Rhinoplasty (Nose Surgery)

While rhinoplasty procedures can change the overall aesthetic appearance of the face, they can have a more profound effect when used to address congenital defects that can result in functional as well as aesthetic difficulties. For children and teens, rhinoplasty is often used to resolve congenital disorders, deviated septum or trauma to the nose.

  • Congenital defects: Structural nasal deformities can be associated with a wide range of congenital conditions, including craniosynostosis and 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 congenital defect or a result from 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. Sometimes trauma may also cause cartilage to shift or scarring to form on the nasal septum. In these cases, our pediatric surgeons can realign the affected bones and/or cartilage to restore an open nasal passage and create a more aesthetically pleasing appearance.

Because the tissue, cartilage and bone that make up the nose are all constantly growing and changing, rhinoplasty procedures require a great deal of experience and technical skill in order to perform them successfully. Rhinoplasty, especially reconstructive rhinoplasty for younger patients, is a difficult and complex procedure. It is vital to preserve normal nasal structures and correct any functional issues during rhinoplasty, so it is important to find a highly skilled and experienced board-certified plastic surgeon who specializes in facial procedures in children and adolescents.

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 his parents.

What to expect from rhinoplasty

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

  • Before: 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 a rhinoplasty procedure. Following the examination, one of our plastic surgeons will sit down with the patient and his parents 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.
  • During: 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: After the surgery, 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 completely healed.

Adolescent rhinoplasty

Adolescence is a critical period of development both physically and mentally, and self-image can play a vital role in long-term happiness and well-being. Where form and function are adversely affected by nasal deformities, adolescent rhinoplasty can result in gratifying results.

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

Before pursuing surgery, all prospective teen patients should have an honest, open discussion with their parents about their concerns and aesthetic goals. From there, our team can perform a thorough preoperative evaluation and discussion of expectations, along with computerized imaging to help avoid the misunderstandings that lead to postoperative disappointment. We believe this is an essential first step before undergoing any cosmetic plastic surgery procedure. Following a step-by-step approach—with an emphasis on a conservative but thorough evaluation of the patient’s aesthetic and functional needs—is the key to achieving the best possible surgical outcome.

Our five-step approach for teens:

  1. Emphasize potential complications and downplay preconceived notions. We focus on the reality that this is a surgical procedure and the results are not quick, easy or guaranteed.
  2. Explain what may happen later. We want to emphasize the impact the surgery will have on the adolescent. The teen body is much more dynamic than the adult body, so we want to make sure to explain the effects of these changes.
  3. Have the teen state their surgery goal verbally. Teens may be ambivalent about the specific results they are looking for. That ambivalence should be a red flag, signaling that the patient could be unhappy with the results no matter how successful the surgery.
  4. Give the patient and parents time to think. A decision is not required immediately after the initial consult. We believe all parties must be comfortable with the decision.

When performed by a skilled plastic surgeon with extensive experience dealing with the subtleties of facial anatomy, adolescent rhinoplasty can be a safe and effective way to resolve congenital disorders or trauma to the nose while greatly improving nasal function and appearance. However, motives should be considered to avoid emotional or physical distress.

Related research publications

  • Burstein, F.D.:“Aesthetic and Reconstructive Rhinoplasty, A Personal Perspective.” Atlanta Medicine, Journal of the Medical Association of Atlanta. 2006 May; 7(3):23-26.
  • Burstein, F.D., Bauer, M.D., Bruce, S.: “Primary Aesthetic Rhinoplasty in Adolescents: Indications and Techniques.” Principles and Practice of Pediatric Surgery. Quality Medical Publishing, Inc. St. Louis, MO., Vol 2, 34:945-966, 2008.

Visit PubMed for additional research publications by Dr. Burstein