Rhinoplasty

Rhinoplasty

Rhinoplasty (nose surgery)

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Nose re-shaping operations can increase or decrease the size of your nose, or change its shape. The medical terms are:

•   reduction rhinoplasty, which makes the nose smaller
•   augmentation rhinoplasty, which makes the nose larger or gives it more bulk

While the shape of your nose is usually the result of heredity, the appearance may have been altered in an injury or during prior surgery.

Also known as rhinoplasty, surgery of the nose improves the appearance and proportion of your nose, enhancing facial harmony and self confidence.

Surgery of the nose may also correct impaired breathing caused by structural abnormalities in the nose. What can surgery of the nose accomplish?

Rhinoplasty can change:

•   Nose size, in relation to the other facial structures
•   Nose width, at the bridge
•   Nose profile, with visible humps or depressions on the bridge
•   Nasal tip, that is large or bulbous, drooping, or too upturned
•    Nostrils that are large, wide or upturned
•    Nasal asymmetry and deviation

Nose surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Surgery of the nose is a good option for you if:

•   Your facial growth is complete and you are 13 years of age or older
•   You are physically healthy
•   You stop smoking
•   You have specific, but realistic goals in mind for the improvement of your appearance

Why have rhinoplasty?

Rhinoplasty may be performed if you are unhappy with the natural shape and size of your nose. It may also be done to restore the shape of your nose after an injury.

It is very important that you are clear in your mind what it is that you dislike about the appearance of your nose and that you are able to explain this to your surgeon. He or she will then be able to tell you what is possible with rhinoplasty surgery and what is not.
Most people who have rhinoplasty report that they are happy with the results of their operation.

Pre operative consultation

Your surgeon will discuss how to prepare for your operation. You will be asked about your medical history and you will have a full examination, including checks on your heart and lungs.
You should ensure you are free from a cough, cold or sore throat at the time of your operation because this can increase the risk of an infection afterwards. If you have any concerns, contact your surgeon or anaesthetist for advice.

Be prepared to discuss:

•   Why you want the surgery, your expectations and desired outcome
•   Medical conditions, drug allergies and previous medical treatments
•   Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
•   Previous surgeries

Your surgeon may also:

•   Evaluate your general health status and any pre-existing health conditions or risk factors
•   Examine and measure your face
•   Take photographs for your medical record
•   Discuss your options and recommend a course of reshaping your nose
•   Discuss likely outcomes of a nose surgery and any risks or potential complications
•   Discuss the type of anaesthesia that will be used

Prior to surgery, you may be asked to:

•   Get lab testing or a medical evaluation
•   Take certain medications or adjust your current medications
•   Stop smoking well in advance of surgery
•   Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

•   What to do on the night before and the morning of surgery
•   The use of anaesthesia during your nose surgery
•   Post-operative care and follow-up

The Operation

When you arrive at the hospital you will be asked to sign a consent form. This confirms that you understand the procedure and have given your permission for it to go ahead.

Your nose will be examined and its shape and size will be measured. You will usually have a photograph taken of your face before the operation, so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

Rhinoplasty can be performed as a day case, which means that you can have the operation and go home the same day. However, you may need to stay between one and two nights in hospital. It depends on the extent and time of the procedure.

1 – Anaesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anaesthesia. Your doctor will recommend the best choice for you.

2 – The incision

Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.

Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

                       
3 – Reshaping the nose structure

Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body.

Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, is used for this purpose.

Occasionally a piece of cartilage from the ear and rarely a section of rib cartilage can be used.

4 – Correcting a deviated septum

If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.

5 – Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

6 – See the results

Splints and internal tubes will likely support the nose as it begins to heal for approximately one week.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine.

During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your nose surgery.

Augmentation rhinoplasty

Your surgeon will make a cut inside or between your nostrils and re-shape the bone. Additional bone or cartilage may be needed to build up the nose. Bone may be taken from:

•   your hip
•   a rib
•   the back of your elbow
•   the surface of your skull

This is called a bone graft.

If cartilage is used it may be taken from:

•   your ears
•   spare cartilage inside your nose
•   Sometimes artificial implants are used.

The skin over your nose will probably not need to be cut as it stretches over the new shape.
After reduction or augmentation rhinoplasty, the cuts inside or between your nostrils will be closed up with dissolvable stitches. Your nose may be filled with surgical packing to help control any bleeding. You may also have small pieces of soft plastic inside your nose to prevent scar tissue from forming.

Post Operatively

Painkillers will be given to help relieve any discomfort as the anaesthetic wears off..
If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. Before you go home, your nurse will give you advice about caring for your nose.

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another minor surgery may be necessary to reach the intended aesthetic goal.

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

It may take several months for swelling to fully dissipate and up to a year - and sometimes longer - for the outcome of the surgery to fully refine.
Although the results of nose surgery are usually permanent, cartilage may continue to reshape and move tissue that may change the outcome over time.

Recovering from rhinoplasty

You will have dressings in each nostril for about a day, which prevent you from breathing through your nose. You will also have a splint over your nose to hold the bones in position. The splint can be made with various materials ranging from thin metal to plaster of Paris. This will be removed after a week or two.

You can expect some minor bleeding for a day or two. You will be advised by your doctor or nurse to:

•   keep your head up as much as possible
•   avoid hot baths
•   avoid alcohol
•   avoid blowing your nose
•   try your best not to sneeze through your nose and cough it out instead
•   wear strong sunscreen and a hat for at least six months as the skin of your nose will be very sensitive to the sun

You will experience some bruising and swelling, particularly around your eyes, which will usually take up to three weeks to disappear completely.

If you find it difficult to breathe through your nose, this should ease as the swelling settles. It will take about three months for the swelling to disappear completely.

Your nose will also feel numb and stiff, particularly around the tip if you have had a reduction rhinoplasty. The numbness will disappear slowly during the next few months but the stiffness is likely to be permanent.

Whilst there is no medical reason why you should stay away from work, you will probably feel more comfortable taking some time off and returning when the bruising has disappeared.

Risks

The risks include:

•   Rupture of small surface vessels of the nose
•   Infection
•   Poor wound healing
•   Anaesthesia risks 
•   Bleeding (hematoma)
•   Nose asymmetry
•   Cardiac and pulmonary complications can occur in longer surgical procedures and may be associated with the formation of, or increase in, blood clots in the venous system
•   Change in skin sensation (numbness)
•   Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose
•   Nasal septal perforation (a hole in the nasal septum) may develop but is rare; additional surgical treatment may be necessary to repair the nasal septum but in some cases, it may be impossible to correct this complication
•   Pain, which may persist
•   Unfavourable scarring
•   Skin contour irregularities
•   Skin discoloration and swelling
•   Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
•   Possibility of revisional surgery