Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

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RHINOPLASTY INFORMATION

General Background

Rhinoplasty (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.

Before the operation

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.

The operation itself

Patients come 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

Rhinoplasty 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 nose.
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.


Complications

All operations carry a risk of complications, and in rhinoplasty these can be grouped into general complications and those related to an unfavourable outcome.

General complications 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.

Summary

Although rhinoplasty is a complex procedure it can give excellent results in the right patient.


Operation Time 2 hours
Anaesthetic General
Nights in hospital 1
Time off work 2 weeks
Return to normality/exercise 4 weeks