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Nose Reshaping (Rhinoplasty)

Rhinoplasty is the medical term for nose reshaping surgery, also known as a ‘nose job’. The size, shape and proportions of the nose have a significant impact on the overall look of the face. 

Nose reshaping surgery can also be performed to correct breathing difficulties caused by injury or damage to the nose, or by the natural shape of the internal passages of the nose. 

There are several types of nose reshaping surgery:

  • Tip rhinoplasty 
  • Open rhinoplasty
  • Secondary rhinoplasty
  • Augmentation rhinoplasty
  • Submucosal resection (SMR) or Septoplasty

Mr Adams will discuss the best procedure for you during your consultation.

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Types of Rhinoplasty

Tip Rhinoplasty

The aim of this procedure is to alter the shape of the nasal tip and is performed under direct vision. There is no bony work or fracturing required and a nasal splint is not applied post operatively.

Open Rhinoplasty

The shape of the whole nose is altered via an incision placed along the inside of the nostril rims and across the base of the columella (the strip of skin between the nostrils in the midline). This allows good access to the bony and cartilaginous parts to the nose to allow accurate reshaping using a number of techniques.

Secondary Rhinoplasty

This operation involves those who have undergone previous rhinoplasty surgery, but who wish further nose reshaping. This can be more difficult as there is often more scarring and corrective work can involve more complex procedures.

Augmentation Rhinoplasty

This involves increasing the size of the nose, and often requires the use of cartilage obtained from the back of the nasal septum, from the ear or sometimes even from rib cartilage.

SMR

This procedure involves removing a portion of the central cartilage septum deep within the nose in order to improve the nasal airway. The central cartilage septum can be bent or deviate significantly enough to affect breathing. Once this bent septum is removed, the airway is improved. This operation does not affect the shape of the nose from a cosmetic point of view, but instead is aimed to improve the airway/breathing. This procedure can be performed at the same time as an open rhinoplasty.
Nose Reshaping

What You Need to Know

What Happens When I Leave Hospital?

Whilst the Nose splint is in place, patients are reminded not to get it wet. Sutures are used to close the incision sites both inside and at the base of the nose (columella). All of these sutures are self-dissolving and the exposed suture material will usually rub out by ten days to two weeks postoperatively.
In most cases, there will be significant bruising around the eyes which may persist for 1-3 weeks following surgery. On many occasions, the bruising and swelling can get worse In the first 2–3 days following discharge from hospital. In order to reduce the degree of swelling and bruising, patients are advised to sleep on two or three extra pillows at night and possibly also raise the head end of the bed for several days following surgery. After removal of the splint, there will still be some swelling around the nose. Whilst it will be possible to have a reasonable idea of what has been achieved, one must wait 9 months to judge the final result. This is as a result of the persistent swelling within and under the skin and the time it takes for the internal scarring to mature. The presence of lumpiness, either to touch or on occasions to see, should not be a matter of significant concern as in the vast majority of cases, this will resolve spontaneously. For several weeks and sometimes months following surgery, the skin of the nose will feel numb and the tip can feel woody and solid. These features will resolve by themselves. The columella scar can remain pink for a number of weeks before fading.
The rhinoplasty procedure is not normally associated with significant pain or discomfort. Immediately following surgery, pain relief will be offered and should be taken on an ‘as required’ basis.
As a result of the splint and swelling around the eyes, patients will not be able to wear glasses or contact lenses for several days following surgery. The splint will prevent glasses from being properly worn, and even when the splint is removed, caution is required when placing glasses over the bridge of the nose, in order not to disturb the nasal bones. Avoid pressure to this area for several weeks following surgery. It can be useful to strap glasses to the forehead with tape to relieve pressure over the bridge of the nose.

Whilst all dressings are in place, you are advised not to drive. You have to be cautious even after the splint has been removed as the healing has yet to be complete. Avoid vigorous activities or sports (swimming, tennis, gym aerobics) for four to six weeks as the nose is still fragile during this time. Contact sport should be avoided for three months. Patients can return to work even with the splint on, as long as this does not involve significant physical activity. Further details will be provided to you preoperatively, and please do ask.

When the nose splint is removed, patients will begin to have a clearer idea as to what has been undertaken, however, the nose will still be slightly swollen, and the healing process within the bone and cartilage will still take some considerable time to settle. The full result of the nasal surgery cannot be judged for up to nine months following surgery. Patients will notice that the nose may feel numb and hard, especially at the tip. This numbness will gradually return to normal after several months and the woodiness of the nose will likewise settle, but after a number of months.

Patients will be reviewed by the cosmetic nurse on removal of the splint at one week to 10 days following surgery. An outpatient appointment is made to see Mr Adams at 6 weeks and nine months. The appointment for removal of the nose splint will be made before you leave the hospital.
The rhinoplasty operation is usually associated with relatively few risks. Some bleeding may be experienced in the first few days following surgery. Should this be marked then patients should seek medical advice. The airways and sense of smell may be reduced initially though in the vast majority of cases this will resolve spontaneously within a few weeks. These should not be a cause for concern. The nose skin is numb and care needs to be taken when exposed to sun as sunburn can occur easily. Patients are advised to use high factor sunblock on the nose for several months following surgery during sun exposure. This can be provided for you.

Resources

Read the full rhinoplasty fact sheet for more information on the types of nose-reshaping surgery, pre-operative advice and what to expect following the procedure

Nose Reshaping Rhinoplasty Fact Sheet 000662664.PDF
Common events and risks in anaesthesia.pdf
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