Redraping the Skin
When your surgeon has finished reshaping the structures within your nose, he or she will redrape the skin over the new framework. If your nose has been reduced in size, your skin will contract to fit the size of the new framework. In general, it isn't necessary to remove any skin during rhinoplasty. If cartilage grafts were added, the skin will likely be
redraped over soft-tissue grafts to prevent the cartilage from becoming visible in the future.
Closing Incisions
Once the best results possible have been achieved, your surgeon will close the incisions. The incisions inside the nose and across the columella are closed using very fine sutures that are about as thick as a single hair. The sutures used in rhinoplasty may be absorbable, nonabsorbable, or a combination of both. Absorbable sutures dissolve on their own and don't require removal in your surgeon's office. Nonabsorbable sutures require removal in your surgeon's office.
Dressings
Once your surgery has been completed, dressings will be applied to your nose. Surgical tape is applied tightly to the skin across the bridge and, in some cases, under the base of your nose. The tape serves a dual purpose: it protects the skin and helps reduce swelling.
A small splint is then placed on the bridge of your nose to stabilize the reshaped nasal bones and tissues. Nasal splints come in a variety of materials, including metal and plaster of Paris. The type of splint used is usually a matter of your surgeon's personal preference. For added comfort, the underside of the splint may be lined with soft cloth. The splint may be self-adhering or may be kept in place with additional tape.
Gauze pads are applied below the base of your nose and are taped into place. The gauze pads are used to absorb any postoperative nasal discharge. Cold cloths may be placed on your forehead to reduce swelling.
Nasal Packing
In the past, long strips of gauze coated with antibiotic ointment or petroleum jelly were used to pack the nostrils to minimize bleeding and support the nose following surgery. Although this nasal packing used to be commonplace, a growing number of surgeons have stopped using it because it increases discomfort, contributes to added swelling and
bruising, and prolongs the recovery period. In addition, while nasal packing is in place, it's impossible to breathe through the nose. Instead of using packing, surgeons now use special surgical techniques to control bleeding and provide nasal support. Some surgeons may insert a small pack of absorbent gauze inside the nostrils which will be removed the following day. It's important to note that even if you don't have any packing in your nostrils, postoperative swelling may make it difficult to breathe through your nose for a few days after your surgery.
Some surgeons may place pliable nasal splints made out of silicone inside the nostrils, especially if the septum was severely deviated. These splints are usually removed in your surgeon's office in approximately one week. Although the splints have tubes attached that allow you to breathe through your nose after surgery, they are usually considered uncomfortable. Most patients prefer not to have anything inside the nostrils
following surgery.
Chin Augmentation
If your surgeon has determined that chin augmentation, in addition to rhinoplasty, will help you achieve a more balanced profile, it is often performed at the time of your rhinoplasty procedure; the implant procedure is usually performed first and takes about thirty minutes. In this procedure, an incision is made either underneath your chin or inside your mouth where your lower lip meets your gum. The surgeon then inserts the chin implant. Chin implants come in a variety of shapes and sizes and are made of natural-feeling synthetic material, such as solid silicone. Once the implant is in place and the desired chin projection is achieved, the surgeon closes the incision with fine absorbable or
nonabsorbable sutures.
In the Recovery Room
After your rhinoplasty procedure, you'll be taken to the recovery room. During your stay in the recovery room, your vital signs will continue to be monitored closely. You can expect to feel drowsy while you're in the recovery room. This drowsiness will soon dissipate; how long it lasts depends on the type of anesthesia used, your individual response to the anesthesia, and whether you received other medications. If you're like most patients, you may be worried about feeling pain immediately following your procedure. Rest assured that there is generally little or no pain following rhinoplasty.
Side Effects of Anesthesia
You may experience some side effects as the anesthesia wears off. The degree to which you experience side effects is highly individualized and may depend on the type of anesthesia used. In general, side effects from sedation anesthesia, commonly used for rhinoplasty, are minimal. It's common to feel confused and disoriented. Mild reactions to anesthesia also include nausea, sore throat, and dry mouth. However, thanks to anti-nausea medications, the risk of nausea and vomiting following surgery is very low.
Allergic reactions to anesthesia are rare and are usually preventable. By informing your surgeon and anesthesiologist of all known allergies, you can help prevent an allergic reaction. Based on the information you give them, your surgeon and anesthesiologist will select the anesthesia drugs least likely to produce a reaction.
Leaving the Surgical Facility
You'll continue resting in the recovery room until the staff decides that it's safe for your caregiver to drive you home. Most rhinoplasty patients are ready to go home within a few hours after surgery.
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