Ask the Expert: Rhinoplasty Surgery [Q&A]

Dr. Angela Sturm shares her insight on frequently asked questions about rhinoplasty including if it improves breathing and how to prevent bruising post-surgery.

Q. I have a bump on my nose and would like to have a straight profile. Do I have to have a full rhinoplasty or can it be tailored to me?

A. Every nasal surgery (rhinoplasty) should be individualized to the person and their anatomy, as well as facial shape. A rhinoplasty can involve taking a hump down, straightening the nose and/or changing the tip shape, among other things. Rhinoplasty should never be done in a standardized way. This is what makes the procedure complex, interesting and my favorite surgical procedure.

Q. I have been told that I have a deviated septum. Will fixing this straighten my nose or take down my hump?

A. Unfortunately, in almost all cases straightening a deviated septum (septoplasty) will not change the outward appearance of the nose. In some very severe septal deviations, this will pull the tip of the nose to one side and this will be corrected with the septoplasty, but this is not true for most people. Since the septum is inside the nose, this will not change a dorsal hump or “bump” on the profile. These are addressed with rhinoplasty.

Q. What does “open” versus “closed” rhinoplasty mean?

A. In a closed rhinoplasty, the procedure is done with incisions that are all inside the nose—there are no external or visible incisions or scars. In an open rhinoplasty, a small incision is made on the undersurface of the center post (columella) below the tip—this incision heals very well and is in a location that is naturally hidden.

Either approach can be taken, however, there are certain circumstances where one may be preferred over the other. A closed approach works well for procedures that are taking down a bump and straightening the nasal bones with minimal change to the tip. An open approach allows the best visualization of the tip and the nose overall and is often preferred for delicate tip work or revision rhinoplasties.

Q. Will a rhinoplasty improve my breathing? Does insurance cover this?

A. Anatomic causes of nasal obstruction include a deviated septum (the divider between the two sides of the nose), large turbinates (structures that heat and humidify the air) and narrow internal nasal valves (the area where the nasal bones end and the cartilage begins). These can be performed at the same time as rhinoplasty and, depending on your insurance coverage, may be covered. Check with your carrier to be sure. Rhinoplasty describes the aesthetic changes to the nose. These can be done at the same time as the functional changes but are not covered by insurance.

Q. What should I do before a rhinoplasty?

A. Once you have chosen your rhinoplasty surgeon and set your date, there are some things that you can do to help limit bruising and swelling. A balanced diet high in vitamin A and C as well as taking supplements, like Arnica and vitamin C, for a few days up to a week before the surgery can help reduce bruising. Arnica can also be taken orally and topically after the surgery to help bruising resolve quicker.

The week before, limit alcohol because it can thin your blood and increase risk of bruising. You should also get good rest so your body can be in tip-top shape for healing. Hydrate well the day before surgery. If you are dehydrated, you may have to be given more fluids by IV to “catch up” and that may contribute to swelling.

Q. I am concerned about pain after the surgery. What should I expect?

A. Many people are concerned about pain with a rhinoplasty. Everyone is different in regard to how their body responds to the surgery. However, most people describe the recovery as mild discomfort and pressure on the sides of the nose, similar to sinus pressure or a headache. This pressure is most noticeable when you bend down or strain, which is one reason why we tell patients not to do these things for 10 days after surgery. These people often do not take any or only a few pills for pain control. Other people do have more discomfort, which is controlled by the pain medications their physician will order.

Q. What is a “nonsurgical rhinoplasty?”

A. Nonsurgical rhinoplasty describes the injection of soft tissue fillers, like Restylane or Juvederm, into the nose to camouflage or augment the nasal appearance. Soft tissue fillers can be used to project or rotate the tip, fill above and below a bump to create a straight profile or fill other depressions. This does not require sedation or anesthetic and can be performed with topical or injected anesthetic only. However, the filler is not permanent and will dissolve slowly over about a year or so, depending on the type of filler used. A word of caution for anyone considering this option: There is a rare but serious risk of compromising the blood supply and therefore, the soft tissue and skin of the nose or forehead. For this reason, it is important to do your research and find an experienced injector.

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