What gives the nose its shape?
The top of the nose is made of bone shaped like a roof, which is hard and can be broken when injured. The middle and tip of the nose are made of cartilage, which is softer. The skin varies in thickness from person to person, and also affects the shape. The individual shape and appearance of your nose is therefore due to the shape of the bone and cartilage skeleton, as well as the skin and soft-tissue envelope overlying it.
What is a rhinoplasty?
The nose is the defining feature of the face. Over 90% of face-to-face communication is non-verbal, and the relationship between the size and shape of the nose and its proportion to the shape of the face is crucial to how a person looks to other people.
Rhinoplasty is a term used to include a number of different operations to improve the shape of the nose. Everyone’s nose is different, so the type of rhinoplasty performed depends on what part of the nose needs changing. The nose can be straightened, made smaller or bigger, bumps may be removed, or hollows filled in. If the latter is required, it is usually achieved with pieces of cartilage taken from the inside of the nose, or from parts of the ear where it isn’t needed; these may be used to strengthen the nose and to fill in the dips. It may not be possible to make a large nose small, but it can be possible to improve the balance between the bridge and the tip of the nose. The shape and size of the nasal tip can also be improved.
What is a septorhinoplasty?
A septorhinoplasty is performed to straighten and unblock a bent nose. Bends of the dividing wall between the nostrils (the nasal septum) on the inside may cause a blocked nose, as well as the twist in the nose that you can see on the outside. A septorhinoplasty will straighten the bones and cartilage on the outside and the septum on the inside, improving the shape of the nose as well as the breathing through it.
What can be achieved with rhinoplasty?
The aim of surgery is to achieve a balanced look to the nose and face, with a natural-looking nose that is in proportion to your face and body and does not look as if it has been surgically altered. Our aim is that the tip of the nose should match the bridge of the nose, and the nose should match the face and body shape in general.
It will never be possible to say exactly how your nose will look after your operation, but satisfaction with surgery is usually very good if expectations are realistic on both our part and yours before the operation is carried out. It is important to emphasise that in all cases of nasal plastic surgery, healing and the results of surgery cannot be guaranteed. Everybody’s nose and face is different, so it is important to realise that it may not be possible to make your nose look exactly like your perfect nose from a magazine.
The thickness and age of the skin over the nose is important in how much better the nose will look after rhinoplasty, and in what can be done. The skin has to settle back down over the nose after the operation, and this process is ongoing over some months afterwards. If the skin is thin, it can make bumps or hollows on the nose difficult to hide; if it is particularly thick, not all the changes made on the inside may show up on the outside. On average, about 10% of patients request further surgery to correct new or persisting irregularities of nasal shape, although the vast majority of our patients are very pleased with the results of their rhinoplasty surgery.
Before the operation
Rhinoplasty surgery is completely non-urgent, but is important to achieve improved self-esteem and quality of life. We appreciate that cosmetic surgery of this nature is a very emotive subject, and we encourage patients to discuss their wishes for rhinoplasty with relatives and loved ones before coming to see us. We think it is also very important to try to bring someone with you to outpatients, at least for the first time.
Rhinoplasty is not appropriate in people who have significant medical problems which would make a general anaesthetic hazardous, or in those with concerns about their mental health.
We will take great care to talk to you before the operation about what can be achieved with surgery. Everyone’s needs and expectations are different, but in all cases realistic expectations allow an informed decision by you about your surgery. For these reasons, we normally see patients requesting rhinoplasty twice prior to surgery.
At the initial consultation, we can discuss which parts of your nose you wish to change, and what a rhinoplasty would and would not be able to improve. Digital photographs will be taken between your first and second appointments, to keep a record of how your nose looked before surgery and to allow us to plan your operation carefully. There is therefore a period of reflection and planning by both you and us between these two consultations. At your second visit we can confirm the surgical plan and, if appropriate, demonstrate the proposed changes on photographs of your nose on a computer screen, by means of digital image manipulation.
How is the operation done?
