What is a Rhinoplasty?
- A rhinoplasty is the general term for a cosmetic nose operation.
- Primary rhinoplasty refers to the first operation on a nose. Secondary or revision rhinoplasty is performed when the nose has undergone one or more previous cosmetic operations.
- The term septorhinoplasty is used when the surgery also involves the nasal septum, the midline wall of cartilage and bone which divides the inside of the nose inside into two halves. If this is crooked it may require straightening (an operation known as a septoplasty) to improve breathing
- Cosmetic and functional surgery to improve breathing should ideally be performed at the same time, rather than separate operations.
- In reality almost all rhinoplasty operations involve the nasal septum to a lesser or greater degree.
- Surgery is generally performed under general anaesthetic (you will be asleep). You will be asked questions to make sure you are fit enough to undergo the procedure and that the anaesthetic does not carry significant risks.
Which Type of Rhinoplasty?
- There are two main types of rhinoplasty: firstly closed (or endonasal) rhinoplasty where the incisions are made inside the nose.
- Secondly open (or external) rhinoplasty where an incision is made between the nostrils to allow the soft tissues of the nose to be elevated. Fortunately the small scar fades quickly and is then very difficult to see.
- The type of rhinoplasty recommended depends upon a number factors. These include the problem which requires correction, whether surgery has been performed previously and the experience and training of the surgeon. There are pros & cons of each approach which need careful consideration so that the best result can be achieved, and your surgeon should discuss these with you.
A main concern for patients seeking a rhinoplasty is how the nose will look after surgery. The skill and experience of the surgeon will of course affect the outcome of surgery, but there are many other factors. These include:
- The nature of the existing deformity and type of cosmetic changes required
- The patient’s skin type is particularly important
- Whether or not there has been previous surgery
- It is very important for a patient to have realistic expectations about what can be achieved. Patients must realise that rhinoplasty is a challenging procedure and it may not be possible for any surgeon to give them the ideal nose they seek.
The surgeon and patient must take sufficient time to discuss the cosmetic changes required and what can realistically be achieved.
Problems after Rhinoplasty
Fortunately serious complications are very rare following a rhinoplasty. However, as in any operation, complications can occur and the surgeon must discuss these with a patient who is considering cosmetic nasal surgery. They can then make an informed decision about whether they wish to proceed.
- Complications include bleeding, severe bruising, infection and numbness of the nose and teeth.
- Permanent numbness is most unusual.
- A serious complication is a septal perforation where a hole forms in the cartilage septum inside the nose. In experienced hands this is a rare complication.
Loss of sense of smell has been reported after a rhinoplasty. This is very rare indeed.
The majority of patients are happy with the result of their surgery, but there is no nasal plastic surgeon who always achieves ideal results, and occasionally a second operation (called a revision rhinoplasty) is required. This possibility and other possible complications must be openly discussed with patients, with the surgeon informing the patient about his or her own personal results.
It is my practice to give patients written information about a rhinoplasty which is often helpful.
Should I Have a Rhinoplasty?
The decision to have a rhinoplasty must of course be considered carefully. In appropriate patients this operation can significantly improve their quality of life. The opposite is however true, and for unsuitable patients the operation can often lead to disappointment and unhappiness.
Surgery may be right for you if:
- there are specific features about your nose which you would like to be changed, and these can be identified by your surgeon.
- you have realistic expectations, and you will be happy with a nice improvement in the shape of your nose and do not expect a perfect nose after surgery.
- you recognise that a rhinoplasty simply aims to improve the shape of your nose and you do not expect all other aspects of your life to also improve.
- you enjoy good physical and mental health
Surgery is not right for you if:
- you are overly concerned about minor abnormalities of your nose, or even obsessional about the appearance of your nose.
- you think that surgery can create a perfect nose, or a nose that you have seen in a magazine or on the face of a celebrity.
- you are not willing to accept that despite the best efforts of your surgeon the result can be disappointing, complications can occur and a second operation may rarely be required.
