Rhinoplasty (Nose Reshaping)

Rhinoplasty is the operation to reduce or refine the nose, and it is one of the most frequent facial surgery requests. The reason may be simply that the person is self conscious of a large hump or a prominent tip or it may just be that this is the subject of irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. For men, it can mean that the nose disturbingly dominates the face. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.

The surgery

The operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required. If alar base reductions have been performed then the scars will be found tucked into the base of the nostrils within the natural skin fold. These are also generally well hidden by the natural shadow cast by the position of the nose. In complex tip surgery, you may require an external incision (open rhinoplasty) carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately.

Any bump on the bridge is removed with a delicate chisel to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) can be altered accordingly.

Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. Sometimes this is done with internal stitches, other times a small segment of your own cartilage is used. When the surgery is complete, small dissolvable stitches are used inside the nostrils and then foamy nasal packs are inserted. These packs are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. Indeed it is exceedingly rare for significant bleeding to occur following a Rhinoplasty. Finally a plaster cast is placed on the bridge and held in place by tape on the forehead and cheeks.

Risks

Infection, as in any operation can occur but is thankfully quiet uncommon. Occasionally though, a “Blind boil” type infection may occur on the skin of the nose. These can be quite uncomfortable and may take a week or so before they finally settle.

After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure (see postoperative instructions). However, rarely it is necessary for medical intervention to stop difficult bleeding.

Irregularities of skin, bone or cartilage may occasionally appear following surgery. These may show up on the surface as slight depressions, dips of bumps. Although through conservative measures and time, most of these situations improve, additional surgery may occasionally be required for correction (2% incidence).
 
Very rarely a perforation in the nasal septum may ensue from this surgery. If this occurs corrective surgery may be needed. Occasionally however it may not be possible to correct this complication.

Some degree of nasal obstruction may also ensue after the surgery. Usually this short-lived and is a result of a mild pre-existing nasal obstruction which may not have been noticed prior to the surgery, but became somewhat exacerbated following the surgery. In this situation, revision surgery to improve the situation is sometimes warranted.

Following a Rhinoplasty it is possible, but again quite rare, for a series of thread or spider type veins to occur. These are permanent. However, they can be treated effectively by laser.

It is also quite possible that surgery on a badly deviated or bent nose may not result in a perfectly straight, well-aligned nose. Many reasons may be responsible for this but it is conceivable, in particularly difficult situations, that two or more procedures may be required to remedy these noses. You will be advised at the consultation what the likelihood of this occurrence will be with you.

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