The adolescent age marks the beginning of the transition to adulthood. A lot of change occurs during this time and the most recognizable change is to one’s body. The emotional response of how one perceives these changes is a different experience for each teen. Adolescence is a great opportunity to address personal aesthetic concerns as they prepare for the big milestones of life ahead such as high school graduation, college, or the start of a professional career.
The slightest imperfection is already a big deal, particularly in today’s society where aesthetics is deemed the measure of everything. The result is the massive popularity of surgical cosmetic procedures which include rhinoplasty. Rhinoplasty is currently one of the most commonly performed cosmetic operations worldwide. Adolescence is often the first time the patients themselves start quoting or stating to their parents that they would like to have a rhinoplasty performed.
Aside from aesthetic concerns, there are other reasons why a patient would want to undergo rhinoplasty during adolescence. One is to correct deformation that has resulted from a trauma or injury. Another is that as we go through puberty, specifically females at around age 13, the face starts to grow very quickly. The nose is made mostly of cartilage. Bones and the cartilage grow at different rates. As a result, there will sometimes be a little deviation of the nasal septum. This causes a nose that does not look straight from the outside and causes nasal obstruction. Therefore, difficulty in nasal breathing could also be a reason for having a rhinoplasty in adolescence. Many patients ask for the operation because they cannot breathe through their nose. Fixing the breathing aspect may sometimes require the straightening of the septum and nose as well. That is when the cosmetic and the functional/medical aspect come together.
An adolescent rhinoplasty, or rhinoplasty in general, may be performed as an open or closed procedure. One is not necessarily more ideal than the other. A surgeon who is properly trained in either a closed or an open procedure can garner excellent results. But there are certain maneuvers or certain types of noses that lend themselves to an easier procedure if done via an open method.
For a primary patient, meaning someone who has never had a nose job before, the operation may be done with either an open or closed approach and obtain similar results. In revision cases, however, the correction might be a little bit easier if done through an open procedure; however, minor revision procedures can still be performed with a closed approach. In general, it largely depends on what the patient’s needs are and the comfort of the surgeon to meet their expectations. It is always recommended for patients to go to a board-certified facial plastic surgeon or a plastic surgeon that specializes in nasal surgeries. A board-certified facial plastic surgeon has completed two board certifications: one for Ear, Nose, and Throat surgery, and another for Facial Plastic & Reconstructive Surgery. They are able to improve function, as well as achieve an aesthetic that a patient may desire.
The difference between an adult and adolescent rhinoplasty lies on the type of patients they cater and not on the procedure itself. Adolescent patients are more enthusiastic about the operation, and excited to achieve improvements at such a crucial point in their lives before University/College or career. Adolescent patients are more likely to have the operation for both function and cosmetic reasons; whereas, adults request it for medical/functional purposes with expectations of subtle cosmetic improvements. Self-image is of the utmost importance for younger patients, so they tend to focus on the result that will coincide with their desired self-image. On the other hand, adults usually have an established social network and career, making them less reliant on their looks and can be more realistic on the final results. Most adult patients who opt for rhinoplasty have wanted the procedure for some time but did not have the financial means or opportunity in their lives to get the surgery done, but now have the money and time to do so.
As far as the procedure itself – adolescent vs. adult rhinoplasty – there is really no advantage or disadvantage regarding the timeframe in which to undergo the procedure. Each nose is unique and must be evaluated by your surgeon individually to formulate a plan that may satisfy each patient’s expectations. But rhinoplasty, in general, comes in different types. There is cosmetic rhinoplasty which aims to improve the appearance of the nose, and functional rhinoplasty which reconstructs the nose to improve breathing. The cosmetic type deals only with the outside of the nose, while functional deals with both the inside and outside. A more focused type of procedure, called septoplasty, is indicated for cases of deviated nasal septum where the external nasal framework does not cause additional nasal obstruction and only inside correction is necessary.
Regardless of the purpose, patients for a true rhinoplasty usually must be 16 years old for females and 17 years old for males. At such ages, the growth of the face has stabilized and surgery can performed with long term goals in mind. Operating on younger than these indicated ages will only increase the chances of need for a revision surgery in the future as the face continues to grow. Simply put, there will be more complications down the line if the patient is younger than what is indicated. There is an exception, though, like in cases of trauma. If a 12-year old patient had nasal injury or trauma, then the nose may be reconstructed as soon as possible.
Adult and adolescent rhinoplasty has pretty much the same risks and complications. The most common short-term risk is bleeding which can be controlled by avoiding the medications as indicated by your surgeon. In adults, bleeding is much more of a problem because older patients tend to be on certain medications that may cause the blood to thin. These medications must be stopped days before the surgery and often a medical clearance is required. Long-term complications are very similar in both age groups. These include asymmetries, slight deviations, swelling, and rarely a need for revision surgery.
The downtime for both adult and adolescent rhinoplasty is usually a day or two. After a few days, the patient should be able to return to a semi-normal lifestyle, however bruising and swelling may still be present around the eyes and nose. Heavy lifting is strictly prohibited for about 2-3 weeks dependent on your surgeon’s instruction. After one week, the patient can return to work if the patient is comfortable with the residual swelling. This residual swelling will greatly improve over the course of the next 2 weeks. With regards to breathing, it depends on what was done during the operation. During the first week, the patient should expect some kind of nasal obstruction. At the first post-operative appointment, the surgeon will take out everything and also clean the nose so they get full breathing. Breathing is expected to be much better than what they had prior to surgery.
The recovery for the open and closed rhinoplasty is also the same. The only difference is that in the open approach, there will be a small scar at the base of the nose which is not visible on frontal view. The sutures will be removed in five to seven days. The scar will fade away completely after approximately three months. There may also be some swelling of the nasal tip because of the incision there, but then again, recovery from such occurs very quickly. Overall, it is important to follow up with your surgeon through the year to ensure proper healing as the ultimate final result can take up to 9-12 months.
The revision rates differ in primary rhinoplasty and revision rhinoplasty. In primary rhinoplasty, the risks and complications are very low. The need for revision is usually is at 3-7%. In revision rhinoplasty, the presence of scar tissue makes the surgery a bit more challenging. Revision rates increases to about 10-15%.
As long as the patient is at their right age before undergoing rhinoplasty, there should not be any changes that could affect the results. As previously mentioned, the ideal age is 16 for females and 17 for males, respectively. Also a very important thing is to get it done by an experienced surgeon, so you can get the best possible results while minimizing complications.
Written by Cosmetic Town Editorial Team- AA
Based on an exclusive interview with Karan Dhir, MD in Beverly Hills, CA