Rhinoplasty : what is it?
Rhinoplasty is the operation in which the bone and cartilage framework of the nose is reshaped. Because it sits at the centre of the face, the nose affects a person’s expression more than any other feature, but it is also the entrance to the airway. A good nose operation is therefore never purely aesthetic: breathing must be preserved or corrected alongside appearance. Problems that obstruct breathing, such as a deviated septum or enlarged turbinates, can be addressed in the same operation.
Who is a suitable candidate?
- Facial growth complete (generally after 17 in women and 18 in men)
- A dorsal hump, drooping tip, width or asymmetry that bothers you
- Difficulty breathing; a deviated septum or history of trauma
- General health suitable for surgery
- Realistic and clearly defined expectations of the outcome
How is it performed?
The operation can be performed with an open or a closed technique. In the closed technique all incisions remain inside the nostrils. The open technique adds an incision of a few millimetres on the skin bridge between the nostrils (the columella); this scar becomes indistinct over time. Because the open approach gives the surgeon direct sight of the structures, it is preferred where the tip requires detailed shaping and in revision surgery.
During reshaping the hump is reduced, the bones are broken in a controlled way and narrowed if needed, and the tip cartilages are repositioned with sutures. Where support is required, grafts taken from the patient’s own cartilage (septum, ear or rib) are used.
At the end of the operation thin silicone splints may be placed inside the nose; a channel through the middle allows you to keep breathing through it. A protective splint is applied on the outside.
Recovery
The timeline below shows an average course. Your personal recovery depends on your age, skin quality, smoking and the extent of the operation.
The first night is spent in hospital. Pain is less than most people expect and is easily controlled with painkillers; the real discomfort is the blocked nose. Keeping your head above heart level reduces swelling.
Splints inside the nose are usually removed on day 2 – 4 and the external splint on day 6 – 8. Bruising and swelling around the eyes peak on day 3 and then subside quickly. Once the splint is off, most people look presentable in public again.
Most of the swelling has resolved and the nose looks natural in daily life. During this period glasses should not rest on the nose, knocks must be avoided and heavy exercise is out. Light walking can start from week 2.
Swelling at the tip is the last to resolve. The final shape can take 12 months, particularly with thick skin, and up to 18 months after revision surgery. The nose continues to change slightly during this time; that is normal.
Possible risks
Every surgical procedure carries risk. Knowing them is not meant to frighten you but to let you decide with full awareness. Each point is discussed individually at your consultation.
- Swelling, bruising and temporary numbness (expected findings that settle on their own)
- Bleeding and infection
- Adhesions inside the nose; temporary or lasting nasal obstruction
- Asymmetry, irregularity or a shape different from the one expected
- The need for a small corrective (revision) procedure
- General risks associated with anaesthesia
This page is for general information and does not replace a consultation. The method that may apply to you, the expected outcome and the risks can only be determined after a medical examination.
Frequently asked questions
How soon can I go back to work?
If you work at a desk, you can usually return from day 7 – 10, once the splint is removed. For physically demanding work this extends to 3 – 4 weeks.
Is the operation very painful?
Most patients say the pain was far less than they expected. What actually bothers people is the blocked nose in the first days and having to breathe through the mouth.
When will I see the final result?
Your everyday appearance settles within a month, but fine swelling at the tip can last up to 12 months. The final result is judged at the end of the first year.
Can my breathing problem be corrected at the same time?
Yes. A deviated septum and enlarged turbinates can be corrected in the same session as rhinoplasty; a separate operation is not needed.
Will splints be used, and is that painful?
The silicone splints used have an air channel through the middle, so you can still breathe, and removing them is far less uncomfortable than with the older generation of packing.
