Rhinoplasty Surgery Approch
Surgical approach: Open vs. closed
Rhinoplasty can be performed under a general anesthetic, sedation, or with local anesthetic. Initially, local anesthesia, which is a mixture of lidocaine and epinephrine, is injected to numb the area and temporarily reduce vascularity. There are two possible approaches to the nose: closed approach and open approach. In closed rhinoplasty, incisions are made inside the nostrils. In open rhinoplasty, an additional inconspicuous incision is made across the columella (the bit of skin that separates the nostrils). The surgeon first separates the skin and soft tissues of the nose from the underlying structures. The cartilage and bone are reshaped, and the incisions are sutured closed. Some surgeons use a stent or packing inside the nose, followed by tape or stent on the outside.
In some cases, the surgeon may shape a small piece of the patient’s own cartilage or bone, as a graft, to strengthen or change the shape of the nose. Usually the cartilage is harvested from the septum. If there isn’t enough septum cartilage, which can occur in revision rhinoplasty, cartilage can be harvested from the concha of the ear or the ribs. Sometimes a synthetic implant may be used to augment the bridge of the nose.
Post Operative Instructions for Rhinoplasty
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount of swelling varies from person to person, but it seems to be more in the face because the features appear distorted.. Sometimes the swelling will be worse the first or second day after you leave the hospital.
Swelling is generally worse when you first arise in the morning.
This is not serious and is not an indication that something is going wrong with your operation. The main thing to remember is: swelling always eventually subsides and your face will return to normal.
You can help normal healing to occur several ways:
1. Stay up (sitting, standing, walking around) as much as possible when you leave the hospital. THIS IS IMPORTANT.
Of course, you should rest when you tire.
2. Avoid bending over or lifting heavy things for one week. Besides aggravating swelling, this may raise your blood pressure and start bleeding.
3. Avoid hitting or bumping your new nose. It is wise not to pick up small children. It is best to sleep alone for one or two weeks after your operation.
4. Sleep with the head of the bed elevated until all the dressings have been removed from the nose. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of it.
Try not to roll on your nose.
5. Ice compresses consisting of moistened wash cloths (not an ice bag) applied diagonally across each eye for
twenty minutes every two hours while awake during the first two days after discharge from the hospital are helpful.
6. Avoid “sniffing”, that is, forcibly attempting to pull air through the nose as some people do when their noses feel blocked. This will not relieve the sensation of blockage – it will only aggravate it because the suction created on the inside will cause more swelling.
7. Avoid constantly rubbing the nostrils and base of the nose with Kleenex or a handkerchief. Not only will this aggravate the swelling, but it may cause infection, bleeding, or the accumulation of scar tissue inside the nose.
Use a moustache dressing instead if the discharge is excessive. Report any excessive bleeding that persists after pressure and lying down for 15 minutes.
8. Tub bathing or showering can be resumed as soon as you feel strong enough to do so. It is probably best to have assistance standing by on the first couple of occasions.
9. When bathing, avoid getting the nasal dressing wet. If it becomes loose, let us know.
10. The hair may be washed, with someone’s help, after 3 or 4 days; care should be taken not to wet the bandage.
Do not use the usual type heat hair dryer used in beauty salons; use a hand-held blow dryer set at a cool or warm temperature.
11. Avoid sexual intercourse for two (2) weeks after your operation.
12. Do not resume exercising, running, aerobics, or nautilus for two weeks after surgery.
13. Avoid sunning the face for prolonged periods for one month; ordinary exposure is not harmful.
14. Do not tweeze the eyebrows for one week.