Blackledge Face Center - Procedure: Rhinoplasty

Rhinoplasty Procedure (before & after). To see more results photos, click here.

Rhinoplasty is the surgery of the nose to correct the characteristics of the nose that keep it from appearing to be in harmony with the rest of the face. Just like the face, each nose is entirely different. Noses are either too wide, too large, too long, crooked or have a hump on the nose. Sometimes, patients don’t exactly have a good idea of what it is they don’t like about their nose – they just know that it doesn’t blend with the rest of their face. During the consultation, we will take your picture and then use the computer imager to sculpt your nose into one that we think fits your face. This is a good opportunity for you to see your “new nose” prior to surgery. Computer imaging is an enormous help in creating dialogue between you and Dr. Blackledge in establishing the goals for the desired rhinoplasty results. All of the procedures in rhinoplasty are designed to either thin, augment, shorten, elongate or otherwise just refine the characteristics that cause a nose to detract from the rest of the face. All of these factors will be discussed with you during your consultation visit.

Dr. Blackledge believes that there is no one patented “nose job.” Instead, the best rhinoplasty is one that alters the nose so that it appears natural, does not appear to be “operated on”, and brings harmony to the face by fitting the other proportions of the face. Rhinoplasty is a very individual operation and is tailored to match the face of the patient. As stated earlier, just like faces, each nose is different and will require different modifications.


The Structure and Function of Your Nose

Rhinoplasty primarily deals with the external aspects of the nose. However, as is often the case, patients may be referred for problems inside the nose. While patients may desire certain aesthetic changes in their nose, the function of the always supersedes any changes we make cosmetically to your nose. For example, internal nasal problems can cause breathing problems, recurrent sinus infections and even nose bleeds. Terms that are usually used to describe the inside problems include “deviated septum, large turbinates and allergy problems.” These may be corrected as an isolated procedure by making the changes inside of the nose to improve the airway. However, many times these conditions may be improved at the same time the patient is having cosmetic rhinoplasty. Only proven surgical techniques that will improve the desired aesthetic changes but also allow for preserved function of the nose will be used in our rhinoplasty operation.


Nasal Tip Surgery

Many patients desiring nasal surgery feel that the nasal tip is too large or bulbous. During the consultation, Dr. Blackledge will examine your nasal tip and then make suggestions as well as computer drawings to show how changes in the nasal tip affect the rest of the nose. The entire goal is to have a nasal tip that fits the rest of the face as well as the rest of the nose. Pinched in, turned up nasal tips appear “operated on” and don’t look natural….often taking away from the rest of the face.


The Nasal Hump

Nasal hump reduction is on of the most common procedures performed in rhinoplasty. While many patients will have a slight hump on the bridge of their nose, Dr. Blackledge’s goal is to create a nose that has a straight bridge as opposed to the classic “scooped out, ski slope” bridges that was so popular during the 1980’s. These noses once again have a classic operated on appearance, and often are not functional as well. In reduction of the nasal hump, the bridge of the nose should be straight with a slight break at the end just above the nasal tip. All of these options will be discussed with you during your consultation.


The Broken and Crooked Nose

Some patients choose rhinoplasty electively. Some patients however have rhinplasty because of nasal trauma with a resultant broken or crooked nose. In preparation for the consultation, this patient is asked to bring in a photograph of their face prior to the injury to the nose.   The obvious goal of surgery in this situation is to restore the nose back to its original appearance as well as original function prior to the injury.   Many patients will also tell Dr. Blackledge that not only would they like their nose returned to its original appearance, but they would also like some minor modifications done to improve the nose aesthetically. All of these changes will be discussed during your consultation.


The Rhinoplasty Procedure

While the details of the surgical procedure may be reviewed with you during your consultation, in general the procedure itself involves raising the skin envelope of the nose from the bony and cartilaginous structures of the nose. These structures are then basically sculpted and molded to the desired size and shape of the new nose. Once the procedure is completed, tapes and a plastic splint will be placed on your nose to be removed in 5 days. Dr. Blackledge does not use any packing in the nose, which allows for a much more comfortable postoperative course.


