Primary Rhinoplasty – What Can You Expect?

Primary rhinoplasty is a procedure designed to cosmetically improve the nose…


The term Primary Rhinoplasty is used to describe a nose surgery procedure which is done purely for cosmetic reasons.  In essence, it is a first time nose operation.  It is typically not performed to correct functional issues in the nose or reconstructive issues resulting from trauma. There are many reasons a person may choose to undergo a Primary Rhinoplasty in Denver, Colorado. Some of the issues that people use rhinoplasty surgery to correct or improve are to change the shape of the tip of the nose, to improve the nasal profile by removing bumps or indentations, to change the angle of the nose as it relates to the mouth, to change the shape or size of the nostrils and to improve overall facial harmony.

A Primary Rhinoplasty procedure is most ideal for patients who’ve completed their mid facial growth period, generally considered to be after 14 years of age in females and after 17 years of age in males. Patients should be in good health and should only be considering rhinoplasty for their own personal benefit and not to please anyone else. Patients should also have realistic goals and expectations. Rhinoplasty procedures can affect a great deal of improvement in a nose, but it is generally not recommended to try to change the nose drastically.  Consulting with a skilled board-certified plastic surgeon who specializes in facial plastic surgery procedures, such as Dr. Manish H. Shah, is the best way to determine if your goals are achievable.

Your consultation with Dr. Shah will allow for a physical examination of your nose after discussing your relevant pre-history.  Dr. Shah will then typically take multiple pictures of your nose from various angles.  He then takes these digital photos and puts them into Rhinoplasty simulation software.  With this software he can simulate various changes to your nose to give you an approximate idea about your possible outcomes.  It is important to note that Rhinoplasty simulations are not a guarantee or warranty of any particular outcome.  Dr. Shah uses the simulations to help educate you, the patient, about what is possible and what is not possible.  Complications from rhinoplasty surgery are quite rare but they can include the following: bleeding, infection, scarring, wound healing problems, asymmetry, numbness, soft tissue loss, breathing problems, septal perforation, dorsal saddle nose deformity, stiffness, need for revision surgery, dissatisfaction with the cosmetic outcome, reactions to medications and anesthesia, heart problems, lung problems, brain problems, and death.  While this might sound scary, rest assured that actual risks are quite rare.  Safety should always be a priority!

Primary Rhinoplasty procedures are typically performed in fully-accredited outpatient surgery centers, and in certain situations, in hospital.  Dr. Shah uses board-certified M.D. Anesthesiologists.  Dr. Shah prefers to use full general anesthesia because he believes it allows for better control of the patient’s airway.  This maximizes safety!  No one, but Dr. Shah, touches the patient.  Dr. Shah, though he loves to teach, is the only person who will be operating on your nose.  Most patients typically experience very little bleeding or post-operative bruising.  Postoperative nausea and vomiting are also fairly rare.  Pain control is fairly easily established, and most patients stop their narcotics by post-operative day # 2. A patient will rarely wake up with nasal packing.  If extensive work is done to straighten a deviated nose, Dr. Shah will often leave temporary internal splints to help mold the airway and insure that breathing will ultimately be improved.  All patients have an external molding splint left on for at least seven days after surgery.  This helps stabilize the skin and keep any surgically fractured nasal bones in place.

The first week is typically the hardest week for the patient.  They will be sleeping with their head elevated.  They will be applying ice packs to reduce bruising and swelling.  They are not allowed to get their faces wet, so hair washing is a bit difficult to do.  Dr. Shah recommends bathing during this first week.  A cool mist humidifier at the bedside is very soothing for the face and throat.  After this week, you will typically have your external splint and any external sutures removed.  External sutures are used only if you are having an open rhinoplasty and/or you are having your nostrils narrowed.  If the rhinoplasty is a closed procedure (endonasal approach) then all the incisions are hidden inside the nose and there will be no sutures to remove.

At this point, you will be taught the second phase of your care.  You will be allowed to rinse out your nose with saline spray and use oral decongestants to unclog your airways.  You will be taught night-time taping techniques and soft tissue massage to help mold your nose.  You will not be able to use eyeglasses, sunglasses, or ski goggles for two months to avoid shifting fractured nasal bones.  Your nose may swell after the splint is removed, but with time it will decongest.  The upper part of the nose settles in after about three months. The bones are at their hardest at this point.  For the next five to six months after this, most patients don’t notice big changes.  Finally, around months ten to twelve after surgery, the tip of the nose finalizes its cosmetic outcome.  Patients must realize that patience is mandatory because it will be at least one year before they see how their Rhinoplasty surgery turned out!

About the author Manish H. Shah, MD, FACS

I am a board-certified plastic surgeon practicing in Denver, Colorado. I specialize in cosmetic surgery of the face and body. Rhinoplasty, Revision Rhinoplasty, and Ethnic Rhinoplasty are my favorite procedures.

All posts by Manish H. Shah, MD, FACS →

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