Dear Alice,

I am considering rhinoplasty. I am 23 years old. Why do I want to do so? The primary reason is my deviated septum, which although barely visible, if at all, from the outside, definitely makes it very difficult to breathe. But the reason that I don't want to settle for a simple septoplasty is that my nose is ever so slightly too big for my face. I would really like to underline ever so slightly. I am lucky to have a balanced face and nice proportions, but I am extremely self-conscious because my nose is just slightly too big. I understand that it's silly and that I should be grateful for my other features, with which I am very content. But ever since a silly ex-boyfriend foolishly joked that my nose is too big, I have become obsessed. I've thought through the reasons and I know that I am doing this for myself, not for anyone else. But I am still very concerned. I read that there can be complications. I even read that you may not wake up after the surgery due to complications with the anesthesia. A slightly big nose (and honestly I wouldn't even call it that) is definitely not worth losing your life! Can you please shed some light on the surgery, on the recovery, and on the risks? Will my voice change? Will I be able to sing? How long do most people walk around with dark circles under their eyes? What if I am unhappy with the results? The most important thing for me, of course, is being able to breathe through my nose and not having any complications.

What's in a nose

Dear What’s in a nose,

A rhinoplasty or “nose job” is actually one of the most sought after procedures worldwide, whether it be for medical or cosmetic purposes. While some people opt for a rhinoplasty to improve their breathing or reconstruct their nose after an injury, others may simply wish to smooth a bump or change the shape of their nose. And some, like you, consider it for reasons related to both form and function. You've mentioned you believe your face to be balanced, but that your ex-boyfriend's comments about your nose initiated your concerns about the shape of your nose. You may find some additional self-reflection helpful to ensure this procedure will result in the emotional and physical changes you're seeking. That said, before electing to have the procedure, there can be a lot to know about the surgery, as well as its associated recovery period and risks. How the surgery works, recovery (including how long the bruises last), and risks are all dependent on the type of surgery you have. Also, since you asked, it’s unlikely that either procedure that you mentioned will affect your voice or singing abilities. Before deciding, you may find it helpful to speak with your medical provider or plastic surgeon who can advise you further.

Similar to you, many people consider surgery to correct a deviated septum, in hopes of reducing difficulty breathing, snoring, nose bleeds, pain, and difficulty smelling. Surgical options include a septoplasty, which realigns the septum without cosmetically altering the nose, or a rhinoplasty, which reconstructs or corrects nasal and septal pathways and makes cosmetic changes. To change the appearance of the nose, non-surgical procedures use injectable fillers to make cosmetic, non-structural, changes to the nose. It’s worth noting that there aren’t any fillers currently on the market that are approved by the Food and Drug Administration (FDA) for a non-surgical rhinoplasty, although it's often used for this purpose off-label.

Since you’re particularly interested in rhinoplasties, it’s helpful to know what to expect during the surgery itself. Rhinoplasties are performed as “open” or “closed” procedures, with the difference being where the surgical incision is made. For an open rhinoplasty, the surgeon cuts the fleshy bit on the underside of the nose that separates the patient’s nostrils. Alternatively, for a closed rhinoplasty, the surgeon doesn’t cut any exterior part of the nose, focusing all surgical work on the inside of the patient’s nose. Some surgeons may prefer to not do a closed rhinoplasty, as it tends to be more difficult than an open rhinoplasty. If you’re deciding which of these two options is better for you, it might be helpful to talk with your surgeon to gauge their comfort in performing each operation and which may fix your deviated septum and achieve the change in nose shape you want.

As you decide on the best procedure for you, you may also consider the recovery period. Typically, a closed rhinoplasty has a shorter recovery period than an open rhinoplasty. During recovery, a splint or bandage is placed on a patient’s nose to provide it with protection and support and usually stays put for a week. It's not uncommon for bruises to appear under the eyes for the first two to three weeks after surgery. Some people may notice their swelling subsiding within a few weeks, while others may have to wait up to a year for the swelling to go down completely and for their new nose structure to fully heal. During the first year following surgery, it’s common for swelling to flare up, especially in the morning.

Regardless of the procedure you decide on, a rhinoplasty comes with its share of risks which vary depending on the patient’s health; however, many of them are rare or can be easily addressed. Surgery-related risks include bleeding during the procedure, infection, scarring, poor wound healing, uncomfortable changes in skin sensation (pain or numbness), difficulty breathing, and the possibility of needing a second surgery to fix any mistakes from the first. Though some of these risks may seem scary or overwhelming, you can find comfort in knowing that surgeons screen patients before they undergo surgery to reduce the risk of any complications.

Before you make a final decision, it's also helpful to reflect on reasons for your discomfort with your nose. It sounds like your ex-boyfriend’s joking got under your skin. Is this the first time that you remember thinking about your nose this way or have you always felt this way? How do you think the change in nose shape will make you feel about your appearance? You may find exploring these questions with a trusted family member, friend, or mental health professional to be helpful. Since there’s a chance the changes you seek may not be guaranteed, it may help to think about if you’re ready for a permanent change to your appearance. If you opt for a rhinoplasty but are unhappy with the results, you could meet again with your surgeon to discuss any modifications, recognizing the costs and risks that could be associated with a second procedure. If you're unsure if having a rhinoplasty is right for you, a quicker and easier fix may be to meet with a makeup artist and learn how to contour your nose using makeup. This could provide a fun, casual, and low-risk way for you explore different nose shapes and size without the permanence of a nose job. Who “nose”, with some reflection and make-up, you might decide to embrace your individual look and opt only to address the breathing concerns associated with your septum.

As you noted, whether a septoplasty or a rhinoplasty is right for you is a decision for you and you alone to make. Working with a health care provider can help inform your decision by providing more information about the various procedures, the risks associated, and what they can do for you specifically to help you achieve your goals. Whatever option you end up choosing will hopefully have you breathing easier soon!


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