Rhinoplasty (Nose Surgery)

Overview

Rhinoplasty is surgery on the bone and cartilage that give the nose its shape. People ask for it for two broad reasons. Some want to change how their nose looks, for example a hump on the bridge, a wide or drooping tip, or a nose that sits crooked after an injury. Others cannot breathe well through their nose because of how it is built inside. Many patients have a bit of both.

When the operation is mainly to improve breathing, it is called functional rhinoplasty. It often includes a septoplasty, which straightens the septum (the thin wall of cartilage and bone that divides the left and right nostrils). When both are done together the operation is called a septorhinoplasty. When the aim is only to change the appearance, it is cosmetic rhinoplasty.

The nose sits in the centre of the face, and small changes can matter a great deal to the person who has them. A careful surgeon spends time understanding exactly what bothers you, and is honest about what your skin, cartilage and bone will allow.

Who needs it

Surgeons usually consider rhinoplasty for adults, and for teenagers only once the nose has finished growing, which is generally in the mid to late teens. Common reasons include:

• A deviated septum or collapsed nasal valves causing a blocked nose that has not improved with sprays or other treatment.
• A nose that was broken and healed out of shape.
• A hump, a wide bridge, a tip that droops or looks bulky, or a nose that is not straight.
• A difficult result from an earlier nose operation (revision rhinoplasty).

You are a better candidate if you are in good general health, do not smoke or are willing to stop well before surgery, and want the change for yourself. Surgeons will ask about medicines and supplements that thin the blood, such as aspirin, ibuprofen, fish oil and some herbal products, since these can increase bleeding.

A good surgeon may advise against surgery. That can happen if the change you want is very small, if your expectations cannot be met with your anatomy, or if you seem to be under pressure from someone else. Some people feel deep, ongoing distress about a small or unseen feature, a condition called body dysmorphic disorder, and surgