What are the recommendations and precautions for undergoing rhinoplasty?

Rhinoplasty: Recommendations and Precautions

Rhinoplasty requires a systematic approach based on individualized analysis of nasal anatomy, as it often addresses both functional problems and aesthetic deformities, with potential complications including breathing difficulties, infection, and dissatisfaction with results. 1

Pre-Surgical Assessment and Patient Selection

• Surgeons should thoroughly evaluate patients' motivations and expectations for rhinoplasty, providing realistic feedback about potential outcomes and documenting this discussion 2
• Assessment should include screening for comorbid conditions that could affect surgical outcomes, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs 2
• Facial asymmetry should be carefully evaluated as it may limit surgical correction possibilities and affect outcomes 1
• Nasal airway obstruction should be evaluated during preoperative assessment to address functional concerns alongside aesthetic goals 2

Surgical Planning and Approach

• The nose should be analyzed by dividing it into horizontal thirds (upper, middle, and lower), examining each third in relation to the midline to facilitate systematic correction 1
• Modern rhinoplasty has evolved from framework reduction to techniques characterized by conservatism, rearrangement, and augmentation using autogenous cartilage grafts 1
• Autogenous cartilage grafts are recommended for repositioning, reinforcement, recontouring, and reconstruction of nasal components to increase stability and improve outcomes 1
• Camouflaging techniques (using thin cartilage wafers to fill depressions) may be employed to create the illusion of straightening and improve asymmetries 1

Potential Complications and Risks

• Breathing disturbances are reported in up to 70% of revision-rhinoplasty patients, making preservation of nasal function a critical consideration 3
• Common postoperative issues include bruising, bleeding (89.2%), pain (73.2%), anesthesia complications (46.1%), inflammation (45%), and dissatisfaction with results (42.8%) 4
• The most frequent postoperative deformity is the "pollybeak" (occurring in about 50% of revision cases), characterized by a deep naso-frontal angle, cartilaginous hump, and reduced tip projection 3
• Other common deformities include pendant and wide nasal tip, retractions of the columella base, or irregularities of the nasal dorsum, often caused by loss of septal support 3
• Rare but serious complications can include infections (sometimes life-threatening), orbital region injuries, necrosis of eyelids, and blindness due to central artery occlusion 3

Perioperative Management

• Perioperative antibiotics, when used, should not be routinely prescribed for more than 24 hours after surgery 2
• Nasal packing should not be routinely placed in the nasal cavity of rhinoplasty patients at the conclusion of surgery 2
• Perioperative systemic steroids may be considered as an option to reduce postoperative swelling 2
• Patients should be educated about strategies to manage discomfort after surgery before the procedure 2

Postoperative Care and Follow-up

• Patients should be advised to refrain from blowing their nose for 1 week and from flying, diving, forceful sneezing, or playing wind instruments for at least 6 weeks 1
• Pain management should be planned in advance, with pain typically peaking in the first 3 days following surgery 1
• Non-narcotic options such as acetaminophen are often effective for pain management, though individual pain experiences vary 1
• Patient satisfaction with nasal appearance and function should be documented at a minimum of 12 months after rhinoplasty 2

Special Considerations

• Septoplasty is infrequently performed in children because it may negatively affect nasal growth, particularly of the nasal dorsum 1
• Nasal surgery alone is not recommended for treatment of obstructive sleep apnea but may be beneficial for reducing high therapeutic CPAP pressure due to nasal obstruction 1
• Maintaining the stability of the caudal septum in septorhinoplasty is key for a predictable result and avoiding typical postoperative deformities 3
• The risk of complications decreases with surgeon experience, highlighting the importance of continuing education and proper patient selection 3