I. INTRODUCTION

Cosmetic rhinoplasty is surgery to reshape the nose. In the United States, approximately 50,000 cosmetic rhi­noplasties are performed each year. Common requests include making a nose smaller, reducing the bridge of the nose, narrowing the nose, making changes to the nasal tip, and lifting a droopy tip. Patients seek­ing treatment also include those whose noses are too short, too long, too narrow, too wide, twisted, and so forth. Also, a significant number of patients who suffer nasal fractures later seek rhinoplasty.

A number of patients desire improvement in their nasal breathing and their nasal appearance. Fortu­nately, a number of procedures (including noncos­metic, or functional rhinoplasty) allow the surgeon to substantially improve nasal breathing at the same time that cosmetic changes are made.

Patients who do not like the way their noses look and who are in good physical and mental health are eligible for a rhinoplasty consultation. The next step is to meet with a skilled surgeon to see if surgery can meet their expectations.

Rhinoplasty is most common in the late teens, twenties, and thirties. A significant number of patients in their forties and fifties also seek rhinoplasty. The oldest patient for whom the author has performed a cosmetic rhinoplasty was in her seventies.

Most rhinoplastic surgeons prefer to wait until an individual has completed his or her growth spurt before performing rhinoplasty. This means about age 16 for girls, and a little later for boys. Of course, this is a generalization—it is very important to take into consideration the individual's emotional and social maturity level.

Rhinoplasty is outpatient surgery. It is typically performed with the patient under general or sedation anesthesia. Under sedation, the nose and surround­ing areas will be numb, and the patient will drift in and out of sleep. With general anesthesia, the patient will be asleep for the entire procedure. Depending on the complexity, a rhinoplasty takes approximately 1-2 hours.

It has been the author's experience that there is not typically much pain or nausea in the recovery period. After-surgery pain is usually well-controlled with amild narcotic. A skillful anesthesia team is essential to provide expert outpatient anesthesia that keeps after-surgery nausea to a minimum.

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