Being in the centre of the face the nose has a very significant impact on facial aesthetics. The most common problems are a hump on the nose and deviation of the nose. The nose can however be too big or too small in proportion to the rest of the face or the shape may be undesirable. There are a variety of procedures that can be undertaken to correct this.
Operative procedures
Tip plasty.
The aim in this operation is to alter the shape of the tip of the nose only. No bone work or fracturing is undertaken.
Rhinoplasty/septorhinoplasty.
In these operations the shape of the whole nose is corrected via incisions placed inside the nostril rim plus/minus a small extension across the base of the columella (this being the bridge of tissue between the nostrils). The bone and cartilage elements are exposed and reshaped and a new nose is created. Work to the septum may be undertaken either to help correct deviation or to improve the airways. An SMR involves removal of a portion of the septum and a septoplasty involves reshaping the septum.
Secondary rhinoplasty.
The secondary rhinoplasty is a procedure undertaken on patients who have already had a previous rhinoplasty where some dissatisfaction with the shape remains. The surgery is more difficult as a result of the previous surgery and the scarring that will inevitably have resulted.
Augmentation rhinoplasty.
This type of rhinoplasty is used when the nose is too small either as a result of a congenital anomaly, trauma, racial characteristics or substance abuse. The nose is rebuilt using cartilage obtained either from the nose septum, the ear or in most cases from the rib.
Preoperative advice
Before surgery the aims and expectations will be discussed in full to try and ensure that the correct nose shape is achieved. Smoking as with all surgical procedures is discouraged preoperatively and in the immediate postoperative period as it may interfere with wound healing. Aspirin and other related anti-inflammatory agents should be avoided for one week prior to surgery as they may increase the risk of bleeding and also lead to more bruising.
Operative procedure
The operation usually takes between 1½ to 2 hours to achieve. The surgery is undertaken under a general anesthetic and although tip plasties may be undertaken as a daycase procedure, in all other forms of rhinoplasty a 1 night stay postoperatively is required. Some stitches are applied to the nose, these usually being self-dissolving and in most cases a plaster of Paris is applied which will need to be left on for between 7 and 10 days. Again in most cases the nose is packed with a Vaseline impregnated gauze, this being removed on the morning of discharge.
Following surgery
In the first 2 or 3 days following surgery patients are advised to rest and at night to sleep with 1 or 2 extra pillows to keep the head slightly elevated. Pain is not normally a significant feature although analgesics may be required. Many patients will develop black eyes in the immediate postoperative period but most of the bruising usually subsides by 10-14 days postoperatively. The plaster of Paris is removed at 10 days and although a lot of the affects of the rhinoplasty will be visible there will inevitably be some swelling which although relatively mild and inconspicuous, means that the full effect of the rhinoplasty cannot be fully assessed for several months postoperatively. In most cases a period of at least 9 months is required before full assessment of the end result can be made.
Follow up
Arrangements for follow up are made prior to discharge. Patients are usually seen between 7 and 10 postoperatively for plaster of Paris removal and then at 1 month and between 6 and 9 months in the outpatients department by the surgeon.
Risks and complications
As with all surgery there are risks of complications however with rhinoplasties the complication rate is relatively low. The main problems that occur in the immediate postoperative period are bleeding and very rarely patients need to be readmitted for nasal packing. Other potential problems in the immediate postoperative period include swelling inside the nose which may restrict the airways and also may restrict the sense of smell and taste. These usually settle spontaneously within 1-2 months following surgery. From a longer term point of view some patients find that the nose shape they have is not the one they were hoping for, either because of some problem with adverse scarring or because of an alteration in the shape of the cartilage or bone postoperatively. In 5-10% of cases further surgery is required to revise the nose. This surgery is usually relatively minor and frequently is undertaken as a daycase procedure. As the nose takes several months to fully settle, re-operation is not usually undertaken prior to the 9 months postoperatively.
Your new look
Healing is a gradual process and especially in the nose, it takes many months for the final result to be achieved.
Before surgery the aims and expectations will be discussed in full to try and ensure that the correct nose shape is achieved. Smoking as with all surgical procedures is discouraged preoperatively and in the immediate postoperative period as it may interfere with wound healing. Aspirin and other related anti-inflammatory agents should be avoided for one week prior to surgery as they may increase the risk of bleeding and also lead to more bruising.