Rhinoplasty

Rhinoplasty, or surgery to reshape the nose (“nose job”), is one of the most common of all plastic surgery procedures. Rhinoplasty can alter the size or shape of your nose, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

If you’re considering rhinoplasty

If you’re considering a ‘nose job’ or rhinoplasty, this information will give you a basic understanding of the procedure: when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask your surgeon about anything you don’t understand.
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The best candidates for rhinoplasty

Rhinoplasty or nose reshaping can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.
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Rhinoplasty for aesthetics

Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes – to correct birth defects or breathing problems. Usually it is thought to be better not to have this operation before the age of 16, although there are exceptions.

It is important to consider teenagers’ social and emotional adjustment too, and to make sure it’s what they, and not their parents, really want.
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All surgery carries some uncertainty and risk

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed or a reaction to the anaesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

Rhinoplasty 01

After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. When rhinoplasty is performed from inside the nose, there is no visible scarring; when an “open” technique is used, or when the procedure calls for the narrowing of flared nostrils, there are small scars on the base of the nose but these usually fade well.

In about one case out of twenty, a second procedure may be required: for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.
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Planning your surgery

Good communication between you and your surgeon is essential. In your initial consultation, I will ask what you’d like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. I will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

I will also explain the techniques I will use, the risks involved and any options you may have. Insurance policies don’t cover purely cosmetic surgery, but if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, it may be covered. Check with your insurer, and obtain pre-authorisation for your surgery.

Be sure to tell me if you’ve had any previous nasal surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties, if you’re taking any medication, vitamins or recreational drugs or if you smoke.

Usually clinical photographs are taken before surgery so that you can discuss them with your surgeon.

Don’t hesitate to ask any questions you may have, especially those regarding your expectations and concerns about the results.
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Preparing for your surgery

It may be useful to take Arnica tablets for a few days prior to surgery to reduce the bruising.

Please be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Rhinoplasty is performed under general anaesthetic as an in-patient.
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The surgery

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is redraped over the new framework.

If your nostrils are too wide, the surgeon can remove small wedges of skin from their base, bringing them closer together.

The surgery

Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an “open” procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils. I am experienced in both these techniques and can discuss the pros and cons of each with you during your consultation.

Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilise the septum, the dividing wall between the air passages.

The surgeon removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose. Trimming the septum improves the angle between the nose and upper lip.
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After your surgery

After surgery – particularly during the first twenty-four hours – your face will swell, you may develop a lot of bruising around the eyes, your nose may ache and you may have a dull headache. You can control any discomfort with the tablets prescribed.

You’ll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses and ice packs will reduce this swelling and make you feel better. In any case, you’ll feel a lot better than you look. The cast will be removed from your nose after one week and most of the swelling and bruising should disappear within two weeks.

After your surgery

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. You will be advised not to blow your nose for a week or so, while the tissues heal.

If you have nasal packing, it will be removed on the morning after your operation and you’ll feel much more comfortable. By the end of one or (occasionally) two weeks, all dressings, splints, and stitches should be removed.

A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose maintain their new shape.
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Getting back to normal

Most rhinoplasty patients are up and about the following day, and able to return to school or sedentary work two weeks following surgery. It will be several weeks, however, before your nose has settled completely.

You will be given more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: avoid strenuous activity (jogging, swimming, bending, sex and any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.

You can wear contact lenses as soon as you feel like it. I will schedule follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can’t do, call the team.
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Your new look

In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will soon be looking better.

Your new look

Day by day, your nose will begin to look better and your spirits will improve. Within two weeks you’ll no longer look as if you’ve just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for as long as a year.

After surgery, you will have a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle between the nose and upper lip.

In the meantime, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose. Or they may be resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If we’ve met your goals, then your surgery is a success.
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