Rhinoplasty with grafting: Sometimes, a rhinoplasty will require the addition of a graft to finesse the results – whether this is a cartilage graft to support the internal structure, or a skin graft to improve the appearance of skin lesions or deformities in nose as a result of trauma.
This graft can be taken from various parts of the body, and is usually done as part of the same procedure, although sometimes it must be performed as two separate operations. Cartilage and bone grafts are often taken from the temples, ears or ribs, while skin grafts can be taken from the forehead, thighs or neck. The best skin grafts come from the forehead, as they’re more likely to provide a good match in colour and texture.
The progress of your surgery depends on your individual circumstances and needs. Most rhinoplasties with additional grafting are performed under general anaesthetic, because they are quite complicated and lengthy procedures. Typically, a rhinoplasty takes 1-3 hours, but it might take more, depending on the level of work you require.
The graft will be taken from a part of the body where any scarring will be subtle and easily concealed. The rhinoplasty itself will be performed with an open approach, meaning that a small incision will be made externally (on the collumellar) so that your surgeon can lift the skin from the nose and access the more delicate layers of tissue, bone and cartilage before.
If you have had a cartilage graft, you will have to wear an internal splint, which will support the graft, as well as an external one that will limit swelling. You should expect to feel swelling and possibly a tight sensation around the eyes, although this will subside within a few days. Generally speaking, your internal splint will be worn for 5-7 days, and your external splint for 7-10 days.
In the event of a skin graft, healing should be fairly swift, depending on what other work you have had done and the size of the skin graft. If you have to have stitches, these might have to be removed at a later date.
You should take between 1-2 weeks off work. This will depend upon your individual circumstances, how you have responded to the surgery and the amount of work you have had done. Either way, you should wait around 6 weeks before resuming participation in any strenuous exercise or contact sports.
Complications are fortunately rare. Time will generally improve the swelling and hence the appearance of the nose. Occasionally bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. Very occasionally, in about one in fifteen cases, a small secondary adjustment will be required. This can often be corrected under local anaesthetic. As swelling of the nose settles following surgery, the nose shape will gradually change over a period of months and minor irregularities should therefore not usually be addressed until most of this swelling has settles which is usually 10-12 months following your initial surgery.
Scarring can occur and in these cases the scar maybe a different colour to the surrounding skin or raised and lumpy. Again scars take time to settle and will usually fade and soften over 6-9 months following surgery.
It is common for the nose – especially the tip – to feel numb following rhinoplasty. This should settle over 4-6 months.
Some nasal asymmetry may still be present following surgery, especially if the nose was deviated before surgery although usually this should be much improved.
Occasionally allergic reactions can occur to sutures, tape, splints and may require treatment.
Wound disruption or delayed healing can occur and rarely some areas of the skin may necrose. This is more likely in patients who either have had multiple procedures on their nose previously, or in smokers and immunosupressed patients e.g. diabetics.
In some cases cartilage grafts need to be placed to support the structure of the nose and this cartilage is usually harvested from the septum inside the nose. Occasionally this can cause a septal perforation which usually does not need further treatment but occasionally can cause discomfort with airflow and breathing and require a secondary procedure to correct.
Differences in breathing maybe apparent following surgery and in the initial healing period nasal airway obstruction is common as the mucosa is more congested and nasal drops may help with this.
Scar necrosis – wherever incisions are made, it is possible to develop scar necrosis, which is the thickening, reddening or hardening of a wound or scar. Gentle and frequent massage – once the initial tenderness has subsided and a scar has begun to form – will help you to minimise this risk. If scar necrosis does develop, it can usually be treated by steroid injections at a later date. Alternatively, you may require scar revision surgery, although this is incredibly rare.
Skin graft failure – there is also a slight chance that your skin graft will not ‘take’ if blood flow is not sufficient to the area. This is more likely in areas of the face with limited mobility, like the nasal tip. If this occurs, you may need a revision procedure. Speak to your surgeon about this is you are concerned.
Dissatisfaction – 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.