What the procedure is
Rhinoplasty reshapes the bony and cartilaginous framework of the nose. It may be purely aesthetic, functional to treat difficulty breathing, or both.
Where there is a deviated septum or enlarged turbinates, these can be corrected in the same sitting — described as functional rhinoplasty.
Two approaches are used: open, through a small incision in the columella between the nostrils giving direct visibility, and closed, through incisions inside the nose with no external scar. The choice depends on the nature of the change required.
The nose is among the more complex areas in plastic surgery, because the result depends on thin tissue healing over a reshaped framework. The final result therefore takes a relatively long time to appear.
Who is a suitable candidate
- People whose facial skeletal growth is complete.
- People in good general health.
- People with functional indications such as difficulty breathing, or a wish to change shape with realistic expectations.
- People who understand that the nose must suit the rest of the face, and that the aim is proportion rather than reproducing a particular shape.
How it is performed
Performed under general anaesthesia, usually taking one and a half to three hours depending on complexity.
Bone and cartilage are reshaped, and cartilage grafts from the septum, ear or rib may be used where additional support is needed.
An external splint is applied for about a week, and internal splints may be used.
Recovery
- Discharge is usually the same day or after one night.
- Swelling and bruising around the eyes are expected in the first week and then subside.
- The splint is usually removed after about a week.
- Return to desk work is often within one week to ten days, avoiding contact sports for several weeks.
- The shape improves gradually, but the final result can take twelve months or more to appear fully, particularly at the tip.
Scars
With the closed approach there is no external scar.
With the open approach there is a small scar on the columella between the nostrils, which becomes inconspicuous in most cases over time.
Where the nostrils are narrowed, there are small scars at the base of the nose.
Risks and complications
Every operation carries risk. This is an educational list, not an exhaustive one; the risks specific to your case are discussed during consultation.
- Risks of anaesthesia.
- Persistent or new difficulty in breathing.
- Asymmetry or contour irregularity, which may appear once swelling subsides.
- The need for revision surgery, more common in rhinoplasty than in many other operations given the complexity of healing in this tissue.
- Nosebleed.
- Infection.
- Change in the sense of smell, usually temporary.
- Adhesions inside the nose or septal perforation, which is rare.
- Prolonged swelling, particularly at the tip in people with thicker skin.
Combining with other procedures
Septal correction is often combined with rhinoplasty in the same sitting. It may also be performed with chin surgery where the profile needs balancing.
Common questions
When does the final result appear?
Most swelling resolves within weeks and the appearance becomes socially acceptable early, but fine swelling — especially at the tip — persists for months, and the final result can take a year or more.
Does the operation treat difficulty breathing?
Where the difficulty results from a deviated septum or enlarged turbinates it can be corrected in the same sitting. If the cause is nasal allergy, treatment is medical rather than surgical, so assessment begins by establishing the cause.