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The term refers to surgical alterations of the nose in younger patients, typically under the age of 18. Teenagers may complain of aesthetic problems, breathing problems, or both. Younger patients differ from adults both physically and emotionally, and it is important to understand these differences before proceeding with a treatment plan.
Emotionally, the motivations for a teenager in wanting a rhinoplasty must be determined. It may be the result of peer and social pressures, teasing, struggles with identity and feeling like an outcast. Adolescent years are important in forging an individual’s identity, self-esteem, and confidence. A person’s physical appearance is only one aspect of what defines a person. Surgically altering a person’s physical appearance, especially in adolescence, may not necessarily lead to improved self-esteem and confidence. It is important to understand the motivating factors that underly a teenager’s desire for altering their physical appearance to ensure that expectations are met, and no emotional issues go on unrecognized. In teenagers, more than any other type of patient, it is important to understand the complete nature of a patient’s complaints and issues beyond the physical. It is vital that patients and their families recognize the complexity of all factors that may be motivating a young patient to seek surgical changes. It is only when a surgeon understands the whole picture, that they can begin to embark on a treatment plan for their young patient.
These conversations often happen in the presence of parents and/or guardians. However, sometimes teenagers may feel more inclined to disclose information in private. It is important for your surgeon to recognize the social and emotional factors prior to focusing on the physical appearance of the nose.
Adolescence is an important time for physical growth, as changes in hormone levels, lead to facial and skeletal changes and growth. The nose is particularly sensitive to these changes and continues to grow not only in adolescence but throughout our adult life. During puberty though, these changes are accelerated and more pronounced. Surgically altering the nose during this sensitive time may lead to long term issues related to the appearance and function of the nose. The nose is like a tent, with internal and external support structures composed of cartilage or bone. Removing or altering critical points of this tent will weaken the foundation of the nose, leading to deficient growth in the long term. Additionally, the bone and cartilages of the nose at a younger age are weaker and less developed.
When performing rhinoplasty in a younger patient, surgeons must be conservative in their alterations of the structures of the nose. Cartilage should be “spared”, and the internal structure of the nose should be reinforced as to allow for continued growth. Rhinoplasty in teenagers is usually deferred to the age of 15 in girls and 16 in boys. However, if a patient suffers from a congenital or traumatic defect of the nose or significant nasal airway obstruction, surgery can sometimes be performed at a younger age.
The techniques are similar to a traditional rhinoplasty.
Teenage rhinoplasty can be performed through what is referred to as an “open approach”. This involves a small incision underneath the nose, followed by elevation and exposure of all of the internal structures of the nose. This is the most commonly performed type of rhinoplasty in both adults and teenagers. This type of rhinoplasty is often used in complicated cases and nasal reconstruction.
This a “minimally invasive” technique, that does not involve an incision on the outside of the nose. All incisions are hidden within the inside of the nose. This type of procedure allows for the same access to the critical portions of the nose and allows for the same type of changes as through a more conventional approach. Post-operative swelling is limited by this type of approach. Dr. Mourad prefers to use this technique, especially in younger patients, as it limits the amount of tissue disruption seen with the open approach, with a better healing profile. Dr. Mourad also prefers this technique because there is no external evidence of “having a nose surgery”, which also may allow for better social acclimatization in the post-operative period.
The healing process is similar to that in a regular rhinoplasty (link to rhinoplasty article). The surgery is usually performed in an outpatient setting. Patients usually have nasal splints and an external cast that is applied for the 1st week after surgery and removed at the first post-operative visit. Teenagers can be cleared to be back to the classroom the next day. Sometimes, teenagers may not want to be seen in their post-operative cast and elect to stay home from school during their first recovery week. Some teenagers may elect to have surgeries performed in the summer as to limit missed time from school and reduce any perceived social stigma. Physical activity should be limited following surgery. Students can resume light aerobic activity 3 weeks after surgery, with a return to full physical activity at 6 weeks after surgery. Sports that may inadvertently cause direct trauma to the nose should be avoided for at least 3 months after surgery (e.g. boxing, basketball, football, contact sports, etc.) However, student-athletes that wish to return to their regular sporting activities can return sooner with appropriate precautions.