What to Expect During Recovery

Even though the recovery period technically starts immediately after surgery, there are several things that we can do before your surgery to make the recovery period smoother. During your consultation, we will review all of these things with you as well as give you all of your instructions….you will be prepared!     Now back to the recovery period. Immediately after surgery, a nasal splint is placed over your nose to protect it during the following 5 days. We will recover you here at the Center until you’re awake and fully functional. Most patients choose to return home the day of surgery. Occasionally, out of town patients will choose to stay over night in the Jackson area and then return home the following morning. Our patient coordinator makes all of these arrangements. Following surgery and upon arrival home, most patients rest the remainder of the day and night after surgery. All of your postoperative instructions will be given to you at the time of the preoperative visit, and then will be reviewed with you before you leave the Center following your surgery. The first day after surgery is strictly a “bed rest” day. Most patients feel better than expected, so the temptation is to “over do” it on this first day. However, patients have less bruising and swelling if they rest with their head elevated on the first day. Dr. Blackledge does not use packing inside the nose, so you should be able to breathe through your nose without difficulty. Swelling is typically mild to moderate reaching its maximum on the third postoperative day, and then starting to decline. With each day, you will start to feel “more like yourself” and will ease back into your normal routine. The splint is removed on day five, and most people are presentable to the general public (with camouflage makeup) somewhere between seven and ten days. Of course, this varies with the individual healing process. All of the “do’s and don’ts” for rhinoplasty surgery will be given to you separately. Dr. Blackledge will be talking to you each evening to go over your detailed list of instructions and also to answer questions you may have.


Bruising

Bruising is expected after any kind of surgery. The amount that you bruise is extremely individualized – some people will bruise more than others. However, with every patient, we can expect a reduction in the amount that you bruise by taking Bromelain during the preoperative and postoperative period. We encourage you to drink at least 8 glasses of water each day during your recovery period to flush the bruising out of your system. Our experience with rhinoplasty surgery is that the combination of Bromelain and water intake will reduce the amount of bruising that you normally would have had.

During the recovery period, you will notice that your bruising changes colors. All bruises initially appear red and change to a purplish hue. By day five, the majority of your bruises will have changed to a green and then yellow color. Once you have reached the yellow stage, you are almost “bruise free.”


Swelling

Just like bruising, expect swelling. The day after surgery swelling will actually increase over the next day. Typically, swelling begins to decrease on the third day after surgery. We often get the question, “what can I do to reduce swelling?” We will recommend to you to keep your head elevated for the first 3 days to reduce swelling. I do not recommend ice compresses over your nose simply because your nose may be tender to the touch, and ice may be uncomfortable.


Sleeping

It is best to sleep in an upright position with your head at least above the level of your heart for the first week after surgery. This helps to reduced swelling and also bruising.   The best beds are usually either a recliner or an incline pillow. Both of these keep the head and shoulders in a natural position. If you try to sleep with your head elevated with pillows, you may be sleeping in an unnatural position and develop muscle spasms in your shoulders.


Exercise

You may begin light walking on the fourth day after surgery. In fact, we usually encourage this because it helps to improve your circulation, which in turn gets rid of bruising and swelling quicker. You can gradually increase the intensity of your walking over the next few days as your body tolerates. Your body will tell you how much exercise is enough! We usually recommend that you refrain from any competitive sports such as tennis or golf for at least two weeks. When it comes to exercise, don’t pull against any tight sensations that you may have.


Pain

A popular question is “how much pain will I have after nose surgery?” Most patients will tell you that they had little to no pain after surgery. The common response is that everything felt “stuffy.” This is usually due to swelling and the tight sensation begins to subside after about 2 – 3 weeks. Patients are given prescriptions prior to surgery for pain medicine and are encouraged to take theme as directed for discomfort. However, most patients switch to Tylenol soon after surgery.


When Will I Look Presentable?

Obviously, this is a very individualized answer. The average patient is able to go back in public without being obviously swollen or bruised in about 7 – 10 days.