When I think about how nasal surgery used to be done and the results that ensued, I am amazed the surgery was ever popular. In the past, numerous patients recounted brutally painful experiences during nasal surgery. Moreover, just about everyone can remember someone they knew who had a "nose job" and came out looking ridiculous.
To learn what is good about cosmetic nasal surgery (rhinoplasty) now; it is helpful to look back and see why it frequently was such a bad experience.
Pain: Significant intraoperative pain was common as the surgery was frequently done under sedation or twilight anesthesia. Unfortunately, the patient's awareness could be inadequately blunted, allowing them to hear their nose being broken, making the anesthesia seem more like the Twilight Zone! Today, general anesthesia is used for most nasal surgery. With strong but short-acting drugs, patients can be completely and safely asleep during surgery and yet be ready to go home an hour or two after the procedure.
Packing: Gauze packing in the nose following nasal surgery used to be standard and clearly prevented the patient from breathing through their nose after surgery. To see how much fun that is, pinch your nose closed for 30 seconds and see how fast you get tired of the feeling. Worse yet, the packing had to be removed. This was usually done five to seven days later in the doctor's office and often felt like someone was backing a small truck out of your nose. Currently, nasal packing is infrequently employed. Instead, plastic surgeons make sure to leave no openings inside the nose that could lead to postoperative bleeding, which is why packing was used in the first place. If packing is felt to be necessary, then absorbable material can be used which dissolves in two to three days and makes removal unnecessary.
Over-resection: The one thing that characterizes an old rhinoplasty is over-resection, or removing too much bone and cartilage during the Procedure resulting in an excessively small nose. This excessiveness resulted in ski-slope or Miss Piggy type noses. Today's rhinoplasty is typified by more finesse in achieving a unique result most suitable to the individual patient. Plastic surgeons rely less on removal and more on sculpting of excess cartilage. The benefit of this approach is that rhinoplasty results are much more predictable.
Open technique: Nasal surgery used to be done exclusively through small incisions inside the nose. While this seemed great, it was frequently detrimental to the final result as it was just too hard for the surgeon to see what was happening. To alleviate this problem of inadequate visualization, many rhinoplasties are done with an "open technique". All this means is that a small additional incision is made across the columella (tissue between the nostrils) to allow the surgeon to see a patient's bone and cartilage in an undistorted manner. It is ironic that in an age of arthroscopy and surgery through smaller incisions, plastic surgeons have elected to make bigger incisions for nasal surgery. However, the incisions usually heal well and the improved results more than justify the open technique.
Poor function: In the past, cosmetic nasal surgery commonly showed little concern for postoperative breathing. If it looked good, who cared if air went through? Plastic surgeons, having listened to their disgruntled patients for years, have come to realize that improved appearance can be achieved without disrupting nasal air flow. In fact, it is now a common practice to perform other procedures at the time of rhinoplasty to actually make breathing better postoperatively.
Nasal surgery remains an extremely challenging undertaking. In general, results are more predictable while surgery and recovery are much more tolerable than in previous time. Working with a capable Board Certified plastic surgeon, you should be able to achieve the changes in nasal appearance you are seeking.
Paul G. Pin, M.D.
American Board of Plastic Surgery Dallas, Texas
Nasal surgery is real surgery and involves risks such as bleeding, infection, and scarring. Results vary. Dr. Pin will be happy to discuss these and other risks of nasal surgery.