Rhinoplasty (re-shaping the nose)
Rhinoplasty is an operation to correct deformities of the nose. Although usually requested by a patient to improve nasal appearance, it can also be performed to improve nasal breathing.
Rhinoplasty is one of the most difficult cosmetic surgery operations to do because the difference between good and bad results can be just a millimetre or two. Because Rhinoplasty is a challenging, three dimensional and sculptural operation, after which you will look different forever, (rather than younger and fresher), you should give careful consideration to your choice of plastic surgeon.
More than any cosmetic operation, Rhinoplasty has been subject to fashion. In the recent past, most women and their surgeons thought it desirable to have an upturned nose. Later, the trend moved toward a natural, strong nose with a high bridge and sculpted tip.
Today, the general consensus amongst surgeons is that no one nasal style is perfect. My purpose in all this is to try and give you an attractive nose that looks natural, functions properly, and is in balance and harmony with your facial features.
Primary Rhinoplasty refers to nasal surgery performed for the first-time, whether for cosmetic or breathing purposes. It involves remodelling bone and cartilage to change the nasal framework and then re-drape the skin over this new scaffold to give the final result.
My goal in primary rhinoplasty is avoid an “operated look” by working with you to match your realistic wishes and my abilities. Your facial proportions and contour, skin texture and thickness, as well as any previous nasal trauma and your individual wound healing biology all play an important role in what can be achieved with a Rhinoplasty – as well as in what should be attempted.
Secondary rhinoplasty is performed to correct problems that persist or develop after previous rhinoplasty surgery. A secondary rhinoplasty is always more difficult and requires more expertise than the primary rhinoplasty. This is because the original (normal) anatomy is no longer intact after the primary surgery and the original tissue planes are now filled with scar tissue. Also many secondary rhinoplasty patients have an unnatural looking nose that does not function properly. As with primary surgery, my goal is to produce a nose that appears natural, functions properly, and is in balance and harmony with other facial features
Commonly asked questions about Rhinoplasty
- Am I a good candidate for a Rhinoplasty?
- What should I expect from my consultation?
- What happens during my Rhinoplasty?
- What about my recovery and return to normal activities?
Am I a good candidate for a Rhinoplasty?
This is best decided during a consultation, but generally speaking, the best candidates for a rhinoplasty are physically and mentally healthy adults who are seeking improvement in the appearance of their nose, rather than perfection.
You are likely to be a good candidate if you are physically healthy, psychologically stable, and realistic in your expectations.
I generally avoid operating on teenagers so as to ensure that they have completed growing and are socially and emotionally mature. Clearly there will always be exceptions, but I will endeavour to be sure that surgery is your choice and is not being sought because your parents or friends think you need it.
What should I expect from my consultation?
During your consultation, I will take a full medical history. I will ask how you would like your nose improved and what bothers you? Then I will examine you and your nose and take standardised-view photographs which will be used to aid us in discussing the possibilities, limitations and risks of surgery.
What happens during my Rhinoplasty?
Before surgery, you will meet and be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be.
On the evening before, or the morning of your operation I will review what we have discussed and planned previously and we will both sign your operative consent forms.
The operation is performed under General Anaesthesia – you will be asleep.
During your surgery, which I perform usually via an open approach using incisions that are mostly hidden inside your nose, I separate the nasal skin from its scaffold of bone and cartilage; sculpt and reconfigure your nose to the desired shape and then re-drape the nasal skin.
When the surgery is complete, a splint is applied to help your nose maintain its new shape during the initial stages of healing. In some cases, soft splints may also be placed in your nostrils to stabilize the septum for a couple of days after surgery. Depending on what needs to be done, a primary rhinoplasty may last up to two hours.
When you wake from your operation, you will have some discomfort and a dull headache for which you will need pain relief. Your face will feel puffy and often you will have black eyes. Most patients stay overnight in hospital and go home the following day.
What about my recovery and return to normal activities?
The swelling and bruising around your eyes will increase at first, to peak at the third day after your operation and it will have resolved usually by 2 weeks after your operation. You will feel blocked up, much as if you have a head cold, for a fortnight or so.
The splint on your nasal bridge and your stitches will be removed after 7 days. It is not unusual for patients to tire easily in the weeks after surgery, and to feel low and a little emotional, but this passes for those who experience it, and most patients are back at work within 2 – 3 weeks of surgery.
In every other respect, you will be able to move around and function relatively normally.
Generally, you can return to work if your occupation is sedentary, as soon as you feel able. Likewise, so long as you can do so with due care and attention, you can begin driving within a day or two of discharge from hospital.
You should avoid blowing your nose for 2 weeks after surgery and should restrict yourself to light exercise for 2 – 3 weeks – avoiding lifting anything heavier than 5Kg.
The final appearance of your new nose matures with time as your body deposits and moulds scar tissue: you will see the final result on the nasal bridge after 9 months and at the tip after up to a year. Depending on your skin type, some patients experience the appearance of small vascular, red spots on the skin surface over the nasal bridge after Rhinoplasty – these are an unpredictable association, rather than a complication of a Rhinoplasty, but they may be responsive to laser treatment.
Scars inside the nose are invisible under normal circumstances. The small scar on the skin between the nostrils, or at the bases of the nostrils after flared nostrils have been narrowed, will fade in time to become barely noticeable. Two or three weeks after your surgery, such scars will benefit from friction-free massage (using vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently from the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.