Rhinoplasty (Nose Reshaping)
Introduction to Rhinoplasty (Nose Reshaping)
Rhinoplasty is a surgical procedure to alter the nose for cosmetic or functional purposes such as congenital defects, nose trauma and for respiratory impediment.
What is Rhinoplasty?
Rhinoplasty (nose job) is a surgical procedure to alter the nose for cosmetic or functional purposes. The procedure is not always cosmetic and is commonly performed for congenital defects, nose trauma and for respiratory impediment. The procedure is generally performed by a ENT surgeon or plastic surgeon. If done cosmetically, the nose can be reshaped by altering the bone and cartilage to create an aesthetic, functional and proportional nose.
How is a Nose Job performed?
The procedure can be performed in two main ways; closed or open. An open rhinoplasty involves a small cut(s) that is made to the outside of the nose, usually at the end of the nasal septum. A closed rhinoplasty involves surgical cuts that are entirely within the nose. Depending on the requirement for the procedure and wishes of the patient, the nose is then reshaped and/or corrected by reshaping the cartilage and bone within the nose.
How to prepare for a Nose Job?
The procedure is not a major operation but is mostly performed under general anaesthetic which has certain risks. Your surgeon will ask you to not eat or drink for a few hours previous to the procedure and will ensure you have both agreed on the exact changes that are to be made, from previous consultations.
What happens after a Nose Job?
After you have recovered from the anaesthetic, there will be a dressing across the nose which will have to remain on for a few days post-operatively. You should be able to go home shortly after the anaesthetic has worn off but it is recommended that you do not drive yourself. The operation may result in the formation of ‘black-eyes’ and there may be swelling around the nasal region. Analgesia will be provided by the surgeon for you to take to relieve any pain. The result of the rhinoplasty will not be fully visible until the swelling has gone down and this may take up to a few weeks.
What is a Septoplasty or Septorhinoplasty?
Septoplasty surgery is performed to correct breathing and not alter the external appearance of the nose. The procedure is relatively quick and normally takes between 30 to 40 minutes.
To correct the septum a small incision is made inside your nose and the deviated (bent) cartilage is then straightened and sometimes partially removed if obstructing the airways. The incisions are sutured with dissolvable stitches.
Risks and Complications of septoplasty surgery
- Excessive bleeding
- Infection, if left untreated could lead to necrosis (death of skin cells)
- A hole in your septum which can cause nosebleeds and blocked nose
- You may also hear a whistling noise when you breathe through your nose
- When a hole in your septum is causing you complications it may require further surgery
- The shape of the bridge of your nose may alter, if required further surgery can correct this
What is a Septorhinoplasty?
Septorhinoplasty is when a septoplasty is combined with rhinoplasty. The procedure normally takes between 90 to 180 minutes.
Closed Rhinoplasty requires all the incisions to be made inside the nose to enable your surgeon to access the bone and cartilage.
Open Rhinoplasty involves making an incision either at the base of the columella (the wedge of skin between the nostrils) and, or in the creases of the nostrils. The skin can then be lifted away to allow your surgeon external access to the bone and cartilage. Due to the disruption of the skin and tissue, you will have more swelling than with closed rhinoplasty.
To make a nose look narrower or to create a straighter nose the bone will normally need to be broken and reshaped, when only a slight difference is required it may be possible to rasp and, or chisel the bone to remove a bump or create a ski slope.
To create a shorter nose the septum can be adjusted and made smaller. The tip of the nose is normally reduced by reshaping and partially removing cartilage.
Cartilage can also be added in the form of grafts, to either lift up the tip or create smoother contours. Grafts can also be utilised to add height and nasal implants may be utilised in the tip.
What is an Ultrasonic (piezoelectric) Rhinoplasty
This method utilises high-speed sound waves to vibrate tiny cutting and shaving tip inserts Piezoelectric inserts (PEI). This reduces trauma to the surrounding tissues and removes all risk of accidental fracture lines. With fewer complications, this method is claimed to produce a more accurate outcome and reduce the need for revision surgery.
