Rhinoplasty

What is rhinoplasty?

Rhinoplasty is surgery that is performed to reshape or repair the outer appearance of the nose. It is commonly known as a 'nose job'. It is performed by a trained surgeon, generally with the patient under general anesthesia.

Reasons for procedure

Rhinoplasty can be performed for the following reasons:

• Cosmetic reasons - where the appearance of the nose may cause low self-esteem and difficulties with socialization, and;
• Medical reasons - where there are breathing difficulties caused by nasal deformities.

Rhinoplasty can help address the following issues:

• Change the size of the nose;
• Re-shape the nose to reduce visible humps on the bridge of the nose, or the appearance of a crooked nose;
• Change the angle of the nose, so it does not appear too sharp or flat;
• Change nostril size and symmetry if the nostrils are too large or uneven, and;
• Reshape the tip of the nose, if it is too large, hooked or upturned.

Types of procedures

Rhinoplasty can be performed in several ways. There are two common types of rhinoplasty:

• Closed rhinoplasty, which involves operating through the nostrils, leaving no visible scars on the outside, and;
• Open rhinoplasty, which involves making a small incision underneath the tip of the nose.

Occasionally, rhinoplasty may be combined with other procedures, such as a facelift or correcting a deviated nasal septum, depending on the reason for the surgery.

It is typically performed by an ear, nose and throat (ENT) or plastic surgeon. Your surgeon will be able to discuss which type of procedure would best suit you. Closed rhinoplasty causes less scarring and less swelling, which may lead to a faster recovery time, while open rhinoplasty can allow for more complex repairs.

It is important to note that there are limits to the changes that can be achieved in the size and shape of the nose. Before embarking on this procedure, ask your surgeon about its likely outcome. Commonly, photographs of your nose may be taken before your procedure, which helps your surgeon plan for the surgery and demonstrate its outcomes.

What happens during the procedure?

Rhinoplasty is generally performed in a hospital, commonly under general anesthesia. Your surgeon will make an incision either within your nostril or under the tip of the nose, depending on the type of procedure. Through the incision, the surgeon will carefully reshape the bones and cartilage to produce the desired outcome.

Occasionally, additional soft tissue, such as cartilage, may be taken from other sites in the body to help reconstruct the nose. This is typically done if there is insufficient soft tissue in the nose for the desired outcome. If this is necessary, your surgeon will discuss the procedure with you prior to surgery.

At the end of the procedure, wound dressings will be placed in and on your nose. Occasionally, soft protective plastic splints are temporarily placed within the nose to keep the soft tissues aligned until the nose is sufficiently healed. The surgery usually takes 1-2 hours, but may take longer depending on the complexity of the procedure.

What happens after the procedure?

Once you have recovered from your anesthetic, you may be allowed to return home, or may need to stay in the hospital, usually for a few days. This usually depends on the complexity of the surgery and your surgeon's preferences.

While some dressings may be removed immediately after the procedure, others will generally need to be kept in place until you revisit your doctor in the following weeks.

After the surgery you may experience pain and swelling in your nose and face. Headache is also quite common. You will usually be given pain-relief medications to help manage the pain.

You will commonly have dressings in and on your nose. These may make breathing uncomfortable; however, the dressings within your nose are usually removed before you are sent home, or within a few days of the procedure, once any bleeding has ceased. The dressings on the nose are left until you see your doctor over the following weeks. These help reduce swelling and provide support to the nose while it heals. Recovery takes several weeks. Swelling and numbness may persist in the tip of the nose for months and you may not be able to see the final results for several months.

It is important to follow the self-care instructions given by your doctor following surgery. These often include:

• Keeping your wounds clean;
• Avoiding blowing your nose unless you really have to, in which case be sure to blow gently;
• Reporting any major bleeding or pain to your surgeon;
• Avoiding hot food and drinks for the first few weeks, as they can make bleeding worse;
• Avoiding contact sports, and;
• Making follow-up appointments to have your doctor remove bandages or check your progress.

Potential complications

Potential complications with rhinoplasty include:

• Bleeding and bruising;
• Breathing issues;
• Reduced sensation at the tip of the nose;
• Infection;
• Scarring, and;
• Unhappiness with the new look of your nose. You may need further surgery to repair these problems.

Smokers are at a higher risk of complications during surgery, so if you are a smoker you may wish to quit smoking.

Alternative procedures

There is an option for non-surgical rhinoplasty, using injectable fillers (synthetic compounds similar to soft tissues in the nose) to reshape the nose by filling sunken areas on it, lifting its tip and/or smoothing bumps on its bridge. This can be performed in a clinic by an experienced health professional. However, it is not suitable for every person considering rhinoplasty. It may be worth discussing this option with your surgeon prior to any treatment.

References

1. Grafts in closed rhinoplasty. [Acta Otorhinolaryngol Ital. 2013] - PubMed - NCBI. Accessed 19 August 2014 from link here
2. Our experience in open rhinoplasty. [Hippokratia. 2007] - PubMed - NCBI. Accessed 19 August 2014 from link here
3. Primary rhinoplasty. [Eplasty. 2013] - PubMed - NCBI. Accessed 19 August 2014 from link here
4. Rhinoplasty - National Library of Medicine - PubMed Health. Accessed 18 August 2014 from link here

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