Introduction

Rhinoplasty is challenging. Over the past 20 years, the trend has shifted from ablative techniques involving reduction or division of the osseocartilaginous framework to techniques that conserve native anatomy. Cartilage sparing suture techniques and augmentation of deficient areas to correct contour deformities and restore structural support are commonly employed. The rhinoplasty surgeon must understand the underlying anatomy and have the ability to perform nasofacial analysis to determine the operative plan ad the training to execute techniques that manipulate bone, cartilage, and aoft tissue. These skills are augmented by an aesthetic eye in order to produce a result that harmoniously with the rest of the face.

 Preoperative assessment

Computer imaging has proven to be a useful tool to provide the patient with a visual understanding of the anticipated outcome, although the images are not meant to guarantee surgical results. These images, combined with standardized anterior, oblique, lateral, and basal photographs, serve as helpful adjuncts in the planning of the operation.  

 Operative technique

There are two schools of modern rhinoplasty – those who prefer the open approach and those who prefer the closed one. While both approaches have their advantages and disadvantages, it is important to be familiar with both. The experienced surgeon will tailor the approach to the patient' s anatomic deformity. Regardless of the approach, however, the modifications made to the underlying framework are more important than which incision is used.

 Postoperative management

1. During the first 48 to 72 hours, the patient is instructed to keep the head of bed elevated at 45° 
2. Any manipulation of the nose, including rubbing, botting, or blowing, is discouraged for the first 3 weeks postoperatively.
3. Sneezing should be done through the mouth during this time
4. It is imperative to keep the nasal splint dry.
5. The hair should be washed with assistance the sink
6. Any foods that require excessive lip movements, such as eating apples or corn on the cob, should be avoided for 2 weeks after surgery
7. The sutures and nasal splints are removed at the initial visit on postoperative days 8 to 10.
8. The nose ( especially the tip ) may appear the swollen and turned up and the tip may feel numb, but the patient is reassured that both are expected and will resolve over several months.
9. Normal sensation usually returns within 3 to 6 months
10. The patient is instructed to avoid letting anything, including eyeglasses, rest of the nose for at least 6 months.
11. Contact lenses may be worn as soon as the swelling has diminished enough to allow easy insertion ( usually less than 5 to 7 days postoperatively)
12. Any contact sports or activities that may cause direct trauma to the nose are prohibited for at least 6-8 weeks after surgery.
13. Although some noses look excellent within 6 to 8 weeks, some may have persistent edema for up 1 year.
14. After 3 to 4 weeks, however, the swelling will generally not be obvious to anyone but patient.
15. After the first postoperative visit, the patient returnes for follow-up at 6 and 12 months postoperatively.