Regarding total time in the operating room for the average primary rhinoplasty, under two hours is common for the most accomplished rhinoplasty surgeons. Other surgeons, often less specialized and less experienced, can take 5-6 hours.
“Not how quickly, but how well” is the proper theme. Speed for speed’s sake is not wise, but efficiency in the surgical exercise is very important. Here’s why:
Swelling and bleeding start to work against the surgery after 2-2 ½ hours. Depending on what you need when undergoing surgery, the time your rhinoplasty will take should never surpass six hours. Tasks like adding correction of deviated and reduction of internal turbinates and their operation can last 30-45 minutes longer, while other factors only add a few minutes. We expand on those factors below.
A longer operation will demand more of the anesthetic and may generate a longer wake-up and some grogginess for the rest of the day. As we shall discuss below, all things equal less time under anesthesia the better, of course.
Whether a surgeon chooses open vs closed rhinoplasty can alter surgery time. Closed rhinoplasty, the classic, still superb technique, patient-favored technique has several advantages: no external scar and all sutures, placed to close the hidden, internal incisions, dissolve. Open rhinoplasty, a good approach to teach and develop surgeons in training does make placement of some cartilage and tissue grafts a bit easier. Performing the external incision and then closing it at the end of the surgery should not add more than 20 minutes or so to the operation. For some patients the horizontal scar between the nostrils is not happiness. Others, who healed better, perhaps, are forgiving of what is a hardly visible incision. Typically, like so many other features of rhinoplasty, the surgeon’s skill determines the outcome, not luck.
Closed rhinoplasty is an elegant procedure when you step back and realize that an entire operation which may include a nearly total restructure of the nasal architecture and improving the breathing and then stitching the hidden incisions is done entirely through the nostrils. Some younger surgeons not exposed to the technique are amazed when they see an ultra-experienced rhinoplasty surgeon perform the procedure. It is quite impressive. The surgeons who mastered the technique are the product of a training program strong on great teachers and a large volume of experience. Impossible to master without both.
Open rhinoplasty, a great teaching tool, also requires great manual dexterity but does make rhinoplasty and associated procedures easier to understand as a trainee. A surgeon in practice, beyond formal residency training, who wants to enhance his ability to move from the open rhinoplasty to the closed procedure will be challenged without having a large volume of patients on which to develop the skill and judgement to perform it.
There are few “Minimal” surgeries. Just like an airplane flight, the loading, take off, landing and unloading are the same whether it’s a flight of 400 miles or 4000 miles. Certain time factors are constants.
All rhinoplasties and other facial plastic surgery procedures are best and safest done in a licensed/certified outpatient surgery center or hospital. Personally, I favor having an anesthesiologist specializing in cosmetic facial surgery procedures “ at the controls”. That’s for patient comfort and safety. Given these protections for the patient, the time necessary to prepare a patient for surgery, connect the patient to the ultra-sophisticated anesthesia and monitoring system, induce the anesthesia, prepare the patient, disinfect the operative area, provide local anesthesia, drape the patient in sterile sheets, connect all instrumentation, and then beginning the actual surgery, there’s quite a ramp up. And, all that takes time, whether the actual cutting and sewing is 45 minutes or seven hours. But, that’s what it takes to do it right and who does not want it right?