Surgery to reshape the nose, or Rhinoplasty, is one of the most commonly performed plastic surgery procedures. It can be used to reduce or increase the size of your nose, change the shape or help relieve some breathing problems. Rhinoplasty may also be used to correct birth defects or injuries.

Most cosmetic rhinoplasties can be performed through incisions inside the nose so that there are no visible scars

Planning your Surgery

A detailed consultation is essential. We will discuss what you' would like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities. Digital photographs may be taken and altered on the computer to aid the discussion of an ideal shape. We will discuss 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, and your age. Previous nose surgery or an injury to your nose, even if it was many years ago may affect your surgery. Planning of your surgery may be affected if you have any allergies or breathing difficulties; if you're taking any medicines, or recreational drugs; and if you smoke.

Preparation for Surgery

You should not take aspirin or non steroidal anti-inflammatory drugs such as Brufen or Nurofen for two weeks before your surgery. These drugs increase the risk of post operative bleeding and have an adverse effect on bruising.

If you smoke, you will need to stop smoking for two weeks before surgery and a week afterwards. Smoking reduces the blood flow to the skin and can prevent healing.

You will need someone to drive you home after your surgery and to help you out for a few days at home.

The Risks

All surgery is associated with some risk. Complications following rhinoplasty are infrequent and usually minor. It is quite common to notice a little bleeding for a couple of days after surgery. More severe bleeding is uncommon and can generally be treated by sitting up and applying a cool gauze lightly against the nostrils.

Rarely, an open rhinoplasty may result in adverse scarring on the columella.

Very occasionally corrective surgery may be needed to correct a minor deformity. The surgery is generally minor. Most scientific papers on rhinoplasty quote the need for minor corrections as at about 5-10%.

The Surgery

A General anaesthetic is usually needed for rhinoplasty. The surgery takes between one and two hours.

Many cosmetic rhinoplasties are undertaken entirely through incisions inside the nose leaving no visible scars. Where more complex surgery is required, for example to correct an asymmetry or perform a revision rhinoplasty, an open rhinoplasty approach is sometimes needed. This involves making an incision on the columella (The part of the nose between the nostrils).

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. Adjustments to the bone and cartilage of the nose are made to correct the shape.
Finally the incisions are repaired with fine sutures (stitches). Dissolvable sutures are used inside. Part of the open rhinoplasty incision is closed with very fine sutures that are removed a week after surgery. A light plastic splint is place over the nose to protect it for the first week.

After your surgery

After surgery, particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a mild headache. There may be swelling and bruising around the eyes. In order to reduce this you will be nursed sitting up after the surgery and also asked to sleep slightly sitting for the first few days. Although there is some discomfort, rhinoplasty is not usually painful.

The swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks.

The plastic splint and any non dissolvable sutures are removed a week after surgery. Most of the swelling and bruising should disappear within two weeks or so.

Getting back to normal

Most people are able to return to work about 14 days after surgery. The nose will be delicate for some time and will take 2-3 months to reach its maximum strength. For this reason contact sports should be avoided for the first 6-8 weeks. Although most of the swelling settles relatively quickly, complete resolution of all the fine swelling within the skin takes approximately 6 to 9 months. This is particularly noticeable in the nasal tip, which is the last site to settle. For this reason a final contour cannot be judged until 6 to 9 months have elapsed from the surgery. There may be some numbness over the nose which will gradually disappear over a few weeks or months.