Rhinoplasty is the term used for reconstructive plastic surgical procedures on the nose, or that part of it which is externally visible. The nose is the central feature of the face, and although there are ethnic variations considered perfectly normal in their own society, a patient might be extremely conscious their nose is different from society’s concept of ideal and wishes to have it altered.
In general, the indication for surgery is the patient’s belief they would feel better about themselves if the nose was different. Perhaps more than any other form of plastic surgery, it is wise to ensure the patient has reasonable expectations and is not attributing past personal and business failures to his nasal appearance.
Reconstructive procedures for birth defects, injuries, etc., are performed as indicated; elective reconstructive procedures are usually deferred until the facial skeleton has matured – for a girl, age 16, for a boy, age 18.
Essential to success is pre-operative planning, knowing exactly what is to be taken from, or added to, each of the several parts of the rather complicated nasal anatomy described in nine subunits: tip; columella; right alar base; right alar wall; left alar base; left alar wall; dorsal; right dorsal wall; left dorsal wall.
The procedure is usually performed under local anesthetic with injection of supportive epinephrine to limit the bleeding in this vascular area, but general anesthetic is not uncommon. Skin and subcutaneous tissue may be elevated from the underlying cartilage-bone framework by incising around the nostrils and peeling it back like a hood; or the procedure may be performed endonasally, from within the nose. The nasal structures are then revised along the lines of the pre-operative plan agreed with the patient. Post-operative splinting of the nose is usual.