Rhinoplasty ("Nose Job")

One of the most common types of plastic surgery, rhinoplasty ("rhino" is the Greek word for nose) is used to reduce or (far less often) increase the size of the nose, change its shape or angle, remove a bump, correct a deviated septum, narrow the span of the nostrils, or correct a birth defect or injury. It can be performed on persons of any age (though the minimum is usually 14 or 15, when the growth spurt is concluded), and sometimes more than once.

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Q. Who can benefit from rhinoplasty?

A. Men and women who would like a better-looking or better-functioning nose, and who realize that perfection is not always possible. Certainly, a "nose job" has helped make millions of women and a lesser number of men more attractive, but it's not for everyone. However, it can be of vital importance if one's nose has been seriously damaged due to an injury or, since birth, has not looked "normal." For those with a deviated (out of place) septum (the structure separating the nostrils), rhinoplasty can facilitate breathing-and thereby make it easier to sleep, run, swim or engage in other activities-and it may even enhance the sense of smell.

Q. What are the risks?

A. When rhinoplasty is performed by a highly skilled aesthetic surgeon, such as Dr. Kapoor, the risk is rare. Still, as with any surgery, there may be complications, such as infection, nosebleed, or a reaction to the anesthesia. In certain instances after surgery, small blood vessels may burst and appear (temporarily or permanently) as tiny red spots on the surface of the skin.

As for scarring, it's usually not a problem. When an "open" (external) surgical technique is used, or if flared nostrils are surgically narrowed, the small scars on the base of the nose will not be visible in most cases. When rhinoplasty is performed from inside the nose, there is no visible scarring at all. Rarely-less than 10% of the time-a minor deformity may require a second, minor procedure.

Q. What's the first step?

A. An initial consultation with Dr. Kapoor in his Beverly Hills office. You'll be asked what you'd like your new nose to look like, and you'll be shown pictures of various sizes and shapes, as well as before-and-after photos of patients who have undergone the procedure. However, there are limitations to what rhinoplasty surgery can achieve. The structure of your nasal bones and cartilage, the size and shape of your face, the thickness and color of your skin, your age and height-all can influence the procedure and the results you can realistically expect.

During your consultation, you'll be asked if you've ever had any injuries to your nose or any operations on it, if you're allergic to anything, if you have any breathing difficulties, if you smoke (it can prevent proper healing), and if you take any vitamins, medications, or recreational drugs. The cost of the procedure will be discussed, and you'll be informed that most health insurance policies don't cover rhinoplasty performed purely for cosmetic reasons. However, some policies do pay for part or all of the cost if it's performed for reconstructive purposes (e.g., after an accident), to correct a marked deformity, or to correct a breathing problem. Check with your insurer and obtain pre-authorization before the surgery.

Q. What's the next step?

A. Once you decide on a date, time and place for your procedure, you'll be given instructions on how to prepare for it. You'll receive guidelines relating to eating, drinking, smoking, taking or avoiding certain vitamins and medications.even how to wash your face after the surgery. You'll need someone to drive you home after the surgery, which is performed on an outpatient basis (no hospital stay), and perhaps to assist you at home for a few days.

Q. What happens during surgery?

A. Depending on the extent of the procedure and what you and Dr. Kapoor prefer, you will be administered either a local anesthesia with intravenous sedation or a general anesthesia. If the former, you will be lightly sedated; only your nose and the surrounding area will become numb. You'll be awake throughout the surgery-relaxed and feeling no pain. Or, with general anesthesia, you'll sleep throughout the operation.

The operation usually takes one or two hours; a complicated procedure will take longer, of course. First, Dr. Kapoor will carefully separate the skin of your nose from its supporting framework of bone and cartilage. Next, like a sculptor, he will reshape the framework according to the desired result. Then he will drape the skin over the remodeled framework and suture it in place.

Depending on what's to be done and the amount of working space available, Dr. Kapoor may perform the procedure from the inside (for an "invisible" or "closed" rhinoplasty) or from the outside (especially if the procedure is complicated). He'll often make a small incision across the columella, which is the vertical strip of tissue between the nostrils. Finally, he'll apply a splint to help maintain the new structure. To stabilize the septum, he'll pack the nose with cotton or place soft plastic splints in your nostrils.

Q. What happens after surgery?

A. You'll awake (if you had general anesthesia) in the recovery room or (if you had a local) just rest there a while until you feel wide awake. During the first 24 hours or so after surgery, your face will look and feel puffy, your nose may ache a little, and you might have a mild headache. Medication can control the pain, and once you're back home, it's best to stay in bed most of the time, with your head elevated, during the first day.

There will be swelling and bruising around your eyes, and you might expect this to diminish as the days go by. Not so. The swelling and bruising will actually increase during the first two or three days, but then they'll decrease, especially if you apply cold compresses. Within about two weeks, most of the swelling and bruising should disappear, although some subtle swelling will remain for several months.

During the first few days, a little bleeding is common, and you may have some stuffiness for a few weeks. Try not to blow your nose for a week or so, until the tissues heal. After a few days, the nasal packing (if any) can be removed and then, a week or two later, the dressings, splints, and sutures can be removed. After about two days, you should feel well enough to move around your home, but wait a week or so before returning to work or school. Avoid any strenuous activity that increases your blood pressure, and avoid rubbing or hitting your nose for eight weeks. Don't let it get sunburned, either. It's important, too, not to wash your face or hair too vigorously.

If you use contact lenses, you can wear them right away. However, because eyeglasses rest on your nose, once the splint is off you should not wear glasses unless they're taped to your forehead. It may look ridiculous, but until your nose is healed they can cause bleeding.

Don't expect overnight results. Your new nose can take months, even a year, before it completes its healing-but the results will be worth the wait.