Even the slightest revision of your nose can appear to change your appearance dramatically.

1. What is Rhinoplasty?
2. Why you might consider Rhinoplasty
3. The Operation: What Happens during Surgery?
4. Recovery / Convalescence

What is Rhinoplasty?

Rhinoplasty, more commonly referred to as a ‘nose job’ is the reshaping, resizing and/or repositioning the nasal features.  It is one of the most popular cosmetic surgery procedures.  Since the nose is the most dominant feature of a person’s face even the slightest revision of the nose can appear to change facial appearance dramatically.

People undergo rhinoplasty for a variety of reasons both cosmetic and physiological.  You may have been born with a nose that you feel is not in proportion or harmony with your other facial features or which you feel has a defect that you would like corrected.  Some people undergo the surgery to improve breathing as their nasal structure has an impact on the airways and their comfort.

While rhinoplasty is a common surgical procedure, it is also a relatively complicated operation, although recovery times are reasonable.  The operation lasts usually between one to two hours, but can be longer.  It is carried out either ‘closed’, with incisions being made from within the nasal passages, or ‘open’, with the surgeon having greater visibility to operate using external incision points.  The choice is determined by the nature of the revisions you require and your surgeon’s preference.

It is possible that your nose appears larger because of another facial feature.  Commonly, surgeons recommend chin augmentation either as well as or instead of rhinoplasty.  You may wish therefore to consider other interventions or complementary surgery along with your rhinoplasty operation.

Why you might consider Rhinoplasty

Rhinoplasty is a highly individualized operation with different goals and outcomes for each person.  You will need to discuss in detail with your surgeon your expectations so both you and your doctor can assess a realistic outcome.

You may wish to undergo Rhinoplasty because:

• You are unhappy with the look of the nose you were born with
• Your are unhappy with the way your nose has changed with ageing
• Accident or injury has altered your nasal features
• Your nasal structure makes it difficult for you to breath clearly

Rhinoplasty is generally carried out only on people whose facial features have matured; so it is not, as a rule, performed on minors less than 15 to 16 years of age other than for physiological reasons.

The surgery is ideal for people with a mature outlook who are happy to have improvements made to their nose but who are not seeking perfection in their appearance.  You need to have considered your self image, your self confidence, any likely reaction of your family and friends and how you will cope with any comments – positive or negative – made about your appearance after surgery.  Before considering surgery, you may wish to think too about your ethnic background, or any particular hereditary family characteristics that may be altered with rhinoplasty.

What Rhinoplasty can do

The aim of rhinoplasty is to give you a nose that has the appropriate and natural look and feel for you.  Your skin type (thickness, elasticity etc), age and your ethnicity all have a bearing on the outcome of your rhinoplasty.

The most popular revisions are: to the tip of the nose, dorsal bone (bridge of nose), the wide bony part of nose and the base of nose, and to reduce wide nostrils and the angle between the nose and the lip.  These are performed as follows:

• Reshaping tip of the nose: this is achieved by adding or removing cartilage.
• Resculpting hump or bridge of nose: the dorsal bone is corrected by removing (literally, the shaving of excess bone away) and then resetting the nasal bone together.
• Reducing a wide bony portion of nose: this is done by breaking the bones of the nose and retting them closer together, inwards.
• Reducing wide base of the nose: tissue is removed and the nostrils moved c closer.
• Reducing wide nostrils: small areas of skin are removed from the base of the nostril.
• Corrections of the angle between nose and lip: the septum (cartilage separating the nasal passages) is trimmed.

What Rhinoplasty won’t do

Rhinoplasty does not come with set guarantees and it is best thought of as corrective and able to enhance your appearance to a given extent.  In some cases, corrective surgery is required as it is impossible to tell before operating how a person’s nose will set, heal or reshape following surgery.

As important as the structural changes in your nose, are the emotional and psychological changes you might experience following your rhinoplasty operation.  You may feel elated or conversely a little disappointed as you will not fully realise the benefits until swelling and bruising has subsided. Even then, you may feel that your nose is not as you would have wished.  You need to understand before the operation, how you will cope with your emotional response to the outcome.

By having frank and detailed discussions with your facial plastic surgeon beforehand, and by following carefully any post-op guidelines you are given, you can increase your chances of having a successful rhinoplasty operation, with the outcome you seek.

The Consultation

The pre-operative consultation with your facial plastic surgeon and the immediate weeks before surgery are very important if you are to make the most of your rhinoplasty surgery.  You will need this time to prepare yourself emotionally and physically.

The more candid you are at this stage, the better your surgeon will be able to assess the type of rhinoplasty is required to improve your nose and whether to operate using ‘closed’ or ‘open’ surgery. You will need to be aware of the options as the method of surgery has implications for scarring and healing and recovery times.

Be clear about what you expect the surgery to achieve.  If you wish, provide photos of how you expect your nose to appear after surgery.  Your surgeon will assess your expectations and advise you if they are attainable.   Remember, you may be advised to undergo other interventions (chin augmentation, for instance) that work in tandem with rhinoplasty to give you the look you are seeking.

