Rhinoplasty

The nose is a key defining characteristic of any face. The shape and size of the nose influences the face’s overall harmony, balance and proportions. Even a slight alteration in shape or size can greatly enhance overall facial appearance, just as a slight distortion can have an amplifying negative effect.

Nose surgery or rhinoplasty is a surgical procedure performed on people who wish to change the shape, size or structure of their noses. Rhinoplasty is not always about appearance. It is often undertaken to remove physical obstructions to facilitate better breathing, better sleep and better health.

Every nose is unique. There is no ideal to aspire to, because what looks best on you depends on the elements of your face as a whole. Beauty is a function of harmony, balance and proportion. With rhinoplasty, your expectation and that of your facial plastic surgeon would be to improve your appearance by making your nose more harmonious with the rest of your face. Even in cases where functional improvement is the primary goal, rhinoplasty offers an opportunity to improve size and shape at the same time.

This article provides you with the basic information you need before making a decision to undergo nose surgery, information about how nose surgery is performed and what you can realistically expect. It is not intended to be a comprehensive guide to nose surgery; nor should it be considered an alternative to a thorough and detailed discussion with your chosen facial plastic surgeon.

Successful outcomes in nose surgery, as with all surgery, are a result of teamwork and rapport between you and your facial plastic surgeon. Only your surgeon can answer questions about what specific changes to your nose might help improve your facial harmony and profile.

Is Nose Surgery for You?

Nose surgery is performed for both aesthetic and functional reasons. If any of these conditions apply to you, you might benefit from nose surgery:

  • You are unhappy with the shape and size of your nose.
  • Ageing has altered your nose, making you unhappy about your appearance.
  • You have suffered an accident or injury to your nose, which requires internal or external correction.
  • You have breathing problems that can be rectified with nasal surgery.

The exact changes desired should be discussed with your surgeon. Your surgeon can also guide you about what is reasonably possible with rhinoplasty and the best ways to restore or improve facial harmony and balance. It is essential to have realistic expectations about what nose surgery can do for you.

Your surgeon will consider your skin type, ethnic background and your age before recommending rhinoplasty.

In young patients, unless breathing is severely impaired, surgeons will typically recommend putting off surgery until the nose has reached its full size. This usually occurs around the ages of fifteen or sixteen.

Sometimes, after inspecting your nose and face, your surgeon may recommend additional surgical procedures to be performed at the same time to improve overall facial appearance. Chin surgery is often combined with rhinoplasty, especially in those who wish to improve their profiles.

As with all elective surgery, you must be in good health at the time of surgery.

Before You Have Surgery

Choosing a facial plastic surgeon you can trust is the most important decision you can make before your surgery. Your trust should be based on the verifiable qualifications and expertise of the surgeon, his or her reputation and past experience with this type of surgery. The rapport you develop with your surgeon during the initial consultation process is also very important.

Many facial plastic surgeons have training in ear, nose and throat surgery as well as facial cosmetic surgery. At the first consultation, your surgeon will examine your nose inside and out and tell you what you can expect from a rhinoplasty. In doing so, your surgeon will explain the inner structures of your nose and how the bone and cartilage can be reshaped to improve appearance.

Whether you require nose surgery only or wish to combine it with other procedures, your surgeon will discuss all the surgical options with you during this initial consultation, addressing the risks involved with each procedure. This discussion should be an open and honest exchange of ideas between you and your surgeon, which will help establish reasonable expectations for the outcomes of surgery.

When you have made the decision to go ahead, and you and your surgeon agree on the best course of treatment, your surgeon will explain the type of anaesthesia that will be employed and provide details of the surgical facility where your procedure will take place.

You will be asked to provide a thorough medical history to help your surgeon take into account any medical conditions that may increase your level of risk during surgery.

When you decide to undergo cosmetic surgery, you should make a commitment to follow closely the pre- and post-operative instructions issued by your surgeon.

As part of the informed consent process, your facial plastic surgeon will also explain to you alternative means, if any, that are available for you to achieve the same outcome and inform you of the costs involved for the proposed procedures.

Understanding the Surgery

During rhinoplasty, incisions are made to allow the surgeon to access the nasal bone and the cartilage support system of the nose. Most incisions are placed inside the nose, out of sight. In some cases it is necessary to make incisions in the area which separates the nostrils. Through these incisions, the surgeon can remove the required amount of bone and cartilage, add to them or rearrange them to give the nose a better shape and structure. For example, if the tip of the nose is too large, the surgeon will sculpt the cartilage to reduce its size. Similarly, the surgeon can change the angle of the nose relative to the upper lip for a more youthful look. Injuries and distortions can be treated in the same way.

Once this work is done, the skin and soft tissue of the nose will be re-draped over the restructured nose frame. The incisions will be closed with sutures. Expect a splint to be applied to the outside to help retain the new shape until healing is completed. Soft absorbent material will be placed inside the nose to keep it stable along the septum, the soft wall that divides the air passages on both sides. Sometimes soft nasal supports are used until nasal breathing can get back to normal.

Depending on the techniques used and the extent of work involved, nose surgery can takes between one and three hours to complete.

What to Expect After Nose Surgery

Immediately following surgery, your surgeon will place a small splint on your nose to protect it and keep its structure stable for at least five to eight days. If packing has been placed inside the nose during surgery, it will be removed after about 7 days.

Expect your face to feel puffy, especially in the first 24 hours after surgery. In some people, swelling may last for weeks after surgery.

You may need pain medication to reduce discomfort during this time.

Your surgeon will give you instructions about caring for yourself and your nose during the recovery period. For the best outcome, follow these instructions closely. In particular you will be asked to avoid blowing your nose for at least 7 days following surgery.

Bruising and minor swelling in the eye area are to be expected. You may use cold compresses to reduce discomfort and bruising.

If your surgeon uses absorbable sutures, there will be no need for suture removal. Otherwise you will make an office visit for this purpose. In six or seven days the nasal dressings and splints you have been using since surgery can be removed.

You will be asked to keep your head elevated for some time. On your back with your head raised on a pillow or wedge is the safest way to sleep during the initial recovery period.

Avoid exposing your face to the sun while you are healing. Strenuous activity such as bending and lifting are best avoided for at least two weeks following surgery. Exertion can impede healing, so rest as much as possible.

Protect your face from risk of injury during your recovery. If you wear glasses, they should not rest on the bridge of your nose. You can use tape and other means to keep glasses from putting stress on your new nose.

Follow-up care is essential, so your surgeon can monitor the progress of healing. Make sure to go to all follow-up appointments on dates specified. In between appointments, report anything unusual to your surgeon without delay.

Healing will take time. It can take as long as a year before your nose is fully healed. The length of recovery time will depend on the exact techniques used as well as how your body responds to the surgery. Within a matter of weeks you will begin to see improvements in your appearance.

Most people can safely return to work within a week or two. Make sure to check on this during your follow up visits.

Additional information

Rhinoplasty helps improve the balance and harmony of your face and enhance the profile. Improved appearance will boost your self-confidence, because you feel better about your appearance and about yourself.

In general, insurance does not reimburse costs of elective cosmetic surgery. But if your nose surgery is performed as part of a procedure to correct breathing obstructions, deformities or as part of treatment for traumatic injury, some parts of the cost may be covered by insurance.

Just to be sure, always check with your insurance plan on the specifics of coverage.

You can find accredited facial plastic surgeons who perform nose surgery among members of the Australasian Academy of Facial Plastic Surgery.

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