Rhinoplasty

Rhinoplasty, commonly called nose surgery or nose job, is carried out to improve the functioning (reconstructive surgery) or appearance of (cosmetic surgery) the nose.

This surgery is often performed with another procedure called septoplasty, in which blocked nasal passages are opened up. Rhinoplasty can enhance the appearance of the nose by changing its width, size, or profile and bring it in proportion to the rest of the face. It is also effective in overcoming breathing problems by correcting nose defects and altering the nose tip and nostril shape. The surgery may not produce a completely symmetrical outcome, but it can accomplish the goal of obtaining a facial balance.

A surgeon may recommend this surgery in the following cases:

• If your nose appears largely asymmetrical or crooked.
• To change the size of your nose (to make it slightly bigger or smaller).
• To modify the nasal tip.
• If the size of your nasal openings is too big and needs to be reduced.
• To repair any deformity caused by cancer or infection.
• If your breathing is compromised due to blocked nasal passages.
• If you have any birth defects affecting the nose shape or damage to the nose caused due to an injury.
• To enhance the look of your nose in relation to your upper lip.
• To correct a flattened area on the nose.

Rhinoplasty is not recommended if you:

• Are still growing as it can give uncertain outcomes and interfere with the growth of the facial bones. Usually, this is up to the age of 17 for boys and 16 for girls.
• Are unable to have an anaesthetic due to any medical reasons.
• Have bleeding disorders or slow healing due to certain health conditions.
• Have any conditions that increase the risk of surgical complications.
• Have unrealistic expectations from the surgery.

It is important to know that the plastic surgeon can only work with the cartilages and bones already present, hence there is a limited extent to which alterations can be achieved.

The following preparations are needed before a rhinoplasty:

• The doctor may perform a blood test, X-ray, and cardiac exams such as an electrocardiograph (ECG) to ascertain that you are healthy enough to be able to undergo the procedure.
• He/she ask you to stop taking aspirin and herbal supplements as they may increase the chances of excessive bleeding during the procedure.
• Also, discontinue substances like garlic and ginkgo since they affect anaesthesia and clotting mechanism.
• Stop smoking before the surgery to avoid post-surgical complications.
• You should inform your surgeon:
  • if you have any allergies.
  • If you are taking any medications including herbal supplements
  • About your medical history
• You will be asked to sign a consent form before the surgery. Make sure to read the form carefully.
• You may need to make an arrangement for someone to drive you home after the surgery.

This surgery is usually conducted under general anaesthesia (a sleep-inducing medicine) and includes the following steps:

• The surgeon will make incisions (cuts) on either inside your nose (closed procedure) or on the thin strip of tissue between your nostrils (open procedure).
• These incisions help to slowly raise the skin over your nose and make the access possible.
• The steps may change depending on the reason for which it is performed:
  • For a broken nose, the surgeon will insert small instruments through your nostril to realign your bones.
  • To decrease the size of your nose, the surgeon will remove some bones or cartilages from the nose.
  • To increase the size of the nose, the surgeon may add cartilage grafts. This graft can be a cartilage from the nasal septum (the tissue that divides the two nostrils), ear, or ribs.
  • To correct a septum deviation, the surgeon will straighten your septum during the surgery and reduce the nasal projections (the distance to which the nose sticks out from the face) to improve your breathing.
• After the nose structure is realigned as needed, the surgeon will position back the skin in place, and the incision is closed with dissolvable stitches.

After the surgery:

• You may experience:
  • Swelling on your nose that may subside in a few weeks
  • Moderate pain and bruising that may last for one or two weeks
  • A stuffy nose
• Bandages may be placed on the outer part of your nose to provide support, and a splint (a rigid material used for supporting a broken bone) may be placed inside. These steps ensure that the shape of the nose is maintained while healing. The doctor will remove the bandages in a week after the surgery.
• The medical staff may give you medications for pain.
• Your doctor would suggest you to avoid eating anything for about five hours.

It may be a day procedure or may require a few days of hospital stay based on the extent of the surgery.

Once you reach home, you may have to take the following care:

• Keep your head elevated under multiple pillows for at least two days when you take rest.
• Use an ice pack to reduce swelling.
• Take pain medications as directed.
• The doctor may advise you to not blow your nose for at least a week, and avoid rubbing it for at least eight weeks.
• Unless permitted by your surgeon, you should avoid physical exercises, swimming, and any other strenuous task for a few weeks.
• Avoid getting your nose sunburned during your recovery as it may cause scarring.
• You can resume work after two weeks.
• For a year following rhinoplasty, you may notice occasional swelling that subsides on its own and is more pronounced in the morning.

After a rhinoplasty, you are likely to observe benefits such as enhanced self-confidence (due to the improved proportion of your nose) and better appearance of your nose.

The results of this surgery are fairly permanent. You may notice the final results of the rhinoplasty almost a year after the procedure, during which you can appreciate small changes. However, your body will undergo natural ageing changes over the years.

When to see the doctor?

Visit or call your doctor if you experience any of the following symptoms:

• Fever or chills
• Increasing redness around the wound or a rash
• Bleeding from the incisions
• Increasing pain or soreness around the surgical site

Some potential complications of this surgery are:

• Excessive bleeding from the surgical site
• The potential need for re-surgery to correct any irregularities
• Infection
• Problems in breathing due to narrowing of the airway
• Haematoma (blood clot) near the incision site, which needs to be drained
• Swelling and bruising around the surgical site
• Discolouration of the skin in the operated area
• Perforation of the nasal septum (rare), which may sometimes be impossible to correct.
• Pain or numbness in the skin over the nose
• Allergy due to the dressings, stitches, or the solution used as an antiseptic
• Risks related to anaesthesia such as nausea
• Scarring over the incisions, which may be itchy and unpleasant to look at
• Numbness in the upper front teeth
• Darkening of the skin under your eyes
• Flattening of your nose caused due to weak underlying nasal structures
• Dissatisfaction over the appearance of the nose after surgery

You will have a follow-up appointment in a week after the surgery where your surgeon will remove the splint.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.