The surgeon will examine all aspects of your nose and overall facial features as well as your skin (its elasticity, thickness and so on) and bone and nasal structure.  The thickness of your nasal skin is important: thin skin can be draped more easily to a new form, however, thick nasal skin will hide any irregularities resulting from the surgery, and can make for reduced convalescing time.

If you are having rhinoplasty to correct impaired breathing, the surgeon will make a very detailed examination of your nasal passages and septum.

The surgeon will ask you detailed questions about your overall health, well-being, goals and your medical history as well as perhaps about your ethnicity and/or any discerning hereditary family nasal characteristics.  The surgeon forms a surgical plan based on this information to select the optimum intervention for your needs.

What to expect from the surgeon

Be prepared to supply information on and/or discuss:

• Your expectations of the surgery
• Any medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Any previous surgery
• Any family history that may be relevant to your nasal or facial characteristics

During the consultation, your surgeon is likely to:

• Assess your general health
• Evaluate any health conditions
• Examine your entire skin’s elasticity, age and so on
• Discuss the likely results of your surgery
• Discuss the value of and any complications of combining your rhinoplasty with other facial plastic surgery
• Take photographs for medical records
• Talk about the type of anesthetic used and its effects

You may be asked in preparation for surgery to:

• Take certain medications or adjust your current medications
• Have certain lab tests or further medical evaluation
• Refrain from smoking in advance of surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Questions you should ask

It is important that you are fully informed of the after care, any possible complications and the likely results of your surgery.  You will also need to know how the procedure is carried out – closed or open rhinoplasty surgery – and in particular where incisions or bone breakages are made and where any scarring, if any, is likely.  Below is a checklist of some key questions to ask:

• What type of rhinoplasty is best for me, or does the surgeon prefer, and why?
• How do I best prepare for the operation
• Do I need assistance in post-operative care?
• What results can I expect?
• What side effects or complications may occur?
• What discomfort will I have?
• How will my nose/face look immediately post op (bruising, swelling etc)?
• Are there any activities or environments I should avoid while I recover?
• How likely is it I will need revisionary surgery?
• What other facial cosmetic procedures can I consider in conjunction with my rhinoplasty?
• What post-operative instructions should I follow after the operation?
• When can I expect to resume normal work-life activity levels?

The Operation: What Happens during Surgery?

Rhinoplasty is a one- or two-hour operation for most people, under general anesthesia but can be performed under local anesthetic and sedation, though this is not common.

Incisions depend on what aspect is being corrected, but can be made from within the nasal lobes  – closed surgery – which is more difficult for the surgeon but which leaves no scars; or with ‘open rhinoplasty’ which entails making a small incision across the columella (between the nostrils) as well as some incisions within the nose.  Open rhinoplasty is used for more complicated surgery as it allows greater visibility.   Ensure you are familiar with the technique your surgeon prefers.

During the operation, the skin of the nose is separate from the nasal structure (bone, cartilage) and then sculpted and repositioned.  Some operations require the removal or addition of cartilage while others involve the resetting of bone.  Skin is then reset, or draped, back over the underlying structure and secured with absorbable sutures.

Recovery / Convalescence

What to expect immediately

When the surgery is over, a splint or plaster is applied to your nose to stablise its shape.  This is removed at around a week following surgery.  You may have nasal packs or malleable plastic splints placed inside the nostrils to support the septum.  These nasal packs also help prop up the divide between your air passages.  These aren’t that comfortable, but are generally removed fairly soon (even within two days) after surgery.

In addition, you will be advised to rest and sleep with your head elevated.  You will have regular pain-relieving medication once the anesthetic wears off.

As with all cosmetic surgery, you will need to be patient and go through some immediate discomfort before you can see the full results of your rhinoplasty.  It is not uncommon in the first days to feel a little dejected as you will have a splint and be swollen.  Be kind to yourself and take time to get over the immediate convalescence before you assess your surgery.  Also, since the nose is fragile, ensure you follow all post-operative care instructions fully.  You will be given information on how to bath, wash your face carefully and so on.

The extent of your discomfort depends on the nature of your surgery – if you had bones broken, you will obviously have more swelling and skin discoloration and a longer recover period.  In most instances, you will feel significantly better by around a week after surgery and start to see the results at around two weeks.

You are advised to refrain from medium and strenuous exercise for up to six weeks; in fact, anything that raises your heart rate too much as this may cause bleeding.  You can assume you can return to near normal work-social life within a week.

You cannot wear contact lenses or eye make-up for 2 weeks after your intervention. These are general guidelines, and you must ask your consultant about your particular situation.

Long-term Care

Rhinoplasty is permanent, and the immediate results are usually clear at two weeks.  But it is worth noting that your age, skin type, and propensity to heal will affect how your nose adjusts over time.  There may be small, almost imperceptible changes for up to six to 12 months.

It is possible you will experience some numbness in the upper lip and tip of your nose even in the months following surgery.  Inform your surgeon and keep abreast of any abnormal signs or changes.

You may feel like you have a permanent cold as your nasal passages may feel blocked for several weeks.  Avoid the temptation to blow your nose or pick as this could lead to bleeding and undermine the healing process.

A little bleeding is common in the first weeks, but be careful with your nose and note any unexplained, or excessive bleeding in later weeks.