Facial bone structure differs among various
human races, each having its own special beauty. Regardless of the
racial origin, individuals desire nasal refinement by improving definition
of the nasal tip and changing the projection and character of the nasal
bridge, (Fig. 8). Such alterations are possible but must be carried
out by observing the principle that a natural look is always more attractive
than features which show obvious signs of forced surgical intervention.
Prior to surgery, appropriate laboratory
tests and an evaluation of the patient's general health are carried
out.
The operation is usually performed under
general anaesthesia. The patient is put to sleep by the anaesthetist,
who assumes constant care of the patient's body functions until he
or she has recovered from the anaesthetic. The remainder of the recovery
period takes place in the recovery room. The surgery itself lasts between
thirty minutes to one hour and forty-five minutes. In some instances,
a rhinoplasty can be carried out with a local anaesthetic under heavy
sedation.
The incisions are usually made inside
the nose so that there are no scars on the skin. In rare instances
a small cut may have to be made under the nasal tip between the nostrils.
(Fig. 9a). This produces a small scar which becomes virtually invisible
six months after the operation. (Fig. 9b).
The details of the type of incision necessary
in your case will be explained to you during the pre-operative assessment.
The external incision only becomes necessary in badly traumatized noses
or in those who have undergone previous surgery by another surgeon and
require a revision. After surgery has been completed, a small cast is placed
on the nose and a small amount of soft packing is inserted into each nostril.
The packing (not the cast) is removed usually the next day.
The length of stay in the hospital normally
does not exceed four to twelve hours after surgery. Following discharge,
the patient is encouraged to remain out of bed most of the time as
being in an upright position will decrease swelling and accelerate
healing.
The cast is removed in the surgeon's
office on the sixth or seventh day after surgery. The swelling and
bruising under the skin, and occasionally in the whites of the eyes,
distort the immediate post-operative appearance. You must be patient
while normal healing takes place. The average patient is usually presentable
in ten or twenty days, even though he or she may resume normal activities
much earlier, provided it is not strenuous exercise or work.
It is expected that the nasal passages
will remain slightly obstructed for up to two weeks. During the same
time blood stained discharge and crusting may appear in the nostrils.
You may start blowing your nose gently, using both nostrils at the
same time after one week. Smoking is not contra-indicated but IT IS
NOT DESIRABLE particularly during the first two weeks as it may increase
the risk of bleeding. You may gently cleanse the outside of your nose
when the dressings are removed and you may use cosmetics.
For a period of six weeks, it is essential
that no pressure be exerted on the nose as this may displace the still
unstable nasal bones. Eyeglasses of any kind must not be worn unless
they are suspended from the forehead with adhesive tape. Contact lenses
can be worn as soon as the eyelid swelling has subsided enough to permit
comfortable insertion. You should protect your nose from prolonged
exposure to direct sunlight or frost during the first year following
the operation. You will find that some areas of the nose will remain
numb for a few months and this may render you susceptible to frostbite
and sunburn. Some temporary numbness or altered sensitivity in the
front of the palate and upper front teeth may also occur.
