There are two major techniques in rhinoplasty surgery:
The closed rhinoplasty technique:
No incision is placed on the skin and the structures of the nose are approached through incisions on the inside of the nostrils. When the corrections of the cartilaginous and bony structures of the nose are completed, the incisions are closed with sutures.
The open rhinoplasty technique:
A small incision is placed across the columella. The columella is the strip of skin between your nostrils. This incision is combined with incisions on the inside of the nostrils. The skin of the nasal tip is then carefully lifted up and the cartilages and bones of the nose are surgically corrected. At the end of the procedure the skin is redraped and the incisions are closed with fine sutures. The small scar on the skin between the nostrils typically heals well and is barely perceptible in most cases.
Most experts agree that excellent results can be achieved with both the closed and the open technique. Advantages of the closed technique include the absence of an external scar and the reduced need for cartilage transplantation during the procedure. Advantages of the open technique include better visibility of the structures of the nose and easier learning for training surgeons. Most experts agree that the choice of technique – closed or open – is not of major importance. Experienced surgeons can achieve excellent results with both approaches. Your surgeon should explain to you why she/he prefers one or the other technique in your case.
Your surgeon will take a detailed history. This includes your complaints related to nasal breathing and your wishes regarding the external shape of the nose. You will also be asked about your past medical history, medications, allergies, smoking habits, previous surgery and more.
Your surgeon will then perform a clinical examination. This may include inspection of the inside of the nose with an endoscope, often before and after application of a nasal decongesting spray. This tells your surgeon about the condition of the midline partition of the nose (the nasal septum) and about the mucosa on the side of the nasal air passage (the turbinates). Your surgeon may also gently spread the nostrils apart with an instrument to observe if the inside of the nostril (the so-called nasal valve) causes obstruction.
Your surgeon will also discuss in detail which changes to the outside shape of the nose are realistic and how they are achieved. Photographs of the nose will be taken prior to surgery in different planes and you may discuss your wishes and expectations with the surgeon with the help of these photographs. Some surgeons utilize computer simulation in order to show you better how the nose may look like after surgery. Of course, simulated images can never perfectly predict the final result, but some surgeons and patients feel it is a helpful instrument for the pre-surgical discussion.
Your surgeon will also talk to you about the risks, benefits and possible complications of rhinoplasty procedures. The discussion includes the type of anaesthesia you will undergo. General anaesthesia is more frequently performed; local anaesthesia with sedation may also be utilised.
If you have previously undergone rhinoplasty or your surgeon feels that the cartilage obtainable from your nose will not be sufficient for shaping and reconstructing your nose, your surgeon may need to harvest cartilage either from your ear or your rib cartilage. The operation may be performed as an outpatient procedure or you may be admitted to the hospital for observation and dressing changes.
You can typically get up and walk around the evening of the surgery or the following morning, initially with assistance. You will have a splint on your nose. Many surgeons also place packing in the nostrils to avoid bleeding for one or two nights. When no packing is used, you may have some bleeding from the nostrils. This typically subsides on its own or with nasal sprays.
During the first week after surgery breathing through the nose may be difficult or impossible. You should be prepared for moderate swelling and some bruising of the skin. The degree of swelling differs from patient to patient. A cold mask may be placed over your eyes and above the splint to decrease swelling and bruising. Generally speaking most of the swelling and bruising will subside in 7-14 days although some swelling can persist for up to 2 months. You should expect to see the final appearance of your nose at the end of 1 year.
At the end of the procedure your surgeon will typically place small strips of adhesive tape over your nose and place a cast on these strips.
You may also have a piece of foil on either side of the nasal septum (on the inside of the nose) to provide support and improve healing. The foil splints inside your nose may be made of non-absorbent material such as silicone or of absorbent material. These foil splints may or may not have airways that assist in breathing. The foil splints on the outside of your nose are removed 6-10 days after the surgery.
Nasal packing may be utilised to avoid bleeding and reduce the risk of a blood collection (hematoma). These nasal packs are typically removed after one or two days. Some surgeons may prefer to use absorbable nasal packs. You will be informed of which material will be used before surgery.
If you have undergone an open rhinoplasty, sutures have been placed the skin between your nostrils. If these are permanent sutures, they will be removed 5-10 days after surgery. If absorbable sutures are used, they do not have to be removed. The incisions inside of the nose are closed with absorbable material and do not need to be removed.
Generally speaking the swelling and bruising around your eyes and nose may last up to 2-3 weeks. The splints on and inside your nose will be removed 1 week after surgery. Most patients are 2-3 weeks off work after nose surgery.
Frequently it is recommended to avoid these activities for about 3 months after surgery in order to allow the swelling to decrease more quickly. Again, your surgeon will give you specific instructions.
Rhinoplasty is a technically difficult procedure. Expertise and experience is required to obtain favorable cosmetic results. The most frequent untoward effect of nose surgery is an unsatisfactory cosmetic (appearance) or functional (breathing) result.
A secondary or touch up surgery may be required to obtain the intended result. Secondary procedures may be minor, some may be performed under local anaesthesia and / or as an outpatient procedure. The need for a secondary procedure does not signify poor quality of the initial surgery. Even in the most experienced hands, rates of secondary procedures of 5% are expected. Secondary or touch-up procedures are typically performed one year or later after the initial surgery.
Other complications occur infrequently. However your surgeon is required to inform you in writing about many possible complications. These include:
Rhinoplasty is a demanding procedure. You should be aware that it will take 1-2 years for your nose to heal completely and take its final form. If after surgery there is a deformity or asymmetry of your nose your surgeon will advise you to wait 6-12 months for complete healing to occur.
If there are still asymmetries or deformities after this period, you should discuss the available options with your surgeon. Ageing also involves the nose and some long-term changes may be observed in your nose as you grow older.