RHINOPLASTY
Who is it for?
Rhinoplasty is performed to improve nose shape, improve breathing or both. It may be purely cosmetic or after trauma (where the nose has changed shape after being broken). A full assessment of your nasal appearance and function is essential before any operation. It is important to be able to discuss particular concerns and desires at this stage to allow appropriate plans to be made. It is essential to mention any previous nasal surgery or trauma. Knowledge of your general health will allow assessment of fitness for an anaesthetic.
How is it done?
Rhinoplasty is performed under general anaesthetic, usually with an overnight stay. Small procedures can be done as day cases. Incisions are often made on the inside of the nostril and are not visible. In some cases an incision may also need to be placed just under the nose. Further incisions may be required to change the size of the nostrils if required.
When only the shape of the nose requires changing the tip of the nose is often addressed first. Here the cartilages can be reduced, reshaped or augmented. After this the mid part of the nose is attended to if necessary. This is where a hump may be reduced or a dip augmented on the area below the bridge of the nose. After this the bridge of the nose is corrected if necessary. This may require the bones to be reshaped or to be reset. Resetting the bones is done by fracturing them and repositioning them.
If the breathing needs correction as well as the shape then this is approached before any surgery to correct the shape is performed. The septum (the cartilage that runs down the middle of the nose and separates the two nostrils) is straightened by freeing it up of any scar tissue, realigning it and removing any cartilage that is particularly deformed. Once the septum has been corrected the shape can be attended to as described above.
What happens after the Operation?
When you wake up from the operation you will have supporting tapes on the nose and, if the bones have been reset, a plaster of Paris splint to support the nose. These will remain in place for one week. You will find it difficult to breathe through the nose and this may be the case for a few weeks. Avoid blowing your nose. Your throat may become dry because you have to breathe through your nose especially after you have slept.
There will be gauze packs within the nostril to stop any bleeding and these will be removed the day after the operation.
You will need to sleep as upright as possible for the first few days to help reduce swelling and avoid any strenuous activity for the same reason.
There will be some bruising and swelling around the nose and if the bones have been reset you will have black eyes. This bruising mostly goes by 2-3 weeks. You will be given some painkillers to help control any pain/soreness.
One week after the operation the supporting tapes, external sutures (if present) and plaster splint (if present) will be removed in clinic. You should notice a difference in the appearance of your nose at this stage but breathing through it may still be difficult. It is still early days and the nose may swell a little after removal of the tapes. This is to be expected. The general swelling of the nose will gradually improve over the next few weeks such that by 3 months it is fully settled. This should also be the case for breathing through the nose. Any external scars may take longer to fully mature.
You will be reviewed in clinic regularly until everything has settled. At this point if all is well you will be discharged.
Are there any Potential Risks?
There are potential risks or complications with any surgery but these are usually low. However it is important to be aware of them before committing to any surgery. You may also have particular circumstances that affect the final outcome and these will be discussed with you at your consultation.
General
You will be assessed for fitness for anaesthetic and providing this is appropriate the risks from general anaesthetic are low. Clots in the leg (DVT) or chest infection are also unlikely to occur with this sort of operation.
Bleeding
Minor bleeding from the nose soon after the operation is not unusual and is often controlled with gauze packs. There may be a little bleeding after the packs are removed but this soon settles. Rarely a patient may experience significant bleeding from the nose that is not stopped by the packs.
If this should occur you may have to go back to theatre to insert special packs to control the bleeding.
Bruising/Swelling
If the bones have been reset you will have black eyes and these will take 2-3 weeks to get better. The nose itself will get swollen after the tapes (and splint) have been removed and again this will take a few weeks to get better. However there may be a little swelling that persists for up to 3 months though this is usually mild.
Breathing
Changing the shape of the nose can sometimes affect the breathing. In the first few days and weeks after the operation swelling inside the nose may make it difficult to breathe through the nose easily. This usually settles. In a small number of people the change in shape is significant enough to impair nose breathing long term.
Equally if the operation is specifically to improve the breathing sometimes the amount of improvement is not as much as you may have wanted.
Small bumps
Occasionally you may be able to feel (or rarely, see) small bumps at the site where the bones have had to be reset. This is more likely if you have thin skin. These often resolve but in a few people they persist and may require a minor operation to improve them.
Overcorrection
As with all surgery it is impossible to guarantee precise removal of tissue to correct the shape of the nose though this is always the intention. The difference between taking just the right amount and too much is sometimes very small. This might mean that if for example a hump on the top of the nose is being removed that instead of being straight there is a slight inward curve or if the tip is being reduced that the tip becomes slightly pinched. It is important to remember that it is difficult to imagine exactly how your nose will look afterwards and often the surgeon will explain what is and what is not possible for you.
Undercorrection
In certain situations the reverse is true in that you may feel not enough tissue has been removed. Again it is a fine line between taking the right amount and just not enough. Sometimes the anatomy of the nose or previous scarring may warrant erring on the side of caution to avoid taking too much tissue away.
Asymmetry
The intention of any surgery is to achieve exact symmetry of the nose. However sometimes swelling or inadvertent minor trauma (e.g. knocking your nose while asleep) may result in things not settling down equally. Sometimes the nose is asymmetric before the operation and it may not possible to fully correct this because of previous scarring or inability to move the tissues as much as is required. This may result in a minor degree of asymmetry that may only become apparent when all the swelling has resolved. It may be very difficult to improve the situation any further in some cases.
Scarring
Scarring within the nose does not usually cause any problems but in a small number of cases the scars may form bands within the nostril. These usually settle but rarely may require a minor procedure to correct. If external scars were required these are usually inconspicuous but some people generate thick scars that may be more visible. These usually improve with time.
Infection
Infections of the wounds are rare but if they do occur you may need antibiotics. Exceptionally rarely (I have not ever seen a case) the bones of the nose may get infected and this may require a prolonged course of antibiotics and may potentially change the shape of the bones.
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