- you think that a rhinoplasty will make you successful or improve your relationships with others
- you are too young or immature to undergo a rhinoplasty
- you do not enjoy good physical and mental health
- Patients are encouraged to visit their General Practitioners to discuss their wish to undergo nasal cosmetic surgery
- Professor Woolford will see you for your initial consultation, as in his view it is important that you discuss the option of a rhinoplasty thoroughly with him in person rather than with another practitioner. He will discuss the changes to your nose that you hope to achieve by surgery and examine your nose both on the outside and inside.
- The kind of rhinoplasty that would be required and realistic outcomes are discussed.
- If asked Professor Woolford will show you pictures of the results of surgery that he has personally performed (rather than a clinic brochure with cases by a number of different surgeons).
Written information about rhinoplasty is given to the patient
- If you would like to move things forward photographs are then taken.
- Patients who wish to proceed to surgery are seen on a second occasion (there is no additional fee for this) where the surgery is again discussed and any questions answered.
- Photographs are reviewed, and the aims of surgery discussed in detail. Professor Woolford ensures that the patient has realistic expectations and is aware of possible complications including the occasional need for a second operation.
After My Operation
- Immediately after your surgery is complete and before you wake up, Professor Woolford will apply a moulded plastic splint to the outside of your nose.
- Most patients stay in hospital one night and the sponges are generally removed from the inside of the nose the following morning. After a review by Professor Woolford you will then be allowed to go home later in the morning.
- You may be given a week of antibiotics to take, although this depends upon the type of rhinoplasty you have had.
- 5 – 7 days after your surgery you will be reviewed in clinic by Professor Woolford, your splint will be removed and if you have stitches these will be taken out.
How Will My Nose Feel Afterwards?
Most patients do not find their nose very painful after their rhinoplasty, although you may experience some discomfort for a week or two. You will be given painkillers to take if you need them.
It is normal for your nose to feel blocked as if you have a cold for a couple of weeks after your rhinoplasty. You may also experience some crusting, blood stained catarrh and occasionally small nose bleeds for 1-2 weeks. A fine watery spray is provided to make your nose more comfortable while it is healing inside.
It is also normal for the nose to be swollen after surgery and this is rather variable. The swelling will improve quickly over two weeks, but some swelling will persist for a number of weeks – you will be encouraged to be a ‘patient patient’!
You may have some bruising around the eyes, although this is generally minor and settles over 7-10 days. Your nose, particularly the tip of the nose can feel rather stiff and numb after your surgery. This generally settles over 2-3 months and is very rarely a long term problem.
Although you can get a good impression about the result of your rhinoplasty after 3 to 4 months, it is not possible to judge the final result of your operation until healing is complete which can take up to 12 months. The nose may actually continue to undergo further minor changes for a number of years after surgery.
Do’s & Dont’s After Your Operation
- Patients are advised to be sensible and rest at home for a week after their rhinoplasty
- Try to keep the nasal splint dry in the week following surgery. After the splint is removed you can gently wash your nose. A damp cotton bud can be used to clean round the nostrils, but force must not be used.
- It is of course best not to smoke before or after your surgery, and smoky environments are best avoided.
- Generally normal work can be resumed 10-14 days after a rhinoplasty, although this of course depends upon the individual and occupation.
- Avoid blowing your nose for the first week after surgery, and then only very gently for a further 2 weeks. It is best to sniff in or gently dab the nose. The watery spray provided after your surgery can be used for 2-3 weeks while your nose is settling.
- It is best to avoid exercise or heavy physical exertion for two weeks after your rhinoplasty. After this resume gently and build things up – again use common sense.
- Contact sports and other situations where trauma may occur should be avoided for 6 weeks following a rhinoplasty. After this the nose has resumed full strength and trauma carries no additional risk.
- Patients are advised to avoid strong sunshine and use a high factor sun cream for 3 months.
- Flying is best avoided for at least 2 weeks after a rhinoplasty. The dry air is particularly unpleasant for the nose and there is a risk of bleeding.
- If your nose becomes increasingly blocked or painful you should be reviewed as this may indicate an infection.
- Small amounts of bleeding or blood stained discharge do occur and generally settle quickly. Significant bleeding is rare, but if it occurs you should seek medical attention. For this reason you should have access to appropriate medical care for two weeks after surgery.