Background: functional rhinoplasty is surgery to enhance the function of the nose.
Nasal Evaluation: Trauma and/or variations in natural nasal anatomy can lead to anatomic issues causing obstruction.
Pre-op Considerations: rhinoplasty surgery has risks and benefits like any surgery. Please see below for specifics.
Surgical Details: rhinoplasty surgery can be done through incisions inside the nose, at times requires an external incision between the nostrils depending on the severity of the problem.
Post-op Care: recovery after rhinoplasty is typically one week off work, followed by another week of decreased activity.

Background:

Functional rhinoplasty is done either to address distortion of the nose from injury or other trauma and/or to allow better breathing.

Nasal Evaluation:

Dr. Reilly will perform an in-depth analysis of your nose, from frontal, profile, base, and oblique views. He will discuss how changes to different areas of your nose may affect the contour and breathing functionality of the nose. With proper analysis, realistic patient expectations and the skills of a qualified facial plastic surgeon, functional rhinoplasty is a very successful procedure in the vast majority of patients.

Pre-operative Considerations

You are considering an operation to improve the appearance and/or function of your nose. The operation is called rhinoplasty, which involves surgical incisions in the nose and nostril area. In some cases, cartilage from the ear is necessary to help rebuild the nose. When this is necessary, surgical cuts in the outer part of the ear are also required. Generally, this type of plastic surgery of the nose is not an emergency, but it may help improve and/or protect your physical health by helping you to breath more easily. Although complications and unsatisfactory results do rarely occur, in the vast majority of patients, the desired surgical result is readily achieved.

The possible complications of rhinoplasty surgery include but are not limited to the following:
Infection, bleeding, swelling, scarring, numbness, skin discoloration, nasal obstruction, palpable and/or visible irregularities, asymmetries, personality changes and mental difficulties following surgery (even if the operation is otherwise successful), and allergic or other negative reactions to one or more of the substances used in the operation.

Some of the complications of this operation may cause the need for further surgery. Some of the complications can cause prolonged illness and permanent deformity. As with any surgery, there are extremely small risks of a complication from anesthesia.

Details of Surgery:

The technique involves first accessing the bone and cartilage support of the nose. This is done with a combination of incisions made inside the nose and in the area of skin separating the nostrils. Next, the underlying bone and cartilage is reduced, added to, or changed to create a newly shaped structure that addressed any post-traumatic deformity and/or nasal airway obstruction.

Once this work is complete, the tissues are then redraped over the new frame and the incisions are closed with dissolving sutures inside the nose and removable sutures on the outside. A small plastic splint is applied to the outside of the nose to minimize swelling and to help maintain the new shape while the nose heals. Soft, absorbent material is most often used inside the nose to maintain stability along the dividing wall of the air passages called the septum.

Post-operative Recovery

Upon completion of the surgery, you will be monitored in the post-anesthesia care area (PACU) until you feel well enough for discharge home. The majority of patients do not experience any significant pain, however, analgesic medications can be given as needed for post operative discomfort. Although Dr. Reilly does not typically use any nasal packing beyond the thin sheets of silicone, most patients will comment that their nasal breathing is limited in the first few days after surgery. This is a result of intranasal swelling and as the swelling subsides, the breathing improves. Your face will feel puffy,especially the first day after surgery. Some patients develop swelling and/or bruising around the eyes. This generally subsides in the first 5 days after surgery. Cold compresses will help minimize and reduce the bruising and any discomfort. Absorbable sutures are generally used inside the nose and do not need removal. Any external sutures, if required, are removed in 5-8 days. Nasal dressings and splints are also removed at 5-10 days after surgery.
It is imperative that you follow your surgeon’s post operative instructions. Keeping your head elevated will minimize swelling. It is important not to blow your nose and to avoid any impact to the nose while the structures inside and out are healing. Activities such as heavy lifting, excessive exertion, sun exposure or any activity that would increase the risk of injury should be avoided. If you wear glasses, you must be careful not to exert excess pressure on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area during healing.
Follow-up care is crucial to success in rhinoplasty. Any concerns regarding your post-operative course such as excess bleeding, unexpected swelling, fever or significant pain should be reported to your surgeon immediately. It is essential that you keep your follow-up appointments with your surgeon. As your healing is being monitored, there may be techniques such as massage, use of nasal sprays or even small injections of cortisone like medications that can further enhance the desired result.

