an external incision is made to expose the tissue and cartilage to the surgeon.  Less frequently a closed rhinoplasty is performed in which all incisions are made on the inside of the nose.

Technology

All of the instruments used to perform a rhinoplasty are standard surgical tools.  Rhinoplasty is very difficult surgery to perform, and about 1 in 10 patients return to have a secondary surgery or enhancement, which can be even more difficult to perform.  For this reason it is essential that you spend time looking for a qualified surgeon with experience performing rhinoplasty.

Recovery / Post Op Expectations

Following surgery your nose will be secured with a metal splint, which will remain for one week, and bandages will be applied to hold it in place.  After the anesthesia wears off you will be free to return home under care.  You should avoid solid foods when possible as chewing will be difficult and avoid smoking or alcohol consumption.  You will have follow up appointments to meet with your surgeon, the first of which is usually the day after surgery.  During this time you will be given additional instructions about eating, medication, how to care for your nose following surgery, and how to breathe.

Swelling and bruising will occur, and even get worse for the first three days.  Return to work will vary based on occupation and the patient's recovery rate, but usually can be expected after two weeks.

Complications

The most common complications associated with surgery are cosmetic ones.  Simply put, some patients are unhappy with the results of surgery, which may or may not be the fault of the operating surgeon.  In addition to these, there are also rare complications that can pose a health risk including infection and blood clotting.

Am I A Candidate?

Candidates for surgery can be of two types; seeking cosmetic enhancement or seeking nasal changes to help improve breathing.  In order for the surgery to be a success you should follow all of your doctor's instructions including staying out of the sun, refraining from eating for a given amount of time prior to surgery, and avoiding smoking.

Cost

The national average surgeon fee for 2003 was $3,188 as reported by the American Society of Plastic Surgery (ASPS).  When facility and anesthesia costs are considered, the final price tag can be $5,000 and higher.