Rhinoplasty can be performed either “open” (using an external incision) or “closed” (no external incision). The choice of approach is dictated by the specific goals of the patient, as well as any functional or anatomic issues which require a specific technique. Closed rhinoplasty, sometimes called scarless rhinoplasty, eliminates the incision in the columella (bottom of the nose, or the skin between the nostrils), and places the remaining incisions between the nasal cartilages inside the nose. This technique is very useful for patients with concerns about the bridge of the nose (nasal dorsum) but who desire minimal or no change to the nasal tip. Septoplasty can be performed along with either an open or closed rhinoplasty and can help to straighten a crooked nose and improve the patient’s breathing or reduce snoring.
Recovery from closed rhinoplasty is very quick. In most patients, the majority of the swelling in the nose lasts for a few days to a week. In addition, Dr. Ransom does not use any nasal packing, which allows the patient to breathe normally after the surgery and significantly reduces postoperative discomfort. Typically, patients will have a flexible plastic cast on the nose for about a week. All the sutures in closed rhinoplasty are dissolvable, so no suture removal appointments are needed. This procedure may be combined with other aesthetic or functional nasal or facial surgery.
For patients who want smaller changes to their nose, especially when the main concern is a “bump” on the bridge, a closed rhinoplasty is a great option. This procedure is ideal for reshaping the upper and middle portions of the nose but is not the best option for refinement of the nasal tip. In addition, patients with a crooked nose, a history of nasal trauma (for example, an untreated fracture), or significant functional concerns (breathing problems), are better served with an open approach. Finally, patients who have had a previous rhinoplasty or who have complex structural issues in the middle part or tip of the nose, are best treated with an open approach.
Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.
In many cases, you will have a cast on the nose for about a week after the procedure. This helps to protect the nose from accidental trauma, and also stabilizes the bones during the initial healing phase. No packing is used in the nose, which makes recovery much more comfortable. Your nose may feel “stuffy” for a few days, but this resolves quickly. Pain is minimal. You will likely feel tired for a couple days and should limit your activities and concentrate on resting and recovery. Contact sports, racket and ball sports, heavy lifting, and straining must be avoided until Dr. Ransom gives you the “okay” – this is typically a couple weeks.
For most patients, the initial recovery is very quick – typically a few days. Depending on the details of the surgery, a cast may be required for a week. Due to swelling inside the nose, many patients feel “stuffed up” for a few days. Bruising is limited, though some swelling will occur throughout the nose. The majority of this resolves over the first week, but some swelling may persist after that and may take longer to go away completely. Pain is minimal and Dr. Ransom does not use nasal packing, making recovery more comfortable for his patients.
During the healing phase after your procedure, there will be swelling inside the nose. This takes some time to resolve, and may cause a temporary sensation of blockage or “stuffy” nose. After the swelling resolves, there should not be any changes to your breathing. In fact, Dr. Ransom is a nose specialist and uses this knowledge to make sure that his patients’ breathing is not negatively affected by nose reshaping. In some cases where the septum is crooked or functional issues (difficult nasal breathing) exist before surgery, Dr. Ransom can actually improve the breathing during your rhinoplasty.
Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.