Nasal Deformities

Nasal reconstruction surgery can encompass many techniques. The extent of the deformity, the health of surrounding tissues, and your overall physical health play crucial roles in determining the surgeon’s approach and the outcome of the reconstructive surgery.

In cases with significant structural challenges or compromised tissue integrity, achieving an ideal aesthetic outcome might not be feasible. However, it is important to recognize that nasal reconstruction is not an operation of perfection. The goal is to improve the current appearance and function of the nose as much as possible.

Functional issues with this crucial part of your anatomy can contribute to discomfort when breathing and related issues like frequent sinus infections, snoring, poor sleep, and challenges with exercise and meditation. Addressing these issues and aesthetics can significantly boost self-confidence and improve your quality of life.

It is important to have realistic expectations about outcomes, given the dual goals of this procedure and the challenges that such a delicate procedure presents. Be sure to have a candid conversation with an experienced surgeon about possible outcomes, potential benefits, and risks of surgery.

Nasal deformities encompass a wide spectrum of structural abnormalities that can affect the appearance and function of the nose. These can be present at birth due to conditions like a cleft lip or develop later in life from various causes, including trauma, skin cancer, autoimmune disorders, or infections. Deformities can also occur due to prior cosmetic rhinoplasty or natural aging. The severity of nasal deformities ranges from subtle changes to significant alterations in nasal shape and size, potentially impacting breathing, smell, and quality of life.

Correction of nasal deformities typically involves surgical intervention, with complex rhinoplasty being the most common procedure. The specific techniques employed depend on the nature and severity of the deformity, ranging from minor adjustments to more elaborate reconstruction using grafts from the rib area or other parts of the body. Skin cancer-related nasal reconstruction often involves using local skin tissues or flaps to restore the nasal structure and maintain functionality and aesthetics. Techniques such as the paramedian forehead flap or skin grafts are commonly applied to achieve optimal results.

There are only a limited number of alternatives to surgery for major nasal deformities. Although minimally invasive methods, such as filler injections, can subtly enhance contours or correct minor nasal asymmetries, surgical approaches offer more comprehensive improvements, ideal for addressing structural issues like cleft noses or post-traumatic deformities. Using fillers for nasal reconstruction also carries risks such as tissue necrosis and vascular complications, including blindness in rare circumstances.

Other non-surgical methods, such as laser therapy and dermabrasion, can enhance skin texture for conditions like rhinophyma — a severe form of rosacea causing nasal deformities through skin thickening and sebaceous gland enlargement. However, surgical repair remains the most effective treatment for significant improvements and severe cases of rhinophyma.

Nasal reconstruction, whether it involves delicate bone realignment, soft tissue modification, or surface treatments, must be personalized, balancing your aesthetic goals with functional restoration. Be sure to seek out an experienced board-certified plastic surgeon or facial plastic surgeon who has extensive expertise in primary and revision rhinoplasty, as well as complex nasal reconstruction.

Before you go

During a nasal reconstruction or complex rhinoplasty consultation, it is essential to ask your surgeon about their experience with similar cases, the techniques they recommend, potential risks, and the expected recovery process. Inquire about before-and-after photos of previous patients, as well as the surgeon’s credentials and board certifications.

Your surgeon should conduct a thorough examination of your nasal structure, discuss your aesthetic and functional goals, and review your medical history. Be transparent about any current or previous use of tobacco, vaping, Afrin (a nasal decongestant spray), or cocaine, as these can impact the surgical timing and planning.

Your surgeon may also perform a CT scan or nasal endoscopy to evaluate deeper nasal structures. They should explain the surgical plan in detail, including the number of stages required, if applicable, and provide clear information on the expected outcomes and potential complications. Morphing software may also be used to help visualize potential results.

During the procedure

On the day of nasal reconstruction surgery, you can expect to arrive at the surgical center early for pre-operative preparations, including changing into a surgical gown and meeting with both your surgeon and the anesthesiologist.

The anesthesiologist will review your medical history and explain the anesthesia process. Most nasal reconstructions and rhinoplasties are performed under general anesthesia so you are comfortable and pain-free.

The surgeon will then review the surgical plan and address any last-minute questions. During the surgery, which may take several hours, the surgeon will carefully reconstruct the nasal structures using techniques discussed during consultation. Conditions such as rhinophyma may additionally require laser resurfacing, dermabrasion, or excision, to improve the nose’s shape. Post-cancer surgery reconstructions might involve complex skin flaps and tissue grafting.

After surgery, you’ll be taken to the recovery room where medical staff will monitor you as you wake from anesthesia. You may have nasal packing or splints in place and will receive instructions for managing pain, swelling, and post-operative care.

Nasal Reconstruction Aftercare 

In the days and weeks following nasal reconstruction, you can expect some pain, swelling, and bruising, particularly around the eyes and nose. Pain is usually manageable with over-the-counter and prescribed medications. Swelling peaks within the first few days and gradually subsides over several weeks.

It is crucial to follow your surgeon’s post-operative care instructions, including keeping your head elevated, avoiding strenuous activities, and attending follow-up appointments. Your nasal cast will be removed after a week, and you can return to work within two weeks. Full healing and final outcomes, including the resolution of residual swelling and refined nasal shape, can take up to one to three years.