Rhinoplasty

Introduction
Rhinoplasty is an operation designed to re-shape the nose. It is one of the most common cosmetic procedures performed in both men and women with patients reporting increased self confidence as a result of improvement in their appearance. The most common request is to reduce the size and shape of a large nose or tip, but occasionally an increase in the height of the profile is also requested. In most instances the incisions are within the nostrils leaving no visible scars on the outside. A detailed consultation and examination are essential before a precise surgical plan can be made by Mr Grover.

How do I prepare for surgery?
Where will my surgery be performed?
What type of anaesthetic will be used?
What does the operation involve?
How long will the surgery take?
Is it painful?
What can I expect after the surgery?
What are the scars like?
What are the risks?
Summary

How do I prepare for surgery?
It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen and Nurofen). If you are a smoker it is helpful to stop for two weeks before surgery and for a week afterwards so as not to restrict the circulation to the skin. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home.

Where will my surgery be performed?
The surgery is performed at the King Edward VII Hospital in central London where Mr Grover works as a Consultant in Plastic and Aesthetic Surgery. You will usually be admitted on the day of surgery, and stay overnight.

What type of anaesthetic will be used?
Rhinoplasty is usually performed under a general anaesthetic, so you'll sleep through the entire operation.

What does the operation involve?
Surgery is usually performed via the nostrils therefore leaving no external scars. Occasionally there is a need for external scars, particularly when reducing nostril size (alar base reduction) or if surgery to the tip is required. In such an event this will be discussed carefully during your pre-operative consultation. Whenever this is performed Mr Grover will always place such scars within the natural shadows of the nasal contour to reduce their visibility.

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. Any bump on the bridge is removed with a delicate file to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the middle and narrow the bridge line. Finally the tip of the nose, comprised of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. When the surgery is complete, small dissolvable stitches are used inside the nostrils and nasal dressings are inserted. Finally a plaster cast is placed on the bridge which is held in place by tape on the forehead and cheeks. This protects the position of the bones over the first week whilst they are setting.

How long will the surgery take?
Rhinoplasty usually takes between an hour and an hour and a half.

Is it painful?
Remarkably, pain after rhinoplasty is not usually a problem. It is carefully controlled by pain killers in the first few hours following surgery and subsequently with a mild analgesic (pain killer) such as paracetamol or codeine as necessary.

What can I expect after the Surgery?
Rhinoplasty can create a "stuffy" feeling in the nose similar to suffering from a cold due to swelling inside the air passages. In order to reduce this you will be nursed sitting up after the surgery and also asked to sleep slightly sitting over the first few days. If the nasal bones are broken and reset, there is usually some swelling around the lower eyelids and cheeks along with a little bruising. Most of the swelling will settle within 10 to 14 days. Any internal stitches within the nose will dissolve spontaneously but on the occasions when external sutures are used these are generally removed between 7-10 days after surgery along with the splint.

You may anticipate returning to work about 14 days after surgery. The nose, however, 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 2 months. Although the immediate and obvious post operative 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. You are likely also to notice some numbness over the bridge of the nose and nasal tip, which may persist for about 6 months.

What are the scars like?
In most instances, all the incisions for a rhinoplasty, are placed within the nostrils and therefore cannot be seen. However, in some instances external scars may be needed to reduce the nostril size or to perform nasal tip surgery. Although these scars are usually a little red for the first few weeks, they do tend to settle and are carefully positioned so as to be as inconspicuous as possible.

What are the risks?
Serious complications following rhinoplasty are fortunately rare.

 

  • It is not unusual to notice a little bleeding for 48 hours after surgery but this generally settles on its own or with light pressure.
  • More severe nose bleeds should be treated by sitting upright, taking deep breaths through the mouth and resting a cool gauze or flannel against the nostrils. The vast majority of nosebleeds will settle in 15 minutes or so.
  • Infection is a theoretical risk but is exceedingly uncommon.
  • The vast majority of patients undergoing a rhinoplasty will attain a result, which achieves their aims. However, there is a small group of about 5% of patients who, along with their surgeon, feel that the shape of the nose at the end of 9-12 months is not perfect. This may require more surgery to correct a minor irregularity and can sometimes be carried out under local anaesthesia. It happens more frequently in noses that have been the subject of severe nasal injury or previous nasal surgery.
Summary
Procedure time 60-90 minutes
General / Local anaesthetic General
No. nights in hospital 1 night
Time off work 10-14 days
Sensitivity period 2-4 weeks
Back to normality / sports 4-6 weeks

 

Rhinoplasty is one of the more common cosmetic operations and has a high degree of patient satisfaction. Patients report that by changing the most prominent feature on their face into a more desirable shape they feel increased self-confidence as a result of their improved appearance.

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