What is a rhinoplasty (nose surgery)?
Rhinoplasty is a surgical procedure that is offered for two reasons. First, it is performed to improve the aesthetic appearance of the nose. The goal is to generate a cosmetic result that is in harmony with the remainder of the face. Second, it is performed to alleviate a blockage of the nasal airway and to create an air passage that allows for comfortable and unhindered breathing. In most cases the cosmetic (enhancing the appearance of the nose) and functional (improving the nasal airway) aspects of the nose are both addressed in the same procedure.
The following are possible reasons why a person may seek rhinoplasty:
- The nose was broken or injured by previous trauma
- The nose is crooked or deviated
- There is a hump on the dorsum (back) of the nose
- There is an indentation (saddle) on the dorsum (back) of the nose
- The nose appears too long or too short
- The nasal tip is too thick, round or uneven
- The nose and lip require correction after previous surgery for cleft lip and/or cleft palate
What is the most appropriate age for a cosmetic rhinoplasty (plastic surgery of the nose)?
Studies suggest a minimal age of 17 years is preferred to perform rhinoplasty as the bony structures of the face near completion at this age and the shape of the bony skeleton of the face will not change much after this age. Infrequently it may be justified to perform the surgery at an earlier time. If this is the case your surgeon will talk to you about the possible need for a second operation in future years.
Could I benefit from a rhinoplasty?
You may be an appropriate candidate for a rhinoplasty for one of the following reasons:
- you have been thinking for a while about improving the appearance of your nose
- trauma or infection has changed the shape of your nose more than 12 months ago
- a congenital defect like cleft lip was corrected at a young age, you are now at least 17 years of age and you would like the nasal deformity corrected.
- the effects of aging have changed the shape of your nose; you may feel the tip of your nose is hanging and droopy.
- breathing through your nose is obstructed and medical treatment (nasal sprays) do not provide lasting alleviation
- you can improve the obstruction of your nasal airway by pushing the nasal tip up or by pulling the cheek tissues to the side
How is rhinoplasty surgery performed?
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.
What are the differences between closed and open rhinoplasty?
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.
What can I expect before nose surgery (rhinoplasty)?
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.
What is computer simulation of before – and after – photos of the nose?
Computer imaging can give you an idea of what your nose will look like after surgery. With most systems, simulations of the profile (the side view) of the nose can be performed more easily. Simulations of the front view are technically more difficult and may not always be of sufficient quality. Remember that the result will almost always differ somewhat from the computer generated outcome, regardless of the surgeon’s expertise.
What can I expect after nose surgery (rhinoplasty)?
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.
Will I have an outside cast, inside foil splints and inside packing after nose surgery (Rhinoplasty)?
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.
Will sutures be removed after nose surgery (rhinoplasty)?
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.
How long will I be off from work after surgery of the nose (rhinoplasty)?
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.
Can I wear glasses after nose surgery (rhinoplasty)?
After the cast on your nose has been removed some surgeons permit the use of glasses immediately whereas some may ask you to refrain from using glasses for a period between 2-6 months. If you need to wear glasses you should specifically tell your surgeon about this before surgery. You may need to obtain contact lenses.
Can I do sports after nose surgery (rhinoplasty)?
You should refrain from exercise prior to removal of the cast and splints. After these have been removed, your surgeon will give you specific instructions when you may resume sports and at which intensity. Contact sports are typically avoided for at least one year.
Can I sunbathe after nose surgery (rhinoplasty)?
Many surgeons recommend to minimise sun exposure during the first year after rhinoplasty surgery. This includes avoiding the sun, especially in the noon hours, applying sunscreen and wearing a sun hat.
May I visit the sauna or steam bath after nose surgery (rhinoplasty)?
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.
Is nose surgery (Rhinoplasty) painful, do I need pain medication?
After surgery pain is mild to moderate for 1 to 3 days and is usually well managed with pain pills. Severe pain is not expected and if you are experiencing this then you should visit your doctor as soon as possible.
What are possible risks and complications of nose surgery rhinoplasty?
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:
- Bleeding: may occur after the surgery and last for up to 4 weeks. Most bleeding is self contained but if your nose is bleeding uncontrollably then you need to present to your surgeon.
- Infection: the risk of infection is very low after rhinoplasty. If swelling, redness or pain increases or you have a fever after surgery, you should notify your surgeon.
- Hypertrophic scars: if you have undergone a closed technique rhinoplasty your scars will be hidden inside your nose. If an open technique rhinoplasty has been performed you will have a small scar that is usually hardly visible between the nostrils. Rarely this scar may not heal properly and leave a perceptible scar requiring scar revision.
- Discolouration: after surgery there may be bruising around the eyes and occasionally on the nose. This bruising usually subsides after 2-4 weeks. Very rarely the colour of the nose skin may become darker or redder, which may persist up to a year.
- Loss of smell: this occurs rarely after surgery, is almost always temporary and can last 6-12 months.
- Numbness of the nose: a certain amount of numbness on the nose is expected after surgery and is almost always temporary. The numbness usually subsides after 6-12 months.
- Implant extrusion: many surgeons use your own cartilage but sometimes implants made from synthetic material may be utilised. During surgery to overcome some deformities your surgeon may use an implant to correct them. Rarely these implants may extrude from your skin and cause deformities.
Is it possible that I will need revision surgery?
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.