A rhinoplasty is a procedure to reshape the nose and/or to improve breathing. Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both.
The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage, skin or all three. Talk with your Boston plastic surgeon about whether rhinoplasty is appropriate for you and what it can achieve.
When planning rhinoplasty, your Boston plastic surgeon will consider your other facial features, the skin on your nose and what you would like to change. If you are a candidate for surgery, your Boston plastic surgeon will develop a customized plan for you.
Sometimes part or all of a rhinoplasty is covered by insurance. The most common reasons patients undergo a rhinoplasty include:
-To change or improve appearance
-To open blocked nasal passages that are caused by a deviated septum
-To correct an injury or birth deformity
The surgery is done by making incisions inside the nostrils or outside the nostrils across the columella. The underlying cartilage and bone structures are then exposed and altered to produce the desired result.  



Who Is a Candidate?  
A rhinoplasty can be done at any age, but the procedure is recommended for those who have finished puberty and nose growth. Any person who wants to improve the appearance of their nose is a good candidate. Patients with a history of nasal trauma and increased difficulty breathing are candidates for evaluation.

Before the Procedure
Some of the specific instructions you’ll receive about preparing for surgery include:
-Smoking cessation
-Medications to avoid
-When to take your prescribed medications
-Proper washing techniques
-Restrictions regarding eating and drinking the night before surgery

Procedure Details
A rhinoplasty can be done in a variety of ways with different types of incisions.  Your plastic surgeon will perform a careful evaluation of your entire face including your chin and mid-face, and suggest which procedure is best for you. The surgeon will show you where the incisions will be made.

A rhinoplasty has three main components:
Lifting the skin of the nose from the bone and cartilage. The nose is injected with xylocaine (a numbing medication), and epinephrine (to minimize bleeding). After the incisions are made, the skin is then lifted off the cartilage of the nose to expose the cartilage and the bone structures that will be altered.
Remodelling bone and cartilage. Depending on the desired outcome, some nasal bone may be removed, precisely cut, and reset to a new shape. Cartilage may be trimmed. Other techniques involve using a tissue graft (most often cartilage or bone) to help remodel the shape of the nose. Occasionally, a synthetic graft may be used.
Redraping the skin over the new base. Once the procedure is finished, the incisions are closed and the skin is redraped over the new bone structure. The skin is taped to keep it in place and a protective splint is applied on the outside of the nose so that it maintains the proper position when healing. Nasal packs generally are not necessary.

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