Nose surgery, also known as rhinoplasty, is a very common surgery designed to bring harmony and balance to all features of the face. Nose surgery can be a very satisfying surgery for those people who feel their noses do not “match” their faces. Nose surgery can reduce or increase the size of the nose, change the shape of the tip or the bridge, narrow the span of the nostrils or change the angle between the nose and the upper lip. By thinning, turning up, augmenting, shortening, elongating or otherwise refining the nose, patients feel a heightened sense of self-esteem and happiness.

The Best Candidate

The best candidate for nose surgery is one who wants to aesthetically improve the appearance of their nose, correct a birth defect or improve the breathing functionality of their nose. It is important to remember that nose surgery can create a more balanced look on the face, but it cannot, however, create perfection.
Nose surgery can be performed on men and women at almost any age. It is recommended, however, that younger patients wait until their final growth spurt has occurred so that all facial features have reached their permanent appearance. For girls, this age is about fifteen to sixteen, for boys, about seventeen to eighteen.
The patient should be in good health and physical condition, stable psychological state, and have realistic expectations of the surgery. As with any cosmetic procedure, the surgery will help to improve the overall appearance of the problem area, but it may not live up to your preconceived ideal. The surgery will attempt to create a more harmonious balance of your face, which can help to make you more self-confident and happy with the appearance of your nose. Be sure to discuss your expectations with Dr. Heddle, as well as your support network. If you are a younger patient, make sure you have made this decision on your own with the help of your parents.

The Office Visit

During your initial consultation, Dr. Heddle will ask for your detailed medical history. Be sure to tell Dr. Heddle if you smoke or are taking any drugs, medications, vitamins, herbal supplements or have any allergies or breathing difficulties. Also during this initial visit, Dr. Heddle will ask questions about your emotional and psychological outlook on the surgery. While the surgery is ultimately a deeply personal decision, help and advice is available for you, so feel free to ask questions and express your concerns.
In this consultation, it is important that a clear and open communication is developed between you and Dr. Heddle. Be sure to tell Dr. Heddle if you have had previous nose surgery or a nose injury in the past. Dr. Heddle will ask you what changes you want completed in order to improve your nose appearance, as well as what you expect your nose to look like after the surgery. Dr. Heddle will evaluate the structure of your nose and face and will also discuss with you the factors that may affect the surgery and the results: any airway obstructions, the structure of your nasal bones and cartilage, the overall shape of your face, the thickness of the skin on your nose, your age and your expectations.

Preparing for the Surgery

Dr. Heddle will give you specific instructions on how to prepare for the surgery, including what you should/should not eat and drink, smoking, avoiding certain vitamins and medications prior to the procedure, and washing your face prior to the surgery. It is very important to follow these guidelines in order to make the surgery go smoothly.
Plan to have someone with you on the day of the procedure who can drive you home afterwards and stay with you for the first 48 hours if needed.
An additional precaution is to set up a mini-recovery area in your home before the surgery. This recovery area may include: plenty of ice, clean towels, gauze, pain medication prescribed by Dr. Heddle, ointments or creams recommended by Dr. Heddle, magazines and books.

How the Surgery is Performed

Nose surgery takes from one to two hours, or more, depending on the complexity of the procedure. As mentioned above, patients desire nose surgery for very unique reasons; therefore, the surgical techniques used will differ according to the specific concerns of the patient.

	Dr. Heddle will make the appropriate incisions for access to the inner structure of the nose. For many types of nose surgery, Dr. Heddle will perform the surgery from within the nose, making the incisions inside the nostrils, completely hidden from view.
	If you are having your nostrils made smaller, you may have two small incisions: one on each side where the nose meets the face and forms a small crease. The incisions will be made in the most appropriate spots in order for maximum camouflage during the healing process. Small sections of skin from each side will be removed, making the nostril opening smaller.
	During the surgery, the skin on top of the nose is separated from the bone and cartilage. The bone is sculpted with a chisel-like tool inserted into the nose to reach the desired shape of the bridge and to reduce the dorsal “hump”. The cartilage is also shaped to sculpt the tip of the nose. The nature of the sculpting, again, will depend on your personal concerns and the decision reached by you and Dr. Heddle.
	Trimming the septum helps to improve the angle between the nose and the upper lip. In addition, it helps to adjust the projection and overall length of the nose.
	Once the desired shape is reached, the skin is redraped over the newly shaped nose. When the surgery is complete, your nose is taped and a splint (made from plaster, metal or most commonly plastic) is applied to the nose to protect it and help it maintain its new shape during the healing phase. The bones will fuse together quite rapidly. Nasal packing may also be placed in your nostrils to stabilize the newly sculpted bone framework. You may remove this nasal packing yourself after three to four days.

After the Surgery

During the first twenty-four hours following the surgery, it is normal for there to be bruising, some swelling, a puffy feeling in your face and a congested feeling in your nose. Any discomfort you experience can be controlled with medication prescribed by Dr. Heddle. The swelling and pressure can be relieved by applying ice to the nose and surrounding area. For the first day, it is important to rest comfortably and keep your head elevated above your heart.
It is normal for the bruising and swelling the reach its peak within the first three days after surgery. It will begin to subside after this point. If nasal packing was inserted on the day of surgery, it will be removed after two to three days, which will make you feel much better. All splints and stitches should be removed within two weeks.
Some bleeding is common during the first few days and some congestion will be experienced for several weeks following surgery. Dr. Heddle may ask you not to blow your nose for about a week in order to allow the tissues in the nose to heal.

Getting Back to Normal

Most nose surgery patients are able to return to work within one to two weeks following surgery. It is important to remember, however, that each recovery is unique, and you must take care to rest as long as your body needs. More strenuous activities may be resumed within two to three weeks. For a period of eight weeks, it is important to avoid hitting your nose and to avoid exposure to the sun. Be sure to follow any additional guidelines outlined by Dr. Heddle.

The permanent appearance of your nose following the surgery will be seen in approximately one year. While the healing may take some time, you can expect the results to be worth the wait. The surgery is personally rewarding and the changes can bring about substantial gains in your self-esteem.