Rhinoplasty surgery can be performed in an office-based surgical suite or in a free-standing ambulatory facility. The average time for the completion of Rhinoplasty can vary between one to three hours and can even take longer.
Medications will be administered to ensure the comfort of the patient during the procedure. General anesthesia is chosen during rhinoplasty, even local anesthesia or intravenous sedation can also be considered in certain cases. Various monitors will be employed to check the heart rate, pulse, blood pressure and oxygen amount that is circulating in the blood during the procedure. The surgical plan that was discussed with the patient will be most likely followed until unless hindered by some changes in the medical conditions of the patient.
The surgeon incision the bones and cartilage that help the nose after the area is covered. Two general incision techniques are usually used, they are open and endonasal. The external tissues within the nose are modified with the inclusion or removal of cartilage and bone, and the nose of the patient can be expanded or reduced, or decreased.
To remodel the tip of the nose, tip grafts that are made from cartilage can be used, giving it a more uplifted, longer, shorter or thinner look as may be desired. The skin and other soft tissues will get remodeled to give the desired shape to the underlying structures. In some patient’s tissue fillers or grafts of fat can be added for bringing about a volume increase in the desired regions of the nose.
Incision approaches can be of two types and they are the open approach and internal or endonasal approach. Additional to incision options there are various methodologies for augmenting the nose to smoothen the deformities that exist on the surface.
Autologous cartilage grafts can be taken from the nasal septum (the wall that separates the nose and makes two separate air passages). This can provide the best chance for a natural result. If the bone and cartilage are removed already from the nasal septum then ear or rib cartilage and even bone from the skull are also considered as an alternative.
Strong silicone implants are still available for nasal surgery, yet they are foreign materials that can become contaminated or connect adversely with the nasal tissues and need to be removed. Therefore, surgeons often choose the supply of natural cartilage since this is an easy option. The grafts or fillers may also be used to smooth the nose fat. It can also be useful for camouflage in the desired areas, or for adding volumes.
In open rhinoplasty, the incisions are made outside the nose with access made in the form of a small incision on the underside of the nose; the region between the nostrils that will then finally connect with other incisions that are hidden inside the nose. The advantage of this method is that it allows the nose to be opened totally thus providing opportunities to visualize the nasal structure properly and gives a more direct route for manipulating it surgically. The small scar which is formed at the base of the nose will be hardly visible once the region heals.
For an endonasal rhinoplasty, the incisions are done in the interiors of the nasal passages. Since the incisions are hidden hence, they are always invisible after the surgery. In the endonasal approach, limited dissection of nasal tissues happen which aids in very good visualization of the nasal structures and it eliminates the scar formed at the base of the nose.
After the completion of the procedure, the patient will be taken into a recovery area where the patient will continue to be monitored closely. A splint will be placed outside the nose for the support of the new shape of the nose and aids in healing. Some nasal packing will be used inside the nose for providing additional support. The patient will be permitted to go home after being under observation for a short period of time and the plastic surgeon can have other plans for the immediate post-operative recovery of the patient.