What is rhinoplasty?

Otherwise known as a nose job, rhinoplasty is an operation performed with the aim of changing the shape of the nose. There are many different kinds of rhinoplasty depending on what needs to be corrected. These include nose straightening, making a nose larger or smaller, removing a bump from the nose or reshaping the tip of the nose. Occasionally it is necessary to remove or add pieces of cartilage or bone to change the nasal structure. Often it is the case that the central partition that separates the nose into right and left halves (the septum) is bent or deviated. In such circumstances, septal surgery (septoplasty) may be performed at the same time as the rhinoplasty in a combined operation called a septorhinoplasty.

A rhinoplasty can be a complex undertaking, as it is not just sufficient to correct the anatomical deformity but to ensure that the end result does not look artificial and closely matches the overall proportions of the face. It is often said that the best complement that someone can pay you following such an operation is not to be able to notice that you have had surgery at all, so natural should the nose look once healing has taken place. As a result it is important that you approach a surgeon with experience and expertise in this challenging but interesting field.

Should I go for a rhinoplasty?

If you are interested in improving the shape and features of the nose in order to change its cosmetic appearances, then rhinoplasty may be for you. If you are also having difficulty in breathing through the nose, this may be due to other structural abnormalities such as a septal deviation or nasal valve problems which can also be fixed at the same time as the nose job.

You need to have a reasonably realistic idea as to what you would like your nose to look like. It is not possible to create any nose on any face, nor indeed sensible as there is a massive degree of variety in human appearances and not every nasal shape will suit every person. There is no such thing as a ‘perfect nose’ but a pleasing nasal shape for a given individual depends on many factors including the bony contours, dimensions of the face, skin colour, skin thickness and race. People who believe that their lives will change if they have cosmetic surgery are often disappointed.

The most common problems that people are concerned with include deviations of the nose to one side, a nasal hump, a ‘dip’ in the nasal profile, too wide or too a narrow nose, or problems with the soft nasal tip which can be over-protrusion, too broad or ill-defined a tip or irregularities.

As there are so many factors involved in the decision regarding surgery and what can be achieved surgically, you are well advised to discuss your aims in detail with your specialist who will also undertake a thorough examination and appraisal of the realistic expectations.

How successful is rhinoplasty surgery?

The thickness of the skin is important in how much better the nose will look after a rhinoplasty. Imagine the skin of the nose is like a duvet on a bed. If the duvet is very thin then an object placed under the duvet may show through on the outside. On the other hand, the very same object may not show through a much thicker duvet. So in the much the same way, if someone has thin skin, it makes it more difficult to camouflage bumps or dips in the nose. If the skin is thick, some of the subtle changes that can be made on the inside may not show up on the outside.

Another factor is that if someone has had several nasal injuries or fractures to the nose, this may make it more difficult to render the external shape perfectly straight. Similarly, it is harder to predict the precise end result in people who have previously undergone rhinoplasty surgery owing to the presence of scar tissue.

As mentioned before, your surgeon will aim to produce a nose that looks natural for you. However, it is rarely possible to say with certainty exactly how your nose will look after a rhinoplasty. It is important that you discuss your expectations with your surgeon. About 90-95 % of patients are happy with the results of their operation but some people request more surgery.

You may change your mind about the operation at any time. Signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist or GP.

Before rhinoplasty – what needs to be done?

Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation. You may also wish to see your specialist on more than one occasion before surgery to allow you sufficient opportunity to ask any questions you may have.

It is important that you are not taking any herbal or other medications which might thin the blood in the two weeks prior to the operation, as this might increase the postoperative bruising around the nose and face.

Rhinoplasty – types of operation

Rhinoplasty surgery involves reduction, augmentation or refinement of the patient’s nose to give a balanced and proportioned nose.

  • Reduction rhinoplasty involves the removal of a nasal hump along with re-breaking the nose to reduce any excessive width.
  • The tip of the nose may be asymmetrical, over-protruberant, depressed or misshaped. If building up is required, this can be achieved using tissue obtained from another part of the patient’s body. Most often cartilage is used and this can usually be conveniently sourced from the nearby nasal septum. Alternative sites which can be used include the ear or rib. Synthetic material are sometimes used, such as gortex or silastic but there is a greater risk of rejection or infection compared with the patient’s own cartilage.

