Treatment: Rhinoplasty

Why you might need? Rhinoplasty

Rhinoplasty is the name for an operation to change the shape of the nose. There are different types of rhinoplasty depending on which part of the nose is being altered including:

• Straightening the nose, making it bigger or smaller or removing bumps
• Changing the shape of the tip of the nose
• Changing the shape of the nose by removing or adding pieces of cartilage or bone.

Septal surgery may also be combined with nose reshaping surgery to become septorhinoplasty if the changes to the shape of the nose also require correcting a twisted septum.

There are main two reasons why rhinoplasty would be offered:

• To improve the aesthetic appearance of the nose.
• To clear a blockage that may be affecting a patient’s ability to breathe.

Some possible reasons why a patient might consider rhinoplasty are:

• Broken or injured nose due to previous trauma
• Crooked or deviated nose
• A hump on the dorsum (back) of the nose
• An indentation on the dorsum (back) of the nose
• Nose is too long or short
• Tip of the nose is too thick, round or uneven
• Nose and lip require correction following a previous surgery

Treatment Info

Surgery is the only way to change the shape of the nose, although very rarely it may be possible to use an injectable skin filler to make small refinements.

It may be the case that a patient’s reasons for wanting to change the shape of their nose are related to a body image disorder (body dysmorphic disorder) and these patients will be referred to a psychiatrist rather than recommended for surgery.

Treatment Aftercare

Like all surgical procedures, there are risks involved and your surgeon will discuss these with you before undertaking the procedure.

• Bleeding – your nose may bleed after the operation requiring packs to be put in your nose to stop it. This can happen any time from the first few hours to 4 weeks after the surgery. Very rarely more major bleeding may occur, requiring a further surgical procedure to stop it.
• Infection – This is very rare but if it happens it can be serious so you should consult your doctor if you experience increased swelling, redness or pain or you have a fever.
• Hypertrophic scars – if you have an open rhinoplasty procedure, you will have a small scar in between the nostrils. On rare occasions this scar may not heal properly, becoming hypertrophic (enlarged) and would then require scar revision.
• Discoloration – you may experience bruising around your nose and eyes which should settle after 2-4 weeks. In rare cases the skin on your nose may become darker or redder, which could last for up to a year.
• Loss of smell – another rare complication which is almost always temporary and can last for up to a year.
• Hole in the septum – This is also rare, but you may end up with a hole in your septum between your two nostrils, which causes whistling when you breathe, nosebleeds or crusting with blockage. This usually wouldn’t cause problems and require further treatment but, if necessary, further surgery can be performed to repair the hole.
• Nose numbness – This is expected after surgery, is almost always temporary and can last for 6-12 months.
• Teeth numbness – also very rare but you may experience some numbness of your teeth which should go away by itself with time.
• Implant extrusion – Usually your own cartilage will be used but in some cases your surgeon may use synthetic material as an implant to correct certain deformities. In rare cases these may be forced out of your skin, causing deformities.

Treatment Recovery

Your surgeon will arrange to take photos of your nose before your surgery for your records and to help plan the surgery. It is possible to create a computer simulation of what your nose will look like following the surgery.

This procedure is usually carried out under general anaesthetic. It should not be painful, but the front of your nose may feel tender for a few weeks afterwards.

Three are two techniques used – open and closed:

• Open Rhinoplasty – Your surgeon will cut the skin between or at the base of the nostrils. They will then lift the skin off the bone and cartilage and make any necessary additions or removals to the bone and cartilage in order to change the shape of the nose. The surgeon may also make a hairline fracture in the nasal bones to assist with changing the shape. When complete, your surgeon will replace the skin and close the cuts with stitches.
• Closed Rhinoplasty – Your surgeon will make cuts inside the nose and any changes to the bones and cartilage inside will be made through these cuts, which are then closed with stitches.

After the procedure, your surgeon will put small strips of adhesive tape over your nose and place a cast over these. They may also put a piece of foil or small plastic splints on the inside of your nose for support and to stop the formation of scar tissue, which will be removed after about a week.

It may be necessary for your surgeon to put packs or dressings on the inside of your nose to hold things in place and stop any bleeding.  These will be removed the day after your operation and may result in a small amount of bleeding that should stop quickly.

You will usually be required to stay overnight but, in some cases, you will be able to go home on the day of your surgery.

After the operation has been completed, your nose will feel like it is blocked on both sides for 10-14 days. Your doctor may give you drops or spray to help with this. It could take up to 3 months for your nose to fully return to normal with completely clear breathing.

For the first week after your surgery, you should not blow your nose and your doctor will confirm when you should be able to gently do so. It is normal for mucus or blood-stained fluid to drip from the nose within two weeks of completion of your surgery, but if you experience heavy bleeding you should see your doctor.

There will be stitches inside your nose that will either need to be removed or if they are dissolvable stitches, they will fall out by themselves.

Avoiding dusty or smoky environments is very important during your recovery.

You may also experience some bruising and swelling around your nose and eyes for the first couple of weeks. Sleeping on extra pillows to keep your head upright will help.

If you wear glasses, you should discuss your options with your doctor as you may be unable to wear them for up to 6 months after your surgery and therefore may need to consider contact lenses.

The skin on your nose will also be more sensitive to the sun so you should ensure that you wear high factor sunscreen and a hat for at least 6 months.

Following your operation, you should rest at home for at least a week, but most take up to three weeks off, especially if your work involves heavy lifting/carrying. You should also avoid any sports with a risk of contact to your nose for at least six weeks, but many take at least a year off.

Treatment Costs

Surgery is the only way to change the shape of the nose, although very rarely it may be possible to use an injectable skin filler to make small refinements.

It may be the case that a patient’s reasons for wanting to change the shape of their nose are related to a body image disorder (body dysmorphic disorder) and these patients will be referred to a psychiatrist rather than recommended for surgery.