>By Wesley Hyatt, Senior Editorial Assistant
>Goal of Procedure:
>To improve the appearance and possibly the function of the nose. Rhinoplasty can correct a variety of conditions including a large nose, a hump on the bridge, an undesirable shape of the nasal tip or a narrow or wide span of the nostrils. To complement other facial features and to provide a balance of proportions, both frontal and profile views of the nose are corrected. Rhinoplasty can also correct breathing problems caused by narrow or partially obstructed nostrils.
>What It Involves:
>Incisions are made inside the rim of the nostrils. Sometimes, tiny, inconspicuous incisions are also made on the rim of the nose. Soft tissues of the nose are then separated from the underlying structures, and the cartilage and bone causing the deformity are reshaped.
>The nature of the sculpting depends on the particular problem. If the size of the nose is being reduced, the nasal bones are carefully fractured toward the conclusion of the procedure. Breathing problems may be improved through a procedure called septoplasty, where the obstructions are removed. Another type of soft-tissue surgery, alar narrowing, adjusts the width of the nostrils.
>To perform a rhinoplasty, surgeons use the open or closed technique. The open technique includes an incision across the columella (the strip of tissue between the two nostrils that is the lower part of the nasal septum). This technique allows a surgeon to completely visualize the internal structures of the nose and place sutures precisely where they may be required. With this type of rhinoplasty, the swelling takes significantly longer to subside, and some of the tissues may be unnecessarily disrupted. The scar is usually quite small and fades rapidly. The closed technique does not require an external incision, heals more quickly and does not disturb the tissues as much as the open technique.
>Length of Procedure, Recovery Time and Possible Complications:
>Rhinoplasty usually takes one to two hours in a hospital or outpatient surgical suite with a general or local anesthetic.
>If the size of the nose is being reduced, a splint will have been applied and the nose will be packed lightly with medicated gauze. After three to five days, the splint and packing will be removed. Sometimes, only tape supports the nose while it is healing. The stitches are self-absorbing and do not require removal. By the end of the second week, all splints, bandaging and stitches will have been removed.
>If an incision is made across the columella, surgeons place skin stitches, which require removal in three to five days. The need to do this is usually identified and discussed fully prior to the procedure, and is usually necessary in only about 5-10 percent of patients.
>Patients usually resume normal light activity and return to sedentary work after a few days. It will take about a month before the nose is completely healed to allow full physical activity.
>In the first 24 hours after surgery, the patient may experience some pain that requires a mild analgesic. After that, there is usually just a feeling of pressure and stuffiness. Patients will look puffy and swollen and, to reduce the swelling, they will need to keep their heads elevated above the level of their hearts for the first few days. Bruising around the eyes usually happens and peaks around 72 hours, subsiding in 7-10 days. Cold compresses help to reduce the swelling around the eyes. Some patients have a little bleeding and need to change their gauze bandages a few times a day for the first several days.
>Patients need to be careful to not blow their noses for about two weeks and avoid bumps to the nose for about six weeks. Eyeglasses should be taped to the forehead, off the bridge of the nose, for the first month.
>Patients may not feel completely back to normal for several weeks. The nose might be numb, especially if there have been considerable changes made to the tip. Patients should use extra sunscreen and be gentle when washing their faces in this period.
>It is common to feel dissatisfied with the appearance of the nose in the immediate post-operative period, when the nose is still quite swollen, and much of the detail is still not visible enough to appreciate. The elasticity of the tissues, the blood flow, the thickness of the skin and the appearance of the nose will change significantly during the first three months, even up to the first year or two.
>Waiting Time From Procedure Until Diving:
>Three months. Dr. Potkin notes that pressure of the facemask, nasal congestion and the ability to equalize are potential issues, especially pertinent to divers who have had this surgery.