WHAT GIVES THE NOSE ITS SHAPE?
The top of the nose is made of bone shaped like a roof, which is hard and can be broken when injured.
The middle and tip of the nose are made of cartilage, which is softer.
The skin varies in thickness from person to person, and also affects the shape.
The appearance of the nose is due to the shape of bone and cartilage under the skin.
WHAT IS A RHINOPLASTY?
The nose is the defining feature of the face. Over 90% of face to face communication is non-verbal, and the relationship between the size and shape of the nose and the face is crucial to how a person looks.
Rhinoplasty is a term used to include a number of different operations to improve the shape of the nose. Everyone’s nose is different, and so the type of rhinoplasty performed depends on what part of the nose needs changing.
The nose can be straightened, made smaller or bigger, bumps may be removed or hollows filled in. If the latter is required, it is usually achieved with pieces of cartilage taken from the inside of the nose or from parts of the ear where it isn’t needed. These pieces may be used to strengthen the nose and to fill in the dips in the nose.
It may not be possible to make a large nose small but it can be possible to improve the balance between the bridge and the tip of the nose.
The shape and size of the nasal tip can be improved.
WHAT IS A SEPTORHINOPLASTY?
Septorhinoplasty is performed to straighten and unblock a bent nose.
Bends of the dividing wall between the nostrils (the nasal septum) on the inside may cause a blocked nose as well as the twist in the nose that you can see on the outside.
A septo-rhinoplasty will straighten the bones and cartilage on the outside and the septum on the inside. This will improve the shape of the nose as well as the breathing through it.
WHAT CAN BE ACHIEVED WITH RHINOPLASTY?
The aim of surgery is to achieve a balanced look to the nose and face, with a natural looking nose that does not look as if it has been surgically altered.
The tip of the nose should match the bridge of the nose, and the nose should match the face and body shape in general.
In all cases of nasal plastic surgery, healing and the results of surgery cannot be guaranteed.
Although it will never be possible to say EXACTLY how your nose will look after your operation, satisfaction with surgery is usually very good if expectations are realistic on both my and your part.
Everybody’s nose and face is different, so it may not be possible to make your nose look exactly like your perfect nose from a magazine.
The thickness and age of the skin over the nose is important in how much better the nose will look after rhinoplasty and in what can be done. The skin has to settle back down over the nose after the operation and this process is ongoing over some years afterwards.
If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is particularly thick, not all changes that can be made on the inside will show up on the outside.
On average about 10% of patients request further surgery to correct new or persisting irregularities of nasal shape.
BEFORE THE OPERATION
I encourage all patients to discuss their wishes for rhinoplasty with their G.P and obtain a referral letter prior to their attendance at my clinic.
Surgery of this nature is completely non-urgent, but is important to achieve improved self-esteem and quality of life.
Rhinoplasty is not appropriate in people who have significant medical problems which would make a general anaesthetic hazardous, or those with issues concerning their mental health.
I will take great care to talk to you before the operation about what we can achieve with surgery. Everyone’s needs and expectations are different, but in all cases realistic expectations allow an informed decision by yourself about your surgery.
For these reasons, I normally see patients requesting rhinoplasty twice prior to surgery.
At the initial consulation, we can discuss which parts of your nose you wish to change and what a rhinoplasty is able to improve and what is not possible.
Digital photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow me to plan your operation .
There is therefore a period of reflection and planning by both yourself and me between consultations.
At your second visit we can confirm the surgical plan, and if appropriate I can demonstrate the proposed surgical changes on the photographs of your nose on a computer screen, by means of digital image manipulation.
HOW IS THE OPERATION DONE?
o Rhinoplasty and septo-rhinoplasty are usually performed with you asleep (general anaesthetic).
o Cuts are made inside your nose where they cannot be seen. Occasionally a small cut across the bridge of skin between the nostrils at the bottom of the nose may be necessary.
o The skin of your nose is gently lifted off the bone and cartilage underneath.
o Hairline breaks may be made in the nasal bones, to change their shape or to narrow or straighten the nose.
o The top of the nose may be trimmed down from the inside and the tip shape may be changed.
o Pieces of cartilage (taken from other parts of the nose or ear where they are not needed) may be put into the nose to fill in any dips or hollows.
WHAT COMPLICATIONS CAN OCCUR?
Bleeding from the nose following surgery is rare, but may need further treatment with nasal dressings on the inside of the nose.
There is a very small risk of a nasal infection which would require antibiotics.
If you have surgery on your nasal septum as part of a septorhinoplasty, very rarely a hole may occur in your septum after surgery. This will usually not cause any problems and you will not be able to see it on the outside of your nose.
Small amounts of bleeding or crusting, and sometimes a whistling sound when you breathe through the nose may be noticed. If this a problem, the hole may be repaired later with another operation.
Redness of the skin overlying the nose may very rarely occur, especially if you have had surgery previously to the nose.
Numbness of the upper teeth very occasionally occurs, and usually settles with time.
DOES IT HURT?
Your nose will be uncomfortable due to blockage for one to two weeks following your operation, but is not usually painful.
Paracetamol is usually sufficient if required, but try to avoid aspirin containing drugs, which may thin the blood and cause bleeding.
WHAT HAPPENS AFTER THE OPERATION?
You may have small dressings (called packs) in the nose for a few hours following surgery, to prevent bleeding, but most of my patients do not need any packing at all after rhinoplasty..
Most patients stay one night in hospital following the operation, but it may be possible to go home on the same day if you wish.
You will have a temporary splint on the outside of the nose for a week. This should be kept dry, particularly in the shower and when washing your hair.
Take particular care taking clothes on and off over your head. Wear button fastened clothes if possible.
You will be seen in outpatients 1 week following surgery to remove the external splint and any other dressings and sutures.
Small sheets of plastic may be placed inside the nose at the end of the operation to prevent scar tissue forming as the nose heals. If they are used , they are usually removed in the outpatient department one week following surgery at the same time as the external splint.
DO’S AND DON’T S
You may have some bruising and swelling around your nose, eyes and top lip for one to two weeks. Sleeping upright with extra pillows for a few days helps.
Glasses should not be allowed to rest directly on the nose for 3 weeks. If you cannot wear contact lenses during this period, tape the bridge of the glasses to your forehead.
Avoid crowds of people or dusty and smoky environments for the first 2 weeks, where the chances of catching an infection are high.
Your nose will feel stuffy (like a heavy cold) for 2 weeks following your operation, and it may take 6 weeks for your breathing to become clear.
As your nose will feel blocked and you will be breathing through your mouth, you may have a dry throat. Drink plenty of clear fluids if this is the case.
A small amount of blood stained mucus from the nose is quite normal during the first week or two, and you may be given some nasal drops or sniffs to help this.
It is important not to blow the nose or to cough and strain during the first week to prevent bleeding. Sneeze through an open mouth, and do not try and ‘bottle the sneeze up’ in your nose and mouth.
You will feel more lethargic than normal for the first week or two, and make arrangements for help at home accordingly!
You should avoid strenuous activity or exercise such as going to the gym for about
2-3 weeks as this may cause discomfort and bleeding. Resume normal activity in stages following this period.
The bones of your nose will be healing back to full strength over a period of about six weeks. During this time it is very important to avoid activities or sports that risk the nose being knocked.
Following nasal plastic surgery, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least three months.
The nose may feel a little stiff and numb for up to three months, particularly around the tip.
Fine swelling may take up to a year to 18 months to settle, and it is only at this stage that the final results of surgery should be judged.