Total Structural Rhinoplasty

How is it performed?

General anesthesia or local anesthesia with sedation. Cartilage harvesting (septal cartilage via an endonasal approach; ear cartilage via a postauricular approach; rib cartilage via a 2–3 cm inframammary incision if needed). Open approach via transcolumellar and intranasal incisions to expose the nasal framework; septal extension grafting, columellar strut placement, lower lateral cartilage reshaping/suturing, tip graft placement, dorsal augmentation using cartilage or synthetic implants, and alar modification if needed; suturing and external splinting. 2–3 hours.

Before the procedure

Undergo a comprehensive pre-anesthesia evaluation and screening (complete blood count, coagulation profile, biochemistry, ECG, and chest X-ray if autologous rib cartilage harvesting is required); discontinue blood-thinning medications for 1 week as instructed; refrain from smoking for 4 weeks before and after surgery; fast for 6–8 hours preoperatively; disclose any underlying medical conditions, previous nasal surgery history, allergies, or history of keloid scars; undergo a nasal CT scan for revision rhinoplasty cases as indicated.

After the procedure

**Post-Operative Care & Follow-Up Schedule** * **Day 1:** Surgical drain removal. * **Days 1–2 (First 48 hours):** Apply cold compresses (10–15 minutes per session, 5 times a day). * **Day 2:** Follow-up visit. * **Day 3 onwards:** Switch to warm compresses. * **Day 5:** Nasal splint change. * **Day 7:** Follow-up visit. * **Days 7–10:** Wear the nasal splint continuously. * **Days 10–14:** Suture and nasal packing removal. * **Weeks 2–3:** Noticeable swelling and bruising will gradually subside; avoid blowing your nose forcefully for 3 weeks. * **Week 4:** Sleep on your back with your head elevated. * **Week 8:** Avoid wearing framed glasses and prevent any physical impact to the nose. * **Follow-Up Appointments:** Scheduled on days 2, 7, 30, 90, 180, and 365. * **Recovery Timeline:** Nasal tip swelling fully resolves in 3–6 months; final aesthetic results are achieved at 12 months. **Daily Care & Lifestyle Guidelines** * Take all prescribed medications strictly as directed. * Care for the autologous rib cartilage donor site properly (if applicable). * Dietary restrictions for 1 month: Avoid seafood, beef, glutinous rice, water spinach, alcohol, carbonated soft drinks, coffee, fermented fish sauce, and fermented bean curd. * Limit laughing loudly and talking excessively. **Emergency & Warning Signs** Contact your doctor or visit the clinic immediately if you experience any of the following: * Abnormal severe swelling, purulent discharge, heavy bleeding, or fever above 38.5°C. * Spreading erythema, localized heat, redness, swelling accompanied by severe pain, or fluid drainage. * Significant nasal deviation after initial swelling subsides. * Implant extrusion.

Possible risks — your doctor explains them before treatment

• Swelling and bruising for 2–3 weeks; numbness at the nasal tip for several months
• Infection, hematoma (rare, manageable with early intervention)
• Rib cartilage warping over time if not harvested and carved properly
• Deviation or asymmetry requiring minor revision after 12 months (low incidence)
• Scars along the columella and at the rib cartilage harvest site (gradually fade; risk of hypertrophic scars/keloids in predisposed individuals)
• Chest soreness for a few days; rare risk of pleural injury during rib cartilage harvesting
• Temporary nasal congestion; rare risk of septal perforation
• Outcomes of revision rhinoplasty are less predictable than primary procedures