The disadvantages of this method are twofold. The device requires more and can only be done currently as open rhinoplasty there is also a risk of noticeable scars, although this is rare.
What is a Revision Rhinoplasty?
Revision surgery can be performed to further reduce the width of the bridge or the tip. When the nose is lower in height than desired or the tip is too refined cartilage can be used to build it back up. Nasal reconstruction may also require the use of additional cartilage. Cartilage can be sourced from the remnant septal cartilage and ear cartilage. When a larger more stable form of cartilage is required this can be harvested from the ribs. For adding height to the dorsum, alloplastic graft materials, such as silicone may also be used.
How will I feel immediately a Nose Job?
If you have had a general anaesthetic you may have nausea, vomiting. You can also feel cold and disorientated. You may be required to stay one night, although it is not unusual to go home the same day of the procedure.
Your nose is likely to be packed making it impossible to breathe for the first 12 hours and covered with a splint (cast) to protect the bones as they fuse back together. You may have some swelling and bruising particularly around your eyes and the tip of your nose will appear swollen. You will need to sleep upright until the splint is removed.
How long will I need off work after a Nose Job?
You may feel well enough to return to work within 3 days although a minimum of a week should be allowed for. This will also depend on what was involved with the procedure and how much swelling and bruising you have. Although rare severe bruising can take up to a month to disappear.
When can I blow my nose or sniff after a Nose Job?
The packing will be removed prior to leaving the hospital and you should not sniff or try to blow your nose. Whilst the splint is on always sneeze with your mouth open and avoid strenuous exercise and heavy lifting. A discharge of a small amount of watery, blood-stained liquid is normal and will normally stop after 7 to 10 days.
How long before I can see my new nose?
The splint will need to protect your nose for between one to two weeks and it will not be possible to determine the shape of your nose until it is removed. The stitches will be dissolvable and fall out by themselves.
How long will I take to recover after a Nose Job?
After the first 3 days, you should notice you start to feel a little better every day. On average it takes two weeks to recover although you may still have some bruising and residual swelling. It is advised not to swim for a minimum of 3 weeks due to the risk of infection. You should avoid any strenuous activity or heavy lifting for six weeks.
When will I be able to see the final shape of my nose?
The most significant changes will be noticeable as soon as the cast is removed and your nose will continue to change as the bones fuse and the swelling reduces over the next 6 to 12 months
Risks and Complications of Rhinoplasty
- Altered sense of smell
- Nasal breathing is affected
- Minor bleeding is common, heavy bleeding is rare but can be severe
- Nerve damage resulting in numbness
- Slight irregularity in the bone or cartilage may be felt or occasionally seen
- Structural scaffolding of the nose could collapse
- Persistent pain, swelling and skin discolouration
- Noticeable scars
- Deviation of septum (hole in the septum)
What is a Non-surgical rhinoplasty (nose filler)?
Dermal filler can be injected above and below the ‘bump’ on the nose, to make it appear straight. Filler can also be injected around the tip of the nose to improve the shape. The tip of the nose can also be lifted by injecting Botox into the muscle to prevent it from pulling the tip downwards.
Benefits of a Non-surgical Nose Job
Compared to ‘traditional’ rhinoplasty procedures recovery is extremely quick, with much lower chances of bruising or swelling. The procedure is quick and normally patients say is painless.
Which type of dermal filler is used?
- Hyaluronic acid, which is naturally present in the body and improves skin elasticity and volume.
- Radiesse, which is synthetically produced and stimulates the growth of collagen.
Questions to ask your doctor prior to a Nose Job
- What method do you advise I have and why?
- How many procedures have you done in the past 12 months?
- How many revision procedures have you done due to complications in the last 12 months?
- If I am unhappy with the results will you charge for revision surgery?