Rhinoplasty & Otoplasty
Rhinoplasty is one of the most commonly performed procedures in Plastic Surgery, yet one of the most difficult. Our goal is to plan a harmonious compliment to the rest of the face. Often this is reduction of an overly large nasal dorsum but may also include tip elevation or modification or even augmentation.
The nose is bone in its upper one-third and cartilage supports the lower two-thirds and tip. The cartilaginous septum is the partition between the right and left nasal airways and the alar cartilage shapes the nostrils. Nasal turbinates fill the airways space and shrink or swell to control air flow. A successful rhinoplasty addresses the balance of all the components and the skin that covers them and results in an attractive nose with an unobstructed airway. Sometimes this can be achieved with an endonasal approach or may require open rhinoplasty for better visualization of the cartilaginous structures.
If endonasal approach is used, the incisions are all inside the nose where an open rhinoplasty and additional small incision is made across the underside of the columella of the nose in addition to the initial incisions. With either approach, some swelling is to be expected. If reduction of the bone is performed there may also be some bruising under the eyes. Internal or external splints may be used to support the bone or cartilages. Nasal packing may be necessary, especially if turbinates are reduced. Packing is usually removed in 24 hours. External splints may be in place up to seven days and internal septal splints (if used) often stay two weeks. The major swelling begins to reduce at three to four days but there is often sufficient soft tissue swelling that as much as two weeks out of work may be warranted, depending on the operation and personal preference. The rhinoplasty continues to evolve and some of the fine details of cartilaginous tip modification may not be fully evidence for up to six months.
The operation itself is almost always performed as an outpatient, usually under general anesthesia at the Bristol Surgery Center but some smaller procedures can be performed in the office. Convalescence is somewhat uncomfortable and narcotic pain medication is usually prescribed for several days but significant or prolonged pain is uncommon. The risks of surgery include bleeding, bruising, a change in the airway, dryness of the nasal lining or limitation in the amount of correction of the initial defect that could be achieved.
Otoplasty or reshaping the ears is another relatively common operation performed for prominent ears but many other conditions can also be corrected. Most often, the protrusion of the ears is congenital and in children it may be covered by insurance; usually in adults, it is not. The surgery to correct this is always performed as an outpatient and usually under a local anesthetic in the office but at personal preference may be performed under a general anesthetic or at a surgery center. Small incisions are made behind the ear where they are not visible and the ear cartilage is sculptured and tailored to look more natural. Very often no dressings are necessary; however, in small children a large head dressing may be used to protect the incision for a week or even two weeks. Often a headband to protect the ears is suggested for up to six weeks for contact sports, especially in children, but usually minimal dressing or after care is necessary. The procedure is somewhat uncomfortable, but not painful although narcotic anesthesia usually is prescribed. A short course of antibiotics is also usual. There will be initial swelling and a bruised appearance of the ears. Often return to work is possible in two to three days and if swelling and bruising are present they are usually resolved within two weeks. As with all other surgical procedures or physical deformities, a complete consultation with a qualified, Board Certified plastic surgeon will help design a procedure in a specific individual.
Rhinoplasty (reshaping the nose) is one of the most common, yet most difficult operations that can be performed in cosmetic surgery. Being the most prominent part of the face, the nose can have great significance in the harmonic balance of the face. As the face is divided into upper, middle and lower thirds, the middle third is essentially dominated by the nose. A large unsightly nose which may or may not be crooked always calls attention to itself. Since only the upper part of the nose consists of bone, the lower two-thirds and the predominant shape of the nose is made up of cartilage. The cosmetic surgeon, utilizing a combination of artistry and great surgical skill, must take the nose that he is presented with and alter it in such a fashion as to come into harmony with the remainder of the face. At the same time, it is always part of the rhinoplasty operation to correct any breathing problems that might exist so that the end result is a nose that fits the harmony of the face and also gives the patient a very nice breathing passage. The operation is performed as an outpatient, usually under general anesthesia, and the recovery time is relatively short, except that a small plastic splint is worn on the nose for one week. Packing within the nose may or may not be used, but if used it is only in place overnight and is removed the following morning. When done by an experienced surgeon, severe bruising and swelling are extremely rare. The goal of a proper rhinoplasty is that the nose looks better, has a good airway but not have that “operated look.”
Otoplasty (reshaping the ears) is another operation that the cosmetic surgeon performs to correct unsightly protrusion of the ears, which is usually from an inherited problem. Small incisions behind the ear are performed and the ear is tailored to look more natural. The operation likewise is performed as an outpatient and may be performed under local anesthesia if the patient desires. A small dressing is worn for two to three days and the ears look relatively normal in less than one week.
For further information on these two popular procedures, our experienced staff would be happy to discuss any further questions.