Rhinoplasty – the operation

Rhinoplasty and septorhinoplasty are usually performed with you asleep under a general anaesthetic. The surgery can be approached either through the nostrils (intranasal) or by the use of a small incision on the under side of the tip of the nose (external). Whichever method is used, the skin of your nose is gently lifted off the underlying bone and cartilage. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips. One reason why an external approach may be chosen is that it gives better access to and exposure of the nasal tip in case any refinement is required here.

If a septoplasty is being undertaken, this is usually performed at the beginning of the procedure. Once the surgery is over, the cuts will be sutured with absorbable sutures.

Packs and splints

It may be necessary to put a dressing into each side of your nose to prevent early bleeding. These are sometimes called ‘packs’, and they will block your nose so that you will have to breathe through your mouth. These are usually quite light and are usually removed a few hours after the surgery, although on occasions they may need to stay in overnight. It is quite usual to get some bleeding when the packs come out – this will settle quickly. By the way, contrary to common perception, removing packs from the nose is not excruciating, unlike in the past when heavier duty packs were used. Your packs should come out quite easily with only a little discomfort.

Sometimes a small piece of plastic may need to be put in your nose to prevent scar tissue from forming. These are called ‘splints’ and they will be removed after about a week.

After rhinoplasty surgery:

You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. Ask your nurse if you need a sick note for your time in hospital.

There will be a little bleeding from the nose for a few days after the operation. This may be blood or more commonly a mucous or clear discharge which is blood stained. This should not be particularly severe and should decrease in amount as time goes on. An increase in bleeding at a later date may indicate a postoperative infection and medical advice should be sought.

The front of your nose is likely to be tender for a few weeks.

The nose is likely to become a little blocked, particularly so if you have also had a septoplasty. In this case, the feeling of blockage gradually gets worse for the first 7 to 10 days and it will feel as though you have a heavy head cold for the first two weeks. The salt water solutions and drops/sprays will help keep it reasonably clear.

You may be able to see some stitches inside the front of your nose – these will dissolve and fall out by themselves. If you had an external approach, you will have stitches in the skin of the front of the nose, which will need to be removed by your specialist approximately 5-7 days after the operation.

You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps. The majority of the swelling subsides after two weeks but it may take longer before the skin and soft tissues over the bone and cartilage fully settle. Fine changes may continue to occur up to a year after the rhinoplasty at which time the final results of surgery may be judged.

Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months. The nose may feel a little stiff and numb for up to three months, particularly around the tip.

How long will I be off work after a rhinoplasty?

You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. Ask your nurse if you need a sick note for your time in hospital.

Do’s and don’ts after a rhinoplasty

Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. Your nose is likely to be tender for a few weeks so try not to get it knocked and be particularly careful around other people, especially young children. Sleeping upright with extra pillows for a few days helps to reduce the swelling and bruising around the nose and eyes. Try to stay away from dusty or smoky places. You should not play sports where there is a risk of your nose being knocked for about a month as it will feel quite tender. As the skin become quite sensitive and prone to the effects of ultraviolet radiation, it is important to wear strong sunscreen and a hat for at least six months.

What can go wrong after a rhinoplasty?

Rhinoplasty surgery is generally extremely safe, but there are some risks and complications that can occur as after any operation. Occasionally, the bleeding that you expect from your nose can be more severe than usual and it may be necessary to put additional packs into your nose or even to need another small operation under an anaesthetic to stop the bleeding. This can happen within the first few hours after surgery or up to 10 days later.

Infections of the nose are rare after this type of operation. You may suspect an infection if you notice a foul smelling discharge from the nose which may contain green pus, a high temperature, increasing headaches, new bleeding from the nose several days later or if your nose becomes more sore. If it happens you are advised to see a doctor as you will almost certainly require antibiotics.

More rarely, if you have had a septoplasty, the operation can cause a hole in your septum going from one side of your nose to the other. You will more than likely be completely unaware that it is there as most of the time it causes no problems at all and needs no treatment. On occasions it can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Further surgery can be carried out if necessary to repair the hole.

Very rarely, you can have some numbness of your teeth and/or upper lip. This usually settles with time.