Rhinoplasty: Overview of the Nose Job Procedure
Guest: Dr. Krishna Patel – Facial Plastic Surgeon, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Krishna Patel, a specialist in the area of facial plastic and reconstructive surgery. Welcome, Dr. Patel.
Dr. Krishna Patel: Thank you.
Dr. Linda Austin: One of your areas of expertise is rhinoplasty, or what people commonly call nose jobs. Tell us, exactly, what a nose job, or rhinoplasty. Who is a candidate for that procedure?
Dr. Krishna Patel: Rhinoplasty, like you said, is surgery on the nose, and there are different reasons why people have rhinoplasty. One of them is for breathing; a functional issue. People feel like they don’t breathe well through their nose. Sometimes this is because they were born that way and they’ve always had difficulty. Other times, it’s after they’ve undergone some type of trauma or blow to their nose, and fractured their nose, and all of a sudden it’s now difficult for them to breathe.
For those people, usually, there are two different types of surgery that tend to be used to help this. One is called a septoplasty. A septoplasty is essentially straightening the area that divides the left and right side of your nose, or your nostrils. That usually helps people with their breathing. However, for some people, that does not do everything. People who have somewhat pinched noses, or breathe in heavy and the side walls of their nose collapse, those people need more than septoplasty to correct their breathing. That’s when you, in addition to the septoplasty, do a rhinoplasty, and we often call the septorhinoplasty.
For those people, the goal is to correct whatever it is on the outside of the nose that’s causing their blockage. This isn’t always something you can see in a person, but it oftentimes changes the shape if the nose after they’ve undergone a septorhinoplasty.
Dr. Linda Austin: And sometimes you do this for purely cosmetic reasons, is that right?
Dr. Krishna Patel: Correct, exactly. That’s the other group of people; people who breathe fine but don’t like the appearance of their nose. They may either have a hump on their nose, or they feel like their nose is crooked. There are lots of reasons why people may not like the appearance. Those people usually undergo rhinoplasty. And, depending on what needs to be done, everybody’s treated differently. You have to really study the nose because there are multiple procedures you can do to correct whatever needs to be corrected.
The reason I like my training is that I did ear, nose, and throat surgery, so I understand the function of the nose. And anytime I do a rhinoplasty, I’m very careful about preserving their ability to breathe while giving them the cosmetic appearance of the nose they wish for.
Dr. Linda Austin: You were double boarded then.
Dr. Krishna Patel: I am. Currently, I’m boarded in ear, nose, and throat surgery, or head and neck surgery, and I’m what’s called board eligible in facial plastic and reconstructive surgery, only because I’ve completed my training and finished all my tests, and passed everything. But there’s a required two-year wait period before you’re fully boarded.
Dr. Linda Austin: Do you perform these procedures for snoring sometimes?
Dr. Krishna Patel: For snoring, that is tricky. It’s often debatable within the field. Snoring can be caused from different levels of breathing. In other words, it can be caused from within the nose, with your septum being crooked, or it can be further down. If you have a long uvula, or your palate, any area, in the back part of your mouth is long or redundant, or floppy, people snore because of that. So, the primary, and most important, thing with snoring is that you be evaluated so you can predict where the snoring is coming from. If it looks as though it is just your nose that has obstruction, sometimes doing a septoplasty can resolve snoring.
Dr. Linda Austin: How long of a procedure is rhinoplasty?
Dr. Krishna Patel: It varies depending on what needs to be done. If it’s just that you need the hump of your nose reduced, that can be as fast as an hour. However, many patients that I see have multiple issues that need to be addressed, or they’ve had previous surgery. With repetitive surgery, there can be scar tissue, and so forth, and it can last up to about four hours.
Dr. Linda Austin: It sounds like it must be very delicate surgery.
Dr. Krishna Patel: It is.
Dr. Linda Austin: Very painstaking surgery to get it just right.
Dr. Krishna Patel: It is. It’s probably one of my favorite surgeries, but it’s extremely challenging, and you have to be very careful, absolutely.
Dr. Linda Austin: How does a child, or teenager, have to be to have a rhinoplasty?
Dr. Krishna Patel: When you have child with a severe deformity and wishes for a rhinoplasty, the safest thing to do is to wait until they’ve finished their growth spurts. It’s different for females and males. For females, it tends to be around 16 years of age. Usually by then, the growth of their nose and face has reached adult status and it’s safe to proceed. For boys, they tend to go through further growth periods until the age of 18, so we tend to wait until they’re 18. Now, there are, sometimes, exceptions. If someone has a severe deformity and it’s completely blocking their ability to breathe, we try doing a very conservative surgery to relieve that.
Dr. Linda Austin: Recovery time, how long does it take before the person is totally back to normal after rhinoplasty?
Dr. Krishna Patel: That’s a good question. Sometimes people are confused. If you just do a septoplasty, where you’re straightening the septum, that recovery tends to be two weeks, and then you start resuming your normal function. Rhinoplasty is different. Rhinoplasty, when you’re doing surgery on the outer part of the nose, you tend to have a lot of swelling involved, and sometimes even the appearance of a black eye, so that takes longer to resolve. I usually tell people that they’re going to be extremely swollen for the first two weeks, and by about week three, their nose will be dramatically better as far as swelling. But they will notice a difference and still won’t look quite like their nose for a couple of months. It’s just a millimeter at a time that the swelling decreases, but most of the swelling goes down by week three.
Dr. Linda Austin: Thanks so much for talking with us today.
Dr. Krishna Patel: Thank you.
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