Nose surgery, or rhinoplasty as it is also known, is a surgical procedure which reshapes the nose. It has long been one of the most common plastic surgery procedures and can reduce or augment the overall size of the nose, remove a hump, narrow the nostril width, and change the angle between the nose and mouth. Rhinoplasty can also correct injuries, birth defects and other problems which may hinder breathing.

You may be a candidate for rhinoplasty if you are physically healthy and have realistic expectations for improving the appearance and perhaps even the function of your nose. Patients are often looking to have the nose straightened, narrowed, shortened, lengthened, or relieved of a hump or hook. Younger patients may be advised to postpone surgery until the age of fifteen or so when the nose has finished growing.

Dr. Manchester performs the rhinoplasty surgery at his clinic in San Diego, California. Surgical times average about two hours and either local or general anesthesia may be used. The incision location will depend on the individual case. With the open rhinoplasty technique, a small incision is made on the skin between the nostrils. This technique allows for better visibility of and access to the inside of the nose and is the preferred method for more complicated cases. With the closed rhinoplasty technique, all incisions are confined to the inside of the nose. Working through the incisions, Dr. Manchester will sculpt the underlying bone and cartilage in order to create the new nasal appearance.

Rhinoplasty involves a relatively short recovery period. Though discomfort is generally minimal, you will be prescribed pain medication. Swelling and bruising can be expected and some patients may experience bleeding as well. You can expect to look good after ten days, though it will take approximately four months before the total healing process is complete and your final results are seen. Work may be resumed one to two weeks after your rhinoplasty surgery while strenuous activities and exercise will need to be suspended for two to three weeks.

RHINOPLASTY (nose surgery)

You are about to undertake an extensive operation on your nose. At last you will be rid of the hump, the hook, and the block or whatever it was that you have wished away for years. This narrative is intended to help you understand this procedure and to serve as a reference for the many questions you might have concerning your treatment and convalescent period. It is not a substitute for my personal attention, for I shall see you during each office visit. Please refer to this letter both before and after surgery.

Since everyone is different, each operation is tailor-made and receives special attention and thought. This is because no two noses are exactly alike. I personally take preoperative photographs during the week prior to surgery in order to be able to study your particular needs. There are, however, many details which we will discuss and you will forget. This letter has been designed to refresh your memory and serve as a reference for you to learn more about the procedure at your leisure.

An individual’s nose is never exactly symmetrical. The two halves of the face and thus the two halves of the nose do not look exactly alike. Irregularities are present in any nose even before surgery. Please do not expect total perfection. It was not achieved at birth and I cannot do it now, but I can improve and correct what bothers you.

Insurance will pay for nasal surgery if the irregularities interfere with breathing and are the result of trauma while the policy was in effect. Your company will require a photograph of visible external deformity along with my operative note.

The operation may be performed in the hospital or at my clinic. You may choose where you wish to have this done. Most patients choose my outpatient facility.

One hour before surgery, you will be asked to come to my clinic. Please come to the back door at the designated time wearing a shirt or blouse that buttons in the front, flat shoes, warm socks, and no make-up. My nurse will give you medication which will allow you to relax. An hour later, you will be taken to the surgery sedated.

During your operation, you will be completely asleep. There will be no pain.

The operation is performed through the nostrils with a small incision at the base of your columella (center strut of the nostril). Your tissues will be reduced, shifted, and reshaped with great care. There should be no pain during your surgery and only mild discomfort due to the nasal packing and mouth breathing in the postoperative period. Following your surgery you will be given small drip pads to place under your nose. These are to be changed when necessary.

Any surgery near the eyes will be associated with some swelling and discoloration to the surrounding skin. This is due to a small amount of blood finding its way into the loose and receptive tissues around the eyes, Do not be concerned, as this is natural and will be absorbed within a week in great part and entirely by two weeks. If you develop a red spot in the white of your eye, do not be alarmed. This is just a small blood vessel that has broken. This will usually disappear in three weeks. Your lip may be stiff, swollen, or slightly numb following the procedure. This will correct itself in a few days to one month.

Following your surgery, you will be discharged in the care of an adult. You must have someone stay with you the first night.

You will have packing in your nostrils and a plaster cast over the top of your nose. This is to create a mold to maintain the new shape of your nose. If you have had septal surgery only, your packing and dressings will be removed on the second day, If you have had a complete rhinoplasty, you will have your packing removed on the second day and cast replaced on the fifth day. Protect your lips with a mild cream so they will not crack. Your cast is removed permanently on the tenth day.

Plastic surgical fiction may have given you the idea that upon removal of the bandages you will be transformed into a movie star even without the aid of a coiffure, make-up artist, and false eyelashes. Please blot out this illusion. When the splint comes off, your eyelids will still show some swelling and discoloration, and this plus the swelling at the sides of the nose, particularly between the eyes, will give you a slightly swollen look. Relax, as most of this will be gone in two weeks.

Avoid wearing glasses or sunglasses for one month. If they are necessary for you to see, tape them to your forehead. The weight of the glasses tends to spread the nasal bones.

In all likelihood, you will be presentable to the public in two weeks following your surgery, give or take a few days. Make-up is encouraged, and make-up around the eyes will most likely be necessary for minimal bruising.

Although your nose may show slight improvement for up to eight to twelve months, by three months you will look very well. The operation was not an act of God but accomplished by human hands and eyes. No nose is absolutely perfect, but for you an improvement with a natural effect has been sought ardently in an attempt to fit your nose to your face, height, and personality. The type of nose you requested, the type of nose you had originally, as well as your ability to heal will all play a part in your final result. Time is also necessary, so allow for it and be patient.

After four weeks, you can resume normal activities such as swimming, dancing, and flying. Postpone contact sports for a month. Sunbathing is permitted in moderation even after two weeks, but you must realize that sunburn on the nose will promote swelling and this will retard your recovery. From here on what you do must be left to your common sense. In other words, your nose knows.

Thank you Gary Manchester, M. D.


What is rhinoplasty?
Rhinoplasty, also known as nose surgery, is a surgical procedure which can reshape the nose by reducing or augmenting the overall size, removing a hump, narrowing the nostril width, or changing the angle between the nose and mouth. Injuries, birth defects, and other problems interfering with breathing can also be corrected during rhinoplasty surgery.

How do I know if I’m a candidate for rhinoplasty?
If you are in good physical health and have realistic expectations for improving the appearance and perhaps the function of your nose, then rhinoplasty may be an option for you.

Are there any age restrictions for undergoing rhinoplasty?
Younger patients considering rhinoplasty are generally advised to wait until about the age of fifteen when the nose has completed its growth.

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