Rhinoplasty, or surgery to reshape the nose, is one of the most common
of all plastic surgery procedures. Rhinoplasty can reduce or increase
the size of your nose, change the shape of the tip or the bridge,
narrow the span of the nostrils, or change the angle between your nose
and your upper lip. It may also correct a birth defect or injury, or
help relieve some breathing problems.
If you're considering rhinoplasty, this information will give you a
basic understanding of the procedure-when it can help, how it's
performed, and what results you can expect. It can't answer all of
your questions, since a lot depends on the individual patient and the
surgeon. Please ask Dr.Rieger about anything you don't understand.
The best candidates for rhinoplasty
Rhinoplasty can enhance your appearance and your self-confidence, but
it won't necessarily change your looks to match your ideal, or cause
other people to treat you differently. Before you decide to have
surgery, think carefully about your expectations and discuss them with
Dr. Rieger.
The best candidates for rhinoplasty are people who are looking for
improvement, not perfection, in the way they look. If you're
physically healthy, psychologically stable, and realistic in your
expectations, you may be a good candidate.

Before surgery, these rhinoplasty
patients have large, slightly hanging
noses, with a hump and an enlarged tip.
Rhinoplasty can be performed to meet aesthetic goals or for
reconstructive purposes-to correct birth defects or breathing
problems.
Age may also be a consideration. Many surgeons prefer not to operate
on teenagers until after they've completed their growth spurt-around
14 or 15 for girls, a bit later for boys. It's important to consider
teenagers' social and emotional adjustment, too, and to make sure it's
what they, and not their parents, really want.
All surgery carries some uncertainty and risk
When rhinoplasty is performed by a qualified plastic surgeon,
complications are infrequent and usually minor. Nevertheless, there is
always a possibility of complications, including infection, nosebleed,
or a reaction to the anesthesia. You can reduce your risks by closely
following your surgeon's instructions both before and after surgery.
After surgery, small burst blood vessels may appear as tiny red spots
on the skin's surface; these are usually minor but may be permanent.
As for scarring, when rhinoplasty is performed from inside the nose,
there is a small incision at the midline base of the nose. All the
rest of the incisions are inside the nose. Rarely, a procedure calls for the narrowing of flared nostrils, the
small scars on the side of the base of the nose are usually not visible.
In about one case out of ten, a second procedure may be required-for
example, to correct a minor deformity. Such cases are unpredictable
and happen even to patients of the most skilled surgeons. The
corrective surgery is usually minor.
Planning your surgery
Good communication between you and your physician is essential. In
your initial consultation, the surgeon will ask what you'd like your
nose to look like, evaluate the structure of your nose and face, and
discuss the possibilities with you. He or she will also explain the
factors that can influence the procedure and the results. These
factors include the structure of your nasal bones and cartilage, the
shape of your face, the thickness of your skin, your age, and your
expectations.
Your surgeon will also explain the techniques and anesthesia he or she
will use, the type of facility where the surgery will be performed,
the risks and costs involved, and any options you may have. Most
insurance policies don't cover purely cosmetic surgery; however, if
the procedure is performed for reconstructive purposes, to correct a
breathing problem or a marked deformity, the procedure may be covered.
Check with your insurer, and obtain pre-authorization for your
surgery.
Be sure to tell your surgeon if you've had any previous nose surgery
or an injury to your nose, even if it was many years ago. You should
also inform your surgeon if you have any allergies or breathing
difficulties; if you're taking any medications, vitamins, or
recreational drugs; and if you smoke.
Don't hesitate to ask your doctor any questions you may have,
especially those regarding your expectations and concerns about the
results.
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for
surgery, including guidelines on eating and drinking, smoking, taking
or avoiding certain vitamins and medications, and washing your face.
Carefully following these instructions will help your surgery go more
smoothly.
While you're making preparations, be sure to arrange for someone to
drive you home after your surgery and to help you out for a few days
if needed.
Where your surgery will be performed
Dr. Rieger prefers to perform the operation in a state-of-the art
accredited outpatient surgery center.
Types of anesthesia
Rhinoplasty can be performed under local or general anesthesia,
depending on the extent of the procedure and on what you and your
surgeon prefer.
With local anesthesia, you'll usually be lightly sedated, and your
nose and the surrounding area will be numbed; you'll be awake during
the surgery, but relaxed and insensitive to pain. With general
anesthesia, you'll sleep through the operation.
The surgery
Rhinoplasty usually takes an hour or two, though complicated
procedures may take longer. During surgery the skin of the nose is
separated from its supporting framework of bone and cartilage, which
is then sculpted to the desired shape. The nature of the sculpting
will depend on your problem and your surgeon's preferred technique.
Finally, the skin is re draped over the new framework.
Some plastic surgeons perform rhinoplasty from within the nose, making
their incision inside the nostrils. Others prefer an "open" procedure,
especially in more complicated cases; they make a small incision
across the columella, the vertical strip of tissue separating the
nostrils.

Incisions are made inside the nostrils
or at the base of the nose, providing
access to the cartilage and bone, which
can then be sculpted into shape.
When the surgery is complete, a splint will be applied to help your
nose maintain its new shape. Dr. Rieger does not pack the inside of
the nose.

The surgeon removes the hump using a
chisel or a rasp, then brings the nasal
bones together to form a narrower
bridge. Cartilage is trimmed to reshape
the tip of the nose.

Trimming the septum improves the
angle between the nose and upper lip.
After your surgery
After surgery-particularly during the first twenty-four hours-your
face will feel puffy, your nose may ache, and you may have a dull
headache. You can control any discomfort with the pain medication
prescribed by your surgeon. Plan on staying in bed with your head
elevated (except for going to the bathroom) for the first day.
You'll notice that the swelling and bruising around your eyes will
increase at first, reaching a peak after two or three days. Applying
cold compresses will reduce this swelling and make you feel a bit
better. In any case, you'll feel a lot better than you look. Most of
the swelling and bruising should disappear within two weeks or so.
(Some subtle swelling-unnoticeable to anyone but you and your
surgeon-will remain for several months.)
A little bleeding is common during the first few days following
surgery, and you may continue to feel some stuffiness for several
weeks. Your surgeon will probably ask you not to blow your nose for a
week or so, while the tissues heal.
By the end of one week, splints and stitches should be removed.

A splint made of tape and an overlay
of plastic, metal, or plaster is applied
to help the bone and cartilage of the
nose maintain their new shape.
Getting back to normal
Most rhinoplasty patients are up and about within two days, and able
to return to school or sedentary work a week or so following surgery.
It will be several weeks, however, before you're entirely up to speed.
Your surgeon will give you more specific guidelines for gradually
resuming your normal activities. They're likely to include these
suggestions: Avoid strenuous activity (jogging, swimming, bending,
sexual relations-any activity that increases your blood pressure) for
two to three weeks. Avoid hitting or rubbing your nose, or getting it
sunburned, for eight weeks. Be gentle when washing your face and hair
or using cosmetics.
You can wear contact lenses as soon as you feel like it, but glasses
are another story. Once the splint is off, they'll have to be taped to
your forehead or propped on your cheeks for another six to seven
weeks, until your nose is completely healed.
Your surgeon will schedule frequent follow-up visits in the months
after surgery, to check on the progress of your healing. If you have
any unusual symptoms between visits, or any questions about what you
can and can't do, don't hesitate to call your doctor.
Your new look
In the days following surgery, when your face is bruised and swollen,
it's easy to forget that you will be looking better. In fact, many
patients feel depressed for a while after plastic surgery-it's quite
normal and understandable.
Rest assured that this stage will pass. Day by day, your nose will
begin to look better and your spirits will improve. Within a week or
two, you'll no longer look as if you've just had surgery.
Still, healing is a slow and gradual process. Some subtle swelling may
be present for months, especially in the tip. The final results of
rhinoplasty may not be apparent for a year or more.

After surgery, the patient has a smaller
nose, a straighter bridge, a well defined
nasal tip, and an improved angle
between the nose and upper lip.
In the meantime, you might experience some unexpected reactions from
family and friends. They may say they don't see a major difference in
your nose. Or they may act resentful, especially if you've changed
something they view as a family or ethnic trait. If that happens, try
to keep in mind why you decided to have this surgery in the first
place. If you've met your goals, then your surgery is a success.
call 316-652-9333 for a consult about Rhinoplasty in Wichita,
Kansas.
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