Arrange for someone to stay with you for the first 24 hours.
Go to bed and rest, lying on your back, with your head elevated with 2-3 pillows. You should be lying at a 45 degree angle for the first night after surgery.
You may be up and around and able to go to the bathroom. You will be able to eat a light meal with assistance.
Take medication as directed.
Some swelling, bruising and tightness of the nasal splint are normal occurrences.
Place ice packs on the nose the first 48 hours (on for 20 minutes, then off for 20 minutes).
You should expect to have some bloody mucous from your nose for up to 72 hours after surgery. This will be cared for by placing a “drip pad” under your nose to catch the mucous. This will likely need to be changed every 2-3 hours until the mucous stops.
If you have an active nosebleed (continuous stream of blood), you should lean forward and squeeze the tip of your nose with moderate pressure for 10 minutes. If the nose continues to bleed, you should come to the office/ED to be seen immediately as you may require packing.
NO heavy lifting for 10 days after surgery. No nose picking and/or nose blowing for 14 days after surgery.

You may be up and around as tolerated but expect to tire more quickly than usual.
Use nasal saline sprays (2-3 sprays in each nostril) at least three times daily to moisturize your nose for the first 2 weeks after surgery.
You will be congested due to the swelling from surgery and will likely need to breathe through your mouth.
For the first 48 hours, be sure to keep the incisions clean and dry; apply petroleum ointment as needed. After 48 hours, you may shower; avoid scrubbing the surgical are and do not submerge your face in water. Any external bandages may be changed daily or as needed, if they become saturated.

You will come into the office for a post-operative check-up, removal of the splint on your nose, and removal of any sutures that you may have.
No alcohol for the first 7 days after surgery, which can increase bruising and swelling.

Your swelling and bruising will gradually fade over this time period.
You will come in for another post-operative check-up at 6 weeks, sooner if you are having any questions or concerns.
Eyeglasses should be avoided for the first 4 weeks after surgery until the bones have had
adequate time to set in place.

1.  Rest and good nutrition are important healing factors, especially during the first 6 weeks. Avoid all contact sports and other potential traumatic activities for the first 6 weeks after surgery.
2.  Some degree of swelling may persist for up to 3 months after surgery.
3.  Numbness and tingling around the surgical site are common occurrences. If they do occur, they
will gradually subside over several months.

What is the plastic I can see and/or feel inside my nose?

These thin sheets of plastic are called silastic splints and they are held in place with a suture to keep your septum stable in the post-operative period. The suture and the splints will most likely be removed at your first post-operative visit.

How much bleeding from my nose is normal?

The average amount of time that a patient experiences bloody or blood-tinged mucous drainage from their nostrils after this procedure is about 2 days. However, the range of normal is anywhere from one day to a full week. As long as there is not a steady flow of active bleeding from the nose, then continue to use the nasal “drip pad” provided to you at the time of surgery and the drainage will continue to slow and ultimately stop, almost always within one week.

What do I do if the cast on the outside of my nose falls off?

Do not worry if the external cast falls off—it is essentially there as a reminder to be gentle with it and not to hit it. However, the tape that is underneath the cast will remain in place until the first post-operative visit and will continue to hold the structure in the desired location during the post-operative period.

Is it normal for my teeth to be numb?

Yes, after this surgery it is normal for the front teeth and the nasal tip to suffer some numbness. The nerve that provides sensation to this area is often transected during the surgery, and it frequently takes up to 6 weeks or more for the sensation to fully recover in this area.

How and when do I use the saline spray?

It is a good idea to use 2 sprays of saline in each nostril at least four times per day following this surgery. This will help prevent large blood clots from forming that may block your breathing and contribute to more post-operative discomfort.

When Can I blow my nose?

No nose blowing or straining for 2 weeks after this surgery unless otherwise directed by your physician.

How and when do I use the saline spray?

It is a good idea to use 2 sprays of saline in each nostril at least four times per day following this surgery. This will help prevent large blood clots from forming that may block your breathing and contribute to more post-operative discomfort.

What do I do if I have to sneeze?

If you need to sneeze in the post-operative period, please leave your mouth open and let the rush of air come out of your mouth.

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