The nose is made up of bone and cartilage. The size and relationship of the bone and cartilage which make up the nose determine the size and shape of the nose.

Nose surgery (rhinoplasty) offers improvement in the appearance in cases in which the nose is cosmetically unappealing. Age may also be a consideration. Many surgeons prefer not to perform cosmetic (elective) rhinoplasties until the growth of the nasal bone is completed (around 14 or 15 for girls, a bit later for boys).

The results of surgery are variable, depending on the initial shape of the nose, but rhinoplasty offers significant improvement in appearance in many cases.

Alternative names    

Rhinoplasty

Definition    

Rhinoplasty is surgery to repair or reshape the nose. See also septoplasty (nasal septum repair).

Description    

Rhinoplasty is one of the most common of all plastic surgery procedures. It can be used to:

• Reduce or increase the size of the nose
• Change the shape of the tip or the nasal bridge
• Narrow the opening of the nostrils
• Change the angle between the nose and the upper lip
• Correct a birth defect or injury
• Help relieve some breathing problems

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and the patient's preference. It may be performed in a surgeon's office-based facility, a hospital, or an outpatient surgery center. Complex procedures may require a short inpatient stay. The procedure usually takes an hour or two, but may take longer.

With local anesthesia, the nose and the surrounding area is numbed. The patient will usually be lightly sedated, but awake during the surgery -- relaxed and insensitive to pain. General anesthesia allows the patient to sleep through the operation, and is typically used in children.

The surgery is usually done through the incision inside the nostrils.

Indications    

Nose surgery is considered "elective" when it is done for purely cosmetic purposes. In these cases, the purpose is to change the shape of the nose to one that the patient finds more desirable. Age may be a consideration. Many surgeons prefer not to perform cosmetic nose surgery until the growth of the nasal bone is completed (around 14 or 15 for girls, a bit later for boys).

In other cases, nose surgery may be needed for medical purposes. For example, surgery may be needed to treat a serious breathing problem or an injury. Age may be less of a factor.

Risks    

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection
• Bruising

After surgery, small burst blood vessels may occasionally appear as tiny red spots on the skin's surface and are usually minor, but permanent. There is no visible scarring if the rhinoplasty is performed from inside the nose. There may be small scars at the base of the nose that are not usually visible when the procedure calls for the narrowing of flared nostrils.

Rarely, a second procedure may be necessary to correct a minor deformity.

Expectations after surgery    

A splint (metal or plastic) will be applied externally to maintain the newly shaped bony structure when the surgery is complete. Soft plastic splints or nasal packs may also be placed within the nostrils to stabilize the septum (the dividing wall between the air passages).

Immediately following surgery, the nose and face will be swollen and painful. Headaches are common. Pain medications will control these discomforts.

Swelling and bruising around the eyes will increase and reach a peak after 2 or 3 days. Keeping the head raised (elevated) and placing cold compresses to the eyes can help reduce the swelling. Within 2 weeks, most of the swelling and bruising disappears. Some subtle swelling remains for several months, but this is generally unnoticeable to anyone but the patient.

During the first few days, minor bleeding from the nose is common. Do not blow the nose, pick the nose, or insert items into the nose for the first week while tissues heal.

The nasal packing is usually removed after 3 to 5 days and the patient will feel much more comfortable. All dressings, splints, and stitches should be removed within 1 or 2 weeks.

Convalescence    

Within 2 days, most patients are up and about, and able to return to school or non-strenuous work within about a week following surgery. Full recovery takes several weeks.

Avoid strenuous activity (jogging, swimming, bending -- any activity that increases blood pressure) for 2 to 3 weeks. Avoid rubbing or bumping the nose. Avoid unprotected sun exposure, especially for the first 8 weeks. Be gentle when washing the face and hair or using cosmetics.

Glasses will have to be taped to the forehead or propped on the cheeks for 4 to 6 weeks after the splint is removed and the nose is completely healed.

The patient may feel depressed following surgery, but day by day the nose will look better. Within a week or two, cosmetics will camouflage signs of the operation. Healing is a slow and gradual process. The tip of the nose may have subtle swelling and numbness for months. The final results may not be apparent for up to a year.

The patient might experience some unexpected reactions from family and friends. They may act resentful, especially if something they view as a family or ethnic trait is altered. The patient should keep in mind the reasons for the nasal correction, and if these have been reached, then the surgery is a success.

Introduction
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It is a reshaping of the cartilage, bone and sometimes the soft tissues of the nose.

What does the rhinoplasty surgery involve?
The skin of the nose is separated from the supporting bone and cartilage which is sculpted to the desired shape using the technique your surgeon has decided on. The bone and cartilage of the nose are altered to the desired shape and the skin repositioned over them giving a most pleasing result. As most surgery is carried out internally there are rarely any visible scars following a nose reshaping procedure.

How long does the rhinoplasty surgery take?
The procedure will require an overnight stay in hospital, although occasionally, where minor corrections to the nose tip alone are required, it may be possible to return home the same day. Rhinoplasty usually takes an hour or two.

What will happen in the recovery period?
For the first 24 hours after surgery your face will feel puffy and your nose may ache however prescribed pain medication will control this. You will have bruising and swelling around the eyes, which lasts for 2 -3 weeks.

A little bleeding is common in the early days after surgery and you may be asked not to blow your nose for a week or so to allow the tissues to heal. By the end of one week, all dressings, splints, and stitches should be removed. For 2 -3 weeks you'll be asked to avoid strenuous activity with no contact sport for 6 weeks. You will have frequent follow-up visits in the months after surgery to check on your progress.

What is the recovery time?
Each patient is individual so no definite timescale for recovery can be given. However most rhinoplasty patients are up and about within a couple of days after surgery, and are able to return to work after just a week. Your surgeon may recommend that you take 10-14 days off from work.

What can I expect from the rhinoplasty surgery?
Your expectations need to be realistic. Day by day, your nose will begin to look better and you can expect a nose that looks natural and blends harmoniously with your other facial features. The vast majority of patients undergoing rhinoplasty gain a feeling of increased self-confidence with improvement in their body image.

Need more information about rhinoplasty surgery?
If you would like more information about rhinoplasty surgery offered by our NHS Consultant, or whether rhinoplasty surgery is right for you, please contact us today.