Nose Surgery Procedure
Techniques (Open, Closed)
Depending on the nasal issues involved, patients may be recommended for either an "open" or a "closed" nose surgery technique.
To better understand the difference between an open and closed nose surgery technique, you need to better understand the basic anatomy of the nose. The outside of the nose is made up of the skin, a bone that is shaped roughly like a pyramid, and supporting cartilage. The tip of the nose is made up of cartilage and skin and the columella is the strip of skin that separates the two nostrils. Internal or "closed" nose surgery techniques involve incisions that are made on the inside of the nose. In contrast, the external or "open" technique involves an incision across the columella.
Closed nose surgery techniques tend to be most appropriate for relatively straightforward procedures. An open nose surgery, however, is best for more complex procedures. By using the open technique, a plastic surgeon can open up the nose to better expose the bone and cartilage so that it can be reshaped. Doctors may add or remove bone, cartilage, or skin from the nose in order to obtain the desired appearance or function.
After the underlying supportive structures have been reshaped in an open nose surgery, the skin is put back in place. If the structure of the nose is added to, bone, cartilage, or skin from a donor location on the body may need to be used to complete the procedure. The surgeon will splint and pack the nose to stabilize the new structure.
The first step in a nose surgery procedure is anesthesia. You and your doctor will discuss anesthesia to determine the best option for you. A local anesthesia in conjunction with a sedative may be used in some relatively straightforward nose surgery cases. In more complicated or lengthy procedures, however, a general anesthetic will probably be recommended.
The nose surgery will probably take between 1 and 2.5 hours. After you are transported into the surgical room, nurses will hook you up to IV's to administer medications during the procedure. Your face will then be cleansed with a special antimicrobial solution.
Once your face has been thoroughly cleaned and dried, your doctor will make incisions in the appropriate location to perform the procedure. For an open nose surgery, the incision will be made across the columella. In a closed nose surgery, the doctor will put incisions up inside the nose. Incisions will be made with great care to avoid leaving scars behind whenever possible.
To shape the nose, your plastic surgeon may use a special hammer, a tool that resembles a chisel, and perhaps a rasp in addition to a scalpel. These tools are necessary in order to shape the bones and cartilage of the nose.
After your surgeon has finished shaping the nose, incisions will be sutured and the nose packed and set with a splint to keep the bones and cartilage from moving around. Your nose may be taped with a special cast to help it keep the proper shape as it heals.
Once the surgery is complete, you will be wheeled to a new room to awaken from the anesthesia which can take as long as 2 hours. You will need to have someone available to drive you home and to take care of you for the first 24 hours following the procedure.
Immediately after the anesthesia wears off, you may feel sleepy or nauseous. Some patients feel very cold as it wears off. Tell your nurse if you feel ill, and make sure that you have someone to drive you home after the surgery while you are still sleepy from the anesthesia. Expect to feel some pain and discomfort on the day of your surgery. Pain medications can help you deal with the pain.
Patients typically have a stuffy nose after surgery because they can only breathe through their mouths. The surgical packing and stuffy nasal cavities can sometimes create pressure that is uncomfortable.
Side effects that are common during nose surgery recovery include:
- Pain and tenderness
- Peeling skin
There are a number of different things you can do to hasten your recovery or at least make it more comfortable:
- Drink plenty of fluids
- Eat a nutritious diet
- Get enough rest.
- With your doctor's permission, use ice or cold compresses
- Communicate with your doctor about medications that you're taking
- Avoid traumatizing the nasal tissues as they are healing.
During recovery, your doctor will probably provide you with a splint or tape. The tape can actually help to reduce swelling and thus diminish the period of recovery. Replace the tapes on your nose, only if your doctor instructs you to do so.
The recovery period after nose surgery typically lasts between 2 and 3 weeks, but your doctor may ask that you avoid strenuous activity for 1 to 3 months after the procedure. Sleep with your head slightly elevated in the first week after your nose surgery to keep swelling and bruising to a minimum and don't wear make-up. Patient who wear contact lenses can begin wearing them immediately, however, wearing glasses should be avoided for up to six weeks.
Any surgery poses risks and nose surgery is no exception. The following are some risks associated with having nose surgery:
- Persistent pain
- Difficulty breathing after the surgery
- Numbness in the nasal region
- Asymmetrical nose
- Recurring nosebleeds
- Persistent swelling
- Discoloration of skin around the nose
- Scar tissue
Discuss the risks involved in nose surgery with your doctor at the initial consultation to learn more about how these risks apply to your situation.
The benefits associated with nose surgery are intimately related to the reasons why you had the surgery to begin with. If you were hoping to correct a functional issue, nose surgery can sometimes help. For example, patients who have trouble with snoring or sleep apnea can sometimes benefit from nose surgery. If you were hoping to correct a flaw with the cosmetic appearance of your nose, rhinoplasty can also be beneficial of course. Talk with your doctor about your unique situation and how nose surgery can specifically benefit you.