American Medical Association Family Medical Guide - American Medical Association [772]
Reshaping a nose
Excess cartilage in the bridge of the nose can produce an oversized or humped appearance (left). Cosmetic surgeons can reshape the nose by removing some of the cartilage (right).
The Procedure
Depending on the desired outcome, surgery can reduce or increase the bridge of your nose, decrease its size or width, make the nostrils narrower, or reshape the tip. Rhinoplasty can be either open or closed. In open rhinoplasty, the surgeon cuts the skin across the bottom of the center of the nose, separates the skin from the underlying bone and cartilage, reshapes the nose (by removing, adding to, or rearranging the underlying bone and cartilage), and then redrapes the skin. In closed rhinoplasty, the surgeon makes most of the incisions inside the nose, where they cannot be seen. In some cases, such as to narrow the nostrils, the surgeon may remove small wedges of skin from the area just under the nostrils. He or she closes the incisions with absorbable stitches (which don’t need to be removed).
After completing the surgery, the surgeon often protects and stabilizes the nose with a splint and may place packs or soft nasal splints inside the nose to secure the positioning of the cartilage between the nostrils. The packing inside the nose is removed the next day, but the splint must stay in place for 5 to 8 days.
Most surgery on the nose is performed on an outpatient basis and takes 1 to 2 hours, although complicated procedures can take longer. Some procedures require general anesthesia, while others need only a local anesthetic combined with light sedation.
After Surgery
Your nose will feel sore after the surgery, and you will have temporary nasal stuffiness, along with swelling and bruising around your nose and eyes.
Incisions for rhinoplasty
To perform closed rhinoplasty, the surgeon makes most of the incisions inside the nose. Sometimes the surgeon removes small wedges of skin from the area just under the nostrils. The incisions are closed with absorbable stitches that do not need to be removed.
You may also have nosebleeds and headaches during the first week after surgery. To minimize swelling and bleeding, keep your head elevated, even while sleeping, and don’t blow your nose for about a week after surgery. Avoid sun exposure for at least 8 weeks.
The main postsurgery risks are infection, bleeding, and broken blood vessels that leave permanent red spots on the skin of the nose. Nose reshaping alters the facial appearance so much that you may not look the way you expected, but more than 95 percent of people who have this type of surgery are satisfied with the outcome.
Most people who have had nose-reshaping surgery can resume their normal activities in 1 or 2 weeks. The final appearance of the nose may not be apparent until about a year after surgery.
Eyelid Surgery
Eyelid surgery, known medically as blepharoplasty, is one of the most common cosmetic surgery procedures, with about 100,000 men and women undergoing the procedure in the United States every year. Surgeons perform eyelid surgery to correct droopy, hooded upper eyelids and puffy lower lids that make the face look tired and older. In some people, the upper eyelids sag so much that they impair vision. (In this case, eyelid surgery may be covered by health insurance because it is not performed only to improve appearance.)
In blepharoplasty, the surgeon removes excess fat, skin, and muscle from the upper or lower lids, or both. Eyelid surgery does not remove dark circles from under the eyes, erase fine lines such as crow’s feet, or lift sagging eyebrows. Sometimes doctors combine eyelid surgery with a forehead lift (see next page) or a facelift (see page 1083) to achieve better results.
People who should have a thorough medical evaluation before having eyelid surgery include those who have glaucoma (see page 1042), a detached retina (see page 1050), a thyroid problem such as hyperthyroidism (see page 901), high blood pressure (see page 574), diabetes (see page 889), or heart disease (see page 558).
The Procedure
Eyelid