NOSE RESHAPING - SPECIFIC SURGICAL RISKS

DESCRIPTION                    

q      INTRODUCTION:  Surgery of the nose (rhinoplasty, tipplasty) is an operation frequently performed by plastic surgeons.  This surgical procedure can produce changes in the appearance, structure, and function of the nose.  Rhinoplasty, tipplasty can reduce or increase the size of the nose, change the shape of the tip, narrow the width of the nostrils, or change the angle between the nose and the upper lip.  This operation can help correct birth defects, nasal injuries, and help relieve some breathing problems.

Surgery of the nasal septum (septoplasty) is performed to correct breathing problems caused by a distorted (deviated) nasal septum, which divides the nostrils.  Septal deviation can interfere with the passage of air though the nose.  Distorted cartilage and bone is selectively removed beneath the mucous membranes of the septum in order to improve nasal breathing.  There are a number of techniques and approaches for septoplasty.  Septoplasty can be performed in conjunction with other nasal surgeries.

A variety of conditions such as allergies, sinus disorders, nasal polyps, snoring problems, and breathing disorders from other causes may co-exist with a deviated septum. 

q      There is not a universal type of rhinoplasty,tipplasty surgery that will meet the needs of every patient.  Rhinoplasty,tipplasty surgery is customized for each patient, depending on his or her needs.  Incisions may be made within the nose or concealed in inconspicuous locations of the nose in the open rhinoplasty procedure.  Internal nasal surgery to improve nasal breathing can be performed at the time of the rhinoplasty. 

q      The best candidates for this type of surgery are individuals who are looking for improvement, not perfection, in the appearance of their nose.  In addition to realistic expectations, good health and psychological stability are important qualities for a patient considering nasal surgery.  Nasal surgery can be performed in conjunction with other surgeries.

RISKS

q      BLEEDING: It is possible, though unusual, that you may have problems with bleeding during or after surgery.  Should post-operative bleeding occur, it may require emergency treatment to stop the bleeding or blood transfusion.  Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this contributes to a greater risk of bleeding.  Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery.  Accumulations of blood under the skin or mucous membrane of the septum may delay healing and cause scarring.  

q      DAMAGE TO DEEPER STRUCTURES: Deeper structures such as nerves, tear ducts, blood vessels and muscles may be damaged during the course of surgery.  The potential for this to occur varies with the type of nasal procedure performed.  Injury to deeper structures may be temporary or permanent.

q      UNSATISFACTORY RESULT: There is the possibility of an unsatisfactory result from the nasal surgery.  The rhinoplasty may result in unacceptable visible or tactile deformities, loss of function, or structural malposition after surgery.  Septoplasty surgery may not improve your nasal breathing.  The procedure may also interfere with normal nasal physiology, or result in structural malposition of the nasal septum.  You may be disappointed that the results of surgery do not meet your expectations.  Additional surgery may be necessary should the result of surgery be unsatisfactory.

q      NUMBNESS: There is the potential for permanent numbness within the nasal skin after rhinoplasty.  There is the potential for permanent numbness within the upper mouth and teeth after septoplasty.  The occurrence of this is not predictable.  Diminished (or loss of skin sensation) in the nasal area may not totally resolve after nasal surgery.

q      ASYMMETRY: The human face is normally asymmetrical.  There can be a variation from one side to the other in the results obtained from a nasal procedure. 

q      CARTILAGE GRAFTS:  Cartilage grafts may be needed if the goal of surgery is to change the projection of the nasal tip.  These grafts can be obtained from donor locations within the nose (nasal septum) or from other parts of the body.  Complications including nasal septal perforation may occur from the procurement of cartilage graft material.  More than one location may be needed in order to obtain sufficient amounts of cartilage.

q      CHRONIC PAIN: Chronic pain may occur very infrequently after nasal surgery.

q      SKIN DISORDERS/SKIN CANCER: Rhinoplasty, septoplasty and tipplasty are surgical procedures to reshape both internal and external structures of the nose.  Skin disorders and skin cancer may occur independently of nasal surgery.

q      LONG TERM EFFECTS: Subsequent alterations in nasal appearance may occur as the result of aging, sun exposure, or other circumstances not related to rhinoplasty surgery.  Subsequent alterations in nasal function may occur as the result of aging, environmental allergies, or other circumstances not related to septoplasty surgery.  Future surgery or other treatments may be necessary to maintain the results of a nasal operation.

q      NASAL SEPTAL PERFORATION: There is the possibility that surgery will cause a hole in the nasal septum to develop.  The occurrence of this is rare.  However, If it occurs, additional surgical treatment may be necessary to repair the hole in the nasal septum.  In some cases, it may be impossible to correct this complication.

q      NASAL AIRWAY ALTERATIONS: Changes may occur after a rhinoplasty, tipplasty or septoplasty operation that may interfere with normal passage of air through the nose.

q      RESIDUAL SEPTAL DISTORTION:  It may not be possible to completely resolve distortions within the nasal septum with surgery.

q      SUBSTANCE ABUSE DISORDERS:  Individuals with substance abuse problems that involve the inhalation of vasoconstrictive drugs such as cocaine are at risk for major complications including poor healing and nasal septal perforation.

q      SNORING DISORDERS:  Snoring disorders may be caused by a variety of factors.  Septoplasty may not relieve the propensity of some individuals to snore.

q      ALTERNATIVES: Alternative forms of management consist of not undergoing the nasal surgery.  Certain internal nasal airway disorders may not require surgery and can be treated medically.  Other forms of surgery may be indicated to treat breathing problems caused by other conditions.  Risks and potential complications are associated with alternative forms of treatment that involve surgery to correct nasal-airway disorders.