Rhinoplasty (sometimes called a ‘nose job’) is a group of operations designed to improve the function or appearance (often both) of the nose. Sometimes, this may be caused by an injury, but often just by a difference during nasal development.
The function of our nose is a complex one, including breathing, but also contributing to taste and smell, humidifying the air as we breathe and it can also affect our voice and sleep.
The appearance of one’s nose is incredibly personal and can affect different people in very different ways. As such, Richard will spend a considerable time discussing your concerns regarding both function and appearance. Richard’s philosophy is that the nose should fall within the harmony of the face, highlighting the midface, whilst still being of the individual. Richard does not believe in a one-size-fits-all production line approach based on social media trends.
What can I expect?
As the structure, function and appearance of the nose are indelibly linked, attention must be paid to all aspects. A beautiful nose that can not breathe is not a success. Together with Richard, you will identify your key goals from rhinoplasty. Common issues for patients seeking rhinoplasty include:
- A dorsal hump.
- A deviated or crooked nose.
- A bulbous or ill-defined tip.
- A nose that is too big for the face.
- A blocked nose.
Depending on the severity of these issues, many can be significantly improved over the long term.
What happens before surgery?
As in many of his procedures, you will see Richard at least twice before consenting to undergo rhinoplasty surgery. The first consultation is often a lot of discussion to ascertain your concerns about your nose and what you wish to achieve, plus a detailed examination of the outside and inside of your nose.
The second, and any subsequent consultations provide an opportunity for you to clarify any questions, discuss expectations and confirm the individualised plan for your surgery, which may include review of any imaging or tests). Depending on your circumstances, Richard often employs pre-operative imaging to guide the surgical plan.
Rhinoplasty surgery is undertaken in a hospital setting, under general anaesthesia. You should not be taking any potentially blood thinning substances (e.g. aspirin, ginko, ginseng, fish oil) leading up to surgery, and absolutely no smoking for six weeks minimum prior to surgery (including vaping or patches). On the day of your procedure, Richard will see you to ensure all the usual checks have been done and you’re ready to go ahead.
What happens during surgery?
Richard follows the open structured rhinoplasty philosophy, with elements of soft tissue preservation in many cases. This employs a small incision across the columella of the nose (the only visible incision, which usually heals imperceptibly) followed by incisions inside the nostrils. This allows the best access to nasal structures, which, in turn facilitates precision and a robust result.
The nasal bones and dorsum may need reshaping, which is often done using a piezotome (often termed ‘ultrasonic rhinoplasty’). A section of the nasal septum may be harvested to use as structural reinforcement, which can also help straighten the nose and improve air flow. The tip cartilages are reshaped to provide a refined appearance and further reinforced for longevity.
Once the shape and airway have been addressed, internal and external nasal splints are applied which need to stay in place until 1-2 weeks after surgery. Patients may choose to stay in hospital overnight to recover and go home the following morning.
What happens after surgery?
Once home, we advise you to spend the next week or so recovering quietly at home. Find a good book or series on TV. You will be given oral antibiotics for ten days plus some antibiotic ointment. In addition to keeping your head elevated, keep your eye mask ice pack regime going for the first 3 days to reduce swelling and improve comfort. You will be given any medication required to keep you comfortable.
You may be able to do office work after the first week, but more often this is closer to two weeks. We will see you after the first week, then again at week two to remove the external and internal splints. At the third week, I usually start nose cones to support the nostrils during healing.
It’s critical that you avoid trying to clear any feeling of blockage or blowing your nose for the first two weeks, and DO NOT PUT ANYTHING UP YOUR NOSE. Not only can this be painful, but you can easily damage the structure of your new nose or introduce infection.
Be prepared that the final result after rhinoplasty reliably takes over a year to fully settle. The nature of nasal skin over a cartilage scaffold means that small bumps, edges and contours may only become palpable or visible a long time after surgery and some of these should be expected as part of the procedure.
Some long-term temporary numbness is normal, as is variable degrees of firmness to the feel of the skin of the nose and underlying cartilage reinforcement.
Possible complications:
The decision to undergo rhinoplasty surgery is a very personal one, and should only be made after considering if the potential benefits can achieve your aims, and whether the risks are acceptable to you. The possible risks/ complications of rhinoplasty surgery include (but are not limited to):
- Cardiac problems, including heart attack or arrythmias.
- Venous thromboembolism (including deep vein thrombosis and pulmonary embolism, which may be fatal).
- Surgical site infection.
- Wound breakdown, delayed healing or protruding sutures.
- Conspicuous scars, including hypertrophic, stretched or migrated scars.
- Numbness (temporary or permanent). Some long-term but temporary numbness should be expected.
- Contour irregularities, which may appear many months after surgery.
- ‘Empty nose syndrome’.
- Possible need for revisional surgery. Richard will only consider revising your rhinoplasty if he believes:
- there is a definable structural issue with the nose,
- this issue is realistically able to be improved with surgery and
- the risk of revisional surgery causing a worse result are minimal.
- You should understand that other people will probably notice you have had facial surgery, and this may draw attention.