Rhinoplasty is one of the most common of all plastic surgery procedures. Yet one of the most complex to preform. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect, injury, or some breathing problems.This information will give you an understanding of the rhinoplasty procedure, when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand thoroughly
          

Anatomy The nose is the peripheral organ of the sense of smell: by means of the peculiar properties of its nerves it protects the lungs from the inhalation of deleterious gases and assists the organ of taste in discriminating the properties of food.

The organ of smell consists of two parts: one external, the outer nose; the other internal, the nasal fossae." The outer nose (nasus externus) is the more anterior and prominent part of the organ of smell. Of a triangular form, it is directed downward, and projects from the center of the face, immediately above the upper lip. Its summit, or root, is connected directly with the forehead. Its inferior part, or base, presents two elliptical orifices, the nostrils or anterior nares, separated from each other by an anteroposterior septum, the columna. The margins of these orifices are provided with a number of stiff hairs, or vibrissae, which arrest the passage of foreign substances carried with the current of air intended for respiration. The lateral surfaces of the nose form, by their union in the middle line, the dorsum, the direction of which varies considerably in different individuals. The lateral surface terminates below in a rounded eminence, the ala nasi.
The nose is composed of a framework of bones and cartilages, the latter being slightly acted upon by certain muscles. Its is covered externally by the interument, internally by mucous membrane, and supplied with vessels and nerves.

The bony framework occupies the upper part of the organ: it consists of the nasal bones and the nasal processes of the superior maxillary.
The cartilaginous framework consists of five pieces, the two upper and the two lower lateral cartilages and the cartilages and the cartilage of the septum.
The upper lateral cartilages are situated below the free margin of the nasal bones; each cartilage is flattened and triangular in shape. Its anterior margin is thicker than the posterior, and continuous with the cartilage of the septum. Its posterior margin is attached to the nasal process of the superior maxillary and nasal bones. Its inferior margin is connected by fibrous tissue with the lower lateral cartilage; one surface is turned outward, the other inward toward the nasal cavity.

The lower lateral cartilages are two thin, flexible plates situated immediately below the preceding, and bent upon themselves in such a manner as to form the inner and outer walls of each orifice of the nostril. The portion, which forms the inner wall, thicker than the rest, is loosely connected with the same part of the opposite cartilage, and forms a small part of the columna. Its inferior border, free, rounded, and projecting, forms, with the thickened integument and subjacent tissue and the corresponding parts of the opposite side, the septum mobile nasi. The part which forms the outer wall is curved to correspond with the ala of the nose; it is oval and flattened, narrow behind, where it is connected with the nasal process of the superior maxilla by a tough fibrous membrane, in which are found three or four small cartilaginous plates (sesamoid cartilages-cartilaginous minors). Above, it is connected by fibrous tissue to the upper lateral cartilage and front part of the cartilage of the septum; below, it falls short of the margin of the nostril; the ala being formed by dense cellular tissue covered by skin. In front the lower lateral cartilages are separated by a notch that corresponds with the point of the nose.

The cartilage of the septum is somewhat quadrilateral in form, thicker at its margins than at its center, and completes the separation between the nasal fossae in front. Its anterior margin, thickest above, is connected with the nasal bones, and is continuous with the anterior margins of the two upper lateral cartilages. Below, it is connected to the inner portions of the lower lateral cartilages by fibrous tissue. Its posterior margin is connected with the perpendicular lammella of the ethmoid; its inferior margin with the vomer and the palate processes of the superior maxillary bones.

It may be prolonged backward (especially in children) for some distance between the vomer and perpendicular plate of the ethmoid, forming what is termed the processus sphenoidalis. The septal cartilage does not reach as far as the lowest part of the nasal septum. This is formed by the inner portions of the lower lateral cartilages and by the skin; it is freely movable, and hence is termed the septum mobile nasi.
These various cartilages are connected to each other and to the bones by a tough fibrous membrane, which allows the utmost facility of movement between them.

The muscles of the nose are situated beneath the integument: they are (on each side) the pyramidalis nasi, the levator labii superioris alaeque nasi, the dilatator naris, anterior and postior, the compressor nasi the compressor narium minor, and the depressor alae nasi. They have been described above.
The integument covering the dorsum and sides of the nose is thin, and loosely connected with the subjacent parts: but where it forms the tip and the alae of the nose it is thicker and more firmly adherent, and is furnished with a large number of sebaceous follicles, the orifices of which are usually very distinct.
The mucous membrane lining the interior of the nose is continuous with the artery of the skin externally and with that which lines the nasal fossae within.

The arteries of the nose are the lateralis nasi from the facial, and the inferior artery of the septum from the superior coronary, which supply the alae and septum, the sides and dorsum being supplied from the nasal branch of the ophthalmic and the infra-orbital.
The veins of the nose terminate in the facial and ophthalmic.
The nerves for the muscles of the nose are derived from the facial, while the skin receives its branches from the infra-orbital, infratrochlear, and nasal branches of the ophthalmic.

BEFORE SURGERY

The best candidates for rhinoplasty.

Rhinoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.

Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems.

Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they've completed their growth spurt-around 14 or 15 for girls, a bit later for boys. It's important to consider teenagers' social and emotional adjustment, too, and to make sure it's what they, and not their parents, really want.

Planning your surgery

Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of you skin, your age, and your expectations.

Your surgeon will also explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Check with your insurer, and obtain pre-authorization for your surgery.

Be sure to tell your surgeon if you've had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you're taking any medications, vitamins, or recreational drugs; and if you smoke." +newline+newline+
"Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where your surgery will be performed

Rhinoplasty may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.

Types of anesthesia

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and your surgeon prefer.

With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you'll sleep through the operation.

The surgery

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the skin is redraped over the new framework."

Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils, others prefer an 'open' procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils.

When the surgery is complete, a splint will be applied to help your nose maintain its new shape, nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.