(nose job) is changing the shape of the nose. It is a complex procedure
in that the overall appearance of the nose is determined by the shape
of its various component parts. Each of the various parts can be altered
separately, so that the final result can be tailored to each individual
patient. It is possible to change many facets of the nose including the
shape of the tip, narrow the width, or to reduce the lump on the bridge
of the nose. In addition, it is possible to straighten the nose and improve
the flow of air through the nostrils.
When you are seen in clinic your nose will be assessed and photographed.
You can then discuss with the surgeon which particular features you would
like to change.
There is nothing
special or complicated to be done by the patient. If you are on the oral
contraceptive pill you should continue to keep taking it, and inform the
surgeon or anaesthetist in the hospital. If you smoke it would be a good
ideal to stop for a month before and two weeks after as this will improve
healing and your post-operative recovery. It would be advisable to stop
any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks
before the operation, in order to reduce bleeding and bruising.
into the hospital on the morning of surgery. The operation is performed
under general anaesthetic and takes between two and three hours. Rhinoplasty
can be performed via a "closed" or an "open" approach.
In a "closed" approach the nose shape is altered through cuts
on the inside of the nose. This type of approach can only be used for
relatively simple changes to the nose. The "open approach" is
used for more complex cases, especially when changes to the tip are being
made. As before, the alterations are made from the inside of the nose,
but with an additional very tiny cut in the columella of the nose - the
columella is the middle piece of skin that connects the upper lip to the
nose tip. This cut heals extremely well and is virtually invisible afterwards.
Each patient's operation is different depending upon which parts of the
nose are being altered.
At the end of the operation, the cuts on the inside of the nose are closed
with dissolving stitches, and a plaster of Paris splint is applied which
remains on for one week.
Post-operative follow-up and after care
patients need to stay in hospital overnight. All being well, you will
be discharged the following day with antibiotics and painkillers. It is
important to leave the plaster of Paris splint alone and not bump the
There is always some degree of bruising around the nose, the extent of
which varies between individuals, although this normally settles by 7
days. Many patients find difficultly in breathing through their nose immediately
after the operation. This is normal and is related to the swelling on
the inside of the nose, which will improve spontaneously.
At 7 days you will be seen in the clinic and the dressing and plaster
removed. It is important to rest and take it very easy for at least 2
weeks after the operation. You wound be advised to take 2 weeks off work
and it is essential to avoid all sexual activity during this period. Vigorous
sport such as jogging or the gym should be avoided for 4 weeks.
It is important to appreciate that the final shape of the new nose may
not be apparent immediately. This is because of swelling in the skin and
underlying structures of the nose following the operation. Approximately
90% of the swelling resolves by 2 weeks, making it possible to return
to work etc. The nose at this point should appear very pleasing and as
the patient wished. However, the final 10% of swelling resolves over the
next 3 months, often improving the result still further. A check-up clinic
appointment at 3 months after the surgery will be arranged for you.
carry a risk of complications, and in rhinoplasty these can be grouped
into general complications and those related to an unfavourable outcome.
are relatively rare. Infections following rhinoplasty are very rare and
are treated with antibiotics. Severe bleeding from the nose requiring
hospital admission is also rare (less than 1%) and nearly always settles
by simply packing the nose.
If an "open" approach to rhinoplasty has been used, there will
be a very small scar under the nose. This normally blends in very well
is virtually invisible to other people. In a minority of patients the
small scar may be slightly red and lumpy for a few months but this usually
settles down by itself without any further treatment.
By changing the shape of the nose on the outside to improve its appearance,
inevitably changes occur on the inside of the nose as well. This may bring
changes in patterns of air flow through each nostril. Sometimes this may
manifest itself as the inability to breathe through a particular nostril.
Great care is taken to avoid this problem at surgery, but if severe and
persistent, it can be corrected subsequently.
Occasionally, a patients is unhappy with the shape of their new nose and
this is known as an unfavourable outcome. An unfavourable outcome following
rhinoplasty occurs for three reasons. Firstly, by a misunderstanding between
what the patient wants their nose to look like and what the doctor thinks
the patient wants. This is not a common problem if sensible discussion
takes place in the clinic about the proposed surgery, and both the surgeon
and patient agree on a plan. Secondly, there is a technical imperfection
at the time of surgery. Most commonly a piece of bone or cartilage is
left behind in the nose that produces an unsmooth contour or bump. This
occurs in between 5 and 10% of cases and is usually corrected by a simple
and quick operation to remove the offending piece. Thirdly, the patient
has unrealistic expectations of what is achievable by rhinoplasty or that
the rhinoplasty will make any personal inadequacies or problems vanish.
This is a serious problem and it is important recognise this problem beforehand
in the clinic and avoid operating at all costs.
is a complex procedure it can give excellent results in the right patient.