Rhinoplasty

What Is Rhinoplasty?

Rhinoplasty is a surgery that changes the shape of the nose. Because the tissue, cartilage and bone that make up the nose are all constantly growing and changing, rhinoplasty requires a great deal of experience and technical skill in order to perform it successfully.

Rhinoplasty, especially reconstructive rhinoplasty on younger patients, is a difficult and complex procedure. It is vital to preserve normal nasal structures and correct any functional issues during the surgery, so it is important to find a highly skilled and experienced board-certified plastic surgeon who specializes in facial procedures in children and teens. At Children’s Healthcare of Atlanta, our team of plastic surgeons is trained to work with kids from birth to age 21 and is prepared to answer any questions a patient or family may have when considering the procedure.

In children, rhinoplasty is often performed to resolve congenital (present at birth) disorders, a deviated septum or trauma to the nose. While rhinoplasty can change the overall appearance of a child’s face, it can also have a more profound effect when used to address congenital defects that result in functional and aesthetic difficulties.

What are some reasons a kid or teen may have rhinoplasty?

• Congenital defects: Structural nasal deformities can be associated with a wide range of congenital conditions, including craniosynostosis and a cleft lip and palate. When the anatomy of the nose is altered, a child can experience difficulties in breathing and speech development, so early intervention is important.
• Deviated septum: This occurs when the interior wall of the nose is misaligned. It can be a birth defect or a result of trauma. A deviated septum affects breathing and can cause congestion.
• Trauma: Nasal fractures are breaks or cracks in the bone over the bridge of the nose. Trauma may also cause cartilage to shift or scarring to form on the nasal septum. In these cases, a pediatric surgeon can realign the affected bones and/or cartilage to restore an open nasal passage and create a more aesthetically pleasing appearance.

Because each patient is unique, every rhinoplasty procedure at Children’s, whether cosmetic or reconstructive, is specifically tailored to the individual patient’s needs and post-surgical goals. Our pediatric board-certified plastic surgeons conduct an in-depth consultation with each patient and family.

What should I expect from my child or teen’s rhinoplasty?

Many patients interested in nose surgery have questions about what they can expect before, during and after rhinoplasty.

• Pre-surgery appointments: Every rhinoplasty performed at Children’s begins with an in-depth consultation. Nasal history, such as trauma or previous surgery, is documented, and a detailed nasal examination is performed. Nasal allergies, use of topical or systemic medications, and overall physical health can all play a significant role in the outcome of rhinoplasty. Following the examination, one of our plastic surgeons will sit down with the patient and family to discuss goals and expectations. Often this is done with the use of computerized facial imaging to give patients and parents a chance to view potential surgical results.
• Surgery: At Children’s, an external “open” approach is used. An incision is made across the columella, the narrow strip of tissue that separates the nostrils, allowing for easy access and complete visualization of the entire nasal anatomy. This approach makes it possible to perform precision sculpting and grafting of the bones and cartilage within the nose, allowing more predictable and natural-looking results.
• After surgery: After the rhinoplasty, nasal dressings consisting of adhesive strips and a custom-fitted plastic splint will remain in place while your child recovers. The plastic splint, along with all nonresorbable sutures, will be removed at a follow-up appointment approximately five to seven days after the surgery. Nasal congestion and swelling may persist for anywhere from six weeks to a year, and the final rhinoplasty results may not be fully apparent until the delicate tissues have healed completely.

How old do you need to be to have rhinoplasty?

Nose surgery should be performed on patients who have reached at least 90% of their physical maturity. In some patients, rhinoplasty can be performed as early as 12 years old, as long as the child is physically and mentally mature and can maintain realistic expectations.

How do I decide if rhinoplasty is right for my child or teen?

Before pursuing nose surgery, young patients should have an open, honest discussion with their parents about any concerns and aesthetic goals. Our team can perform a pre-operative evaluation and discuss the expectations with your child or teen, in addition to creating a computerized image of what the results may look like. We believe these are essential first steps for any patient before undergoing cosmetic plastic surgery.

Our four-step approach for parents to discuss the procedure with children and teens who are good candidates for rhinoplasty:

1. Discuss potential complications and downplay preconceived notions. We focus on the reality that this is a surgical procedure and that results are not quick, easy or guaranteed.
2. Explain what changes your child may experience in the future. We want to emphasize the impact the surgery will have on the child or teen. The growing body is much more dynamic than the adult body, so we want to make sure to explain the effects of these changes.
3. Talk about your child’s surgery goal. She may have mixed feelings about the specific results she is looking for. This should be a red flag, signaling that your child could be unhappy with the results—no matter how successful the surgery.
4. Provide time for family discussion and decisions. A decision is not required immediately after the initial consult. We believe the patient and family must be comfortable with the decision.

Is it safe for my child or teen to have rhinoplasty?

When performed by a skilled plastic surgeon like those on our team at Children’s, and one with extensive experience performing surgeries on the face, rhinoplasty can be a safe and effective way to resolve congenital disorders or trauma to the nose while greatly improving nasal function and appearance for your child or teen. However, the reasoning behind having the procedure should also be considered so that the patient and family can avoid any emotional or physical issues throughout the process.