Rhinoplasty, more commonly known as a ‘nose job’ – is an operation to alter the appearance, and sometimes the function, of the nose. During a septorhinoplasty, the surgeon will operate on the septum (the cartilage that separates the two nostrils) as well as the nose externally. Each nose has its own individual anatomy, and this renders planning a rhinoplasty a very personalised and bespoke process.
An effective rhinoplasty draws on the rest of the facial features and creates an overall sense of facial harmony. The vast majority of people seeking rhinoplasty surgery are looking for just this – a natural looking result that does not draw attention to itself. During your consultation, you should be advised as to what is a realistic expectation from your surgery, and the level of results you can actually expect.
The results of rhinoplasty depend on several factors: the thickness of the facial skin, the anatomy of the nose itself and any previous nose surgery or trauma are all things that can affect how a rhinoplasty is performed. It is surprisingly common for people to seek rhinoplasty surgery for a perceived large nose, when actually the thing that is affecting their facial harmony is a small or receding jaw or chin. For these candidates, chin surgery and minimal nasal surgery can produce effective results that have a positive impact on the face as a whole.
Throughout the whole process, it’s imperative that you work closely with your surgeon to get the best results, and for this reason, it may be advisable to have two consultations prior to surgery. Imaging technology that shows a mocked up before and after can be useful for surgery of this nature, and provide excellent communication aids and a good place to work from, but they can in no way be used to guarantee a specific outcome.
Rhinoplasty surgery is most commonly performed under general anaesthetic, but minor adjustments to the structure of the nose may be performed under local anaesthetic. The length of the procedure varies from patient to patient and depending on the amount of work required, but it is generally said to take between 1 and 3 hours.
Surgical rhinoplasty can be performed in one of two ways – a closed technique, whereby all the incisions made are hidden on the inside of the nose, or an open approach, where an additional incision is made on the outside of the nose, across the collumellar (the vertical strip of tissue that separates the two nostrils). Many patients may have reservations about an external incision, but the scar generally heals very well and is rarely visible at all.
Which technique is the right one to use varies from patient to patient, and your surgeon should have a comprehensive discussion with you about which they think you would be best suited to.
A cartilage graft can also be beneficial for many patients in order to support the cartilage that is already present in the nose. Usually, this can be taken from another part of the nose, and therefore can form part of one rhinoplasty procedure. Less commonly, cartilage may have to be taken from another part of the body, such as the ear or the ribs. If this is necessary for your individual procedure, it will be discussed during one of your consultations and well ahead of your procedure.
The small bones that form the upper third of the nose often need to be fractured in a controlled way and re-set in order to achieve the most effective results. Access to these bones may require an incision – in which case around 2-4 very small (2mm long) incisions will be made along the sides of the nose. As with external incisions to the collumellar, these scars usually heal very well and are barely visible postoperatively. You will be advised ahead of the procedure if this is a necessity for you.
During the procedure, you will have a splint applied to the outside of your nose. This must remain in place for 7-10 days postoperatively, as it will help to protect the nose and control the amount of swelling. In some cases, you may also require a pack or splint on the inside of the nose. A pack will be removed fairly quickly after your surgery – either later the same day, or the following day. If you have had a cartilage graft taken from the septum, your internal splint will have to stay on for around 5-7 days after surgery.
You should expect some bruising around the eyes and over the upper part of the face – this is routine, and nothing to be concerned about. Swelling and bruising will likely be at its worst 2-3 days after your surgery, after which point it will gradually subside. You can help accelerate the healing process by sleeping with your head elevated, and making sure to avoid strenuous activity and exercise. You may experience some discomfort, which can be managed by painkillers that will be prescribed to you by your surgeon.
When your external splint is removed, the majority of swelling will have subsided, but it is not uncommon to still experience numbness and stiffness to the tip of the nose. Nasal tip swelling will take several months to settle completely. When patients have thick or oily skin, the swelling is slower to subside.
Please note that, the results that are apparent immediately after removal of your splint can be misleading. Patients can sometimes feel disappointed when their splint is removed after the 10 day mark, but they should not make judgements based on the appearance of the nose at this point, as the results will continue to settle and develop over time.
For a few weeks postoperatively, your nose will be delicate. You should therefore avoid strenuous and potentially harmful activities such as contact sports. Glasses wearers can be worn whilst the cast is on, and while they still can be worn after it is removed, they should not rest on the nose for long periods during the first few weeks of recovery whilst the nose is still tender. Contact lenses can be worn as soon as the eyes are no longer swollen.
Usually, patients are required to take 10-14 days off work in order to allow any swelling and bruising to subside. Visible bruising can be concealed by makeup.
Complications from rhinoplasty are rare. In general, time will improve the overall appearance of the nose, particularly due to contributing factors like swelling. Sometimes, bruising takes a little longer than expected to completely disappear, particularly in patients who have darker skin. Nose bleeds and infections are possible, but unlikely, and they are easy to correct with access to early treatment.
In about 1 in 15 cases, a small secondary procedure will be required to readjust the nose. As the swelling subsides, the shape will gradually change, and therefore minor irregularities will not be addressed until a consistent shape has been maintained. It can often be performed under local anaesthetic, and is generally something to be considered around 10-12 months after your initial surgery.
Sometimes, scarring can occur, and if this is the case the scar may be a different colour to the surrounding skin, or it might be raised and lumpy. Scars take time to settle, so please be mindful that any scarring may fade and soften within 6-9 months of surgery.
There may be some remaining nasal asymmetry following surgery, especially if the nose was already deviated before your surgery. This should be much improved at the very least.
Allergic reactions may also occur to sutures, tape or splints. These will require treatment.
Delayed healing, or skin necrosis, is uncommon but can occur. This is more common in patients who have had multiple nasal procedures, in smokers, or in immunosuppressed patients (e.g. diabetics).
Postoperatively, you might notice a difference in your breathing. During the initial healing, nasal airway obstruction is common, because the mucosa is congested. In this occurrence, nasal drops will help.
You need to be realistic in your expectations following surgery and you must communicate with your surgeon so that you fully understand the risks and benefits.