Rhinoplasty and septorhinoplasty are performed with you asleep (general anaesthetic). Cuts are either made inside your nose where they cannot be seen (closed-approach rhinoplasty), or a small cut is made across the bridge of skin between the nostrils at the bottom of the nose (open-approach rhinoplasty). Which approach is used depends on the nature of the rhinoplasty operation required in your individual case. The skin of your nose is gently lifted off the bone and cartilage underneath. The top of the nose may be trimmed down from the inside, and the tip shape may be changed. Hairline breaks are made in the nasal bones to change their shape, or to narrow or straighten the nose. Pieces of cartilage (taken from other parts of the nose or ear where they are not needed) may be put into the nose to fill in any dips or hollows.
What complications can occur?
Bleeding from the nose following surgery is rare, but may need further treatment with nasal dressings on the inside of the nose for a short period, usually no more than 24 hours.
There is a very small risk of a nasal infection, which would require antibiotics.
If you have surgery on your nasal septum as part of a septorhinoplasty, very rarely a hole may occur in your septum after surgery. This will usually not cause any problems, and you will not be able to see it on the outside of your nose, though small amounts of bleeding or crusting — and sometimes a whistling sound when you breathe through the nose — may be noticed. If this is a problem, the hole can sometimes be repaired later with another operation.
Redness of the skin overlying the nose may very rarely occur, especially if you have had previous surgery to the nose. Numbness of the upper teeth very occasionally occurs, and usually settles with time.
Does it hurt?
Your nose will be uncomfortable due to blockage for one to two weeks following your operation, but is not usually painful. Paracetamol is usually sufficient if required, but try to avoid aspirin-containing drugs, which may thin the blood and cause bleeding.
What happens after the operation?
The surgery is carried out as a day case under general anaesthetic. You are discharged home the same day, as soon as you are awake and mobile and have had something to eat. You will have a temporary splint on the outside of the nose for a week; this should be kept dry, particularly in the shower and when washing your hair. Take particular care taking clothes on and off over your head to prevent catching your splint — wear button-fastened clothes if possible. You will be seen in outpatients 7 to 10 days following surgery to remove the external splint. Occasionally, small sheets of plastic are placed inside the nose at the end of the operation to prevent scar tissue forming as the nose heals; if used, they are usually removed in the outpatient department one week after surgery, at the same time as the external splint.
Do’s and don’ts
You will be given comprehensive post-operative instructions on discharge from hospital, and will be advised to use saline nasal douches via the Sinus Rinse system by NeilMed.
You may have some bruising and swelling around your nose, eyes and top lip for one to two weeks. Sleeping upright with extra pillows for the first 48 hours or so can help.
Glasses should not be allowed to rest directly on the nose for four weeks. If you cannot wear contact lenses during this period, tape the bridge of the glasses to your forehead. Alternatively, a silicone shield can be worn on the nose underneath your glasses to protect it during this initial healing phase; these can be purchased from rhinoshields.com.
Avoid crowds of people, or dusty and smoky environments, for the first two weeks, where the chances of catching an infection are high. Your nose will feel stuffy (like a cold) for two weeks following your operation, and it may take six weeks for your breathing to become clear. As your nose will feel blocked and you will be breathing through your mouth, you may have a dry throat — drink plenty of clear fluids if this is the case.
A small amount of blood-stained mucus from the nose is quite normal during the first week or two, and you will be given some decongestant nasal spray on discharge to help with this for the first seven days. It is important not to blow the nose, or to cough and strain, during the first week, to prevent bleeding. Sneeze through an open mouth, and do not try to ‘bottle the sneeze up’ in your nose and mouth.
You will feel more lethargic than normal for the first week or two, so make arrangements for help at home accordingly. You should avoid strenuous activity or exercise, such as going to the gym, for about 2 to 3 weeks, as this may cause discomfort and bleeding; resume normal activity in stages following this period. The bones of your nose will be healing back to full strength over a period of about six weeks, during which it is very important to avoid activities or sports that risk the nose being knocked.
Following nasal plastic surgery, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least three months afterwards. The nose may feel a little stiff and numb for up to three months, particularly around the tip. Finally, it is crucial to understand that fine swelling around the nose may take up to a year to 18 months to settle, and it is only at this stage that the final results of surgery should be judged.