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Nose Surgery

Nasal surgery or rhinoplasty, can improve the appearance of the nose externally as well as the internal function of the nasal airways. The appearance of the nose can affect the overall balance and aesthetic proportions of the entire face. To preserve your individuality and maintain the uniqueness of your nose, Dr. Forley will spend a lot of time with you, discussing your desires and explaining how the changes you request will affect other features of your nose and face. By changing only the negative features and carefully preserving the positive characteristics, your nose will blend aesthetically with your face without appearing overly operated. Dr. Forley uses advanced cartilage shaping techniques to create a natural appearing result. Deformities of the nasal septum can cause breathing difficulties. Internal nasal surgery is often combined with surgery of the external nose to improve airway function as well as the appearance of the nose.

Before After
38 year old female 10 months following rhinoplasty

*Results may vary.

Is This For Me?

You should consider a rhinoplasty if:

  • You feel self conscious about the appearance of your nose
  • You have breathing problems
  • You feel that the shape of your nose just doesn’t look right on your face
Before After
17 year old female 5 months following rhinoplasty and septoplasty

*Results may vary.

The Consultation

During your consultation, Dr. Forley will first ask about your medical history and to describe what concerns you most about the appearance of your nose. He will want to know if you have any breathing problems, sinus congestion or infections, or history of trauma to the nose. He will examine your nose both externally and internally to assess the various aspects of the nose that must be considered prior to performing surgery including the tip, bridge, nasal bones, septum, and nostrils. Dr. Forley will discuss your anatomy, the surgical options, and how best to achieve the result you desire. The procedure will be explained in detail and you will be given an idea of realistic expectations for improvement with examples of before and after results. In addition, a 3-D simulation of the potential outcome of the surgery will be utilized to help you visualize the result. You will have plenty of time to get all your questions answered.

Before After
27 year old male 3 months following rhinoplasty

*Results may vary.

Preparation

Instructions pertinent to reducing the risk of bleeding and bruising will be discussed during your pre-operative appointment two weeks prior to the surgery. A program of vitamins and supplements designed to enhance healing and minimize bruising and swelling will be provided to you for use before and after the surgery. If needed, imaging studies of your internal nasal airway may be requested to aid in the treatment of any breathing problems.

Before After
31 year old female 6 years following open rhinoplasty

*Results may vary.

The Procedure

Dr. Forley will carefully mark your nose before the anesthesiologist reviews with you the twilight/sedation technique that is utilized exclusively in the Joint Commission accredited office surgical suite. Most incisions are located inside the nose but in certain cases, depending on the extent of work to be done, carefully designed external incisions may be necessary for optimal correction. This open rhinoplasty approach typically involves a small incision at the base of the nose to enable better visualization of the nasal anatomy and thereby increased surgical precision. The framework structures of the nose including the cartilage and bone are carefully altered and reshaped to achieve the desired changes. The skin is then redraped over the reshaped framework to achieve the final appearance. Internally, deviated areas of the nasal septum will be straightened to maximally open the airways. Areas of severe deformity are conservatively removed to open the airways while preserving the support function of the septum.

Before After
49 year old female 18 months following rhinoplasty

*Results may vary.

What to Expect After Your Procedure

Tape and a nasal splint will be applied at the end of your surgery to protect the changes made to your nose and remain for 1 week. Discomfort is usually minimal following nasal surgery and is easily controlled with pain medication. Swelling and bruising develop in the first 24 hours and start to diminish after 72 hours. No nasal packing is used but a small internal splint may be placed if surgery on your septum was performed. It is normal to feel like you have a stuffy nose for a few days since the nose swells on the inside as well as the outside. The amount of activity you are permitted will depend on the extent of nose surgery performed. Exercise can usually be resumed after 2-3 weeks. If external sutures are placed, they will be removed at 7 days. Any residual bruising can be concealed with make-up until it resolves within 10-14 days. Although the initial post-operative swelling resolves within 1-2 weeks, continued swelling of a lesser degree will improve gradually up to 12-18 months. This will result in a progressive refinement in the appearance of the nose.

The Stages of Recovery

  • Day of surgery: May be performed as an outpatient procedure in our accredited office surgery suite. A nurse can be booked to monitor you overnight.
  • Bruising and swelling resolve: Much improvement occurs in the first 1-2 weeks with minor swelling persisting for up to 12-18 months.
  • Sensation returns: A gradual process that occurs over 6-12 months.
  • Return to work, social activity: Average is 7-10 days.
  • Aerobic or strenuous activity: 2-3 weeks.

Potential Risks and Complications

Risks common to all surgical procedures such as bleeding, infection, and thickened scar tissue formation occur in a very small percentage of cases. Occasionally, cartilage or bony irregularities that appear after the swelling has subsided may need to be corrected with a minor revision procedure. We will give you more detailed information about these and other rare risks in our written information and encourage you to discuss any which concern you during your consultation.

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5 MYTHS ABOUT NOSE SURGERY 1. It will be obvious that I’ve had my nose done. Modern nose surgery techniques have resulted in the ability to create natural, unoperated appearing outcomes when rhinoplasty is performed. An in depth understanding and analysis of the aesthetics of your nose and how it relates to the adjacent characteristics of your face enables Dr. Forley to produce needed modifications to your nose without any telltale stigmata of surgery. 2. The bones have to be broken as part of the procedure. Every nose surgery needs to be customized to the aesthetics and anatomy of the individual patient. The nasal bones can be modified in many cases with a simple rasping or filing technique to decrease a bump. The only time the bones need to be broken is when they are too wide or, rarely, too narrow. The procedure involves making a controlled cut in the bone to allow for a modification in bony width. 3. Nose surgery is very painful. Pain is not typically a major component of the recovery after nose surgery. Although there may be some discomfort, it generally is short term in duration and well managed with medication. 4. My nose can be made to look like that of any celebrity I want. Photos of celebrities can be useful tools when discussing your preferences in nasal appearance. However, every face is different and what looks good on a particular celebrity’s face may not be the best choice in your particular case. In addition, there are many anatomic variables of cartilage, bone, and skin thickness that affect the outcome of nose surgery in each individual nose and cannot necessarily be duplicated from that of a celebrity. 5. I can achieve my goal with new non-surgical filler techniques. There has been a lot of marketing recently of the “non-surgical nose job”. It is important to understand that the use of injectable fillers to alter the appearance of the nose is possible but only for a limited number of changes. It is a simple way to manage minor asymmetries or irregularities of the bridge and nasal tip without surgery. The same procedure, however, will have to be repeated within a year to maintain the result. Injectable fillers function to camouflage an underlying problem but do not produce a definitive correction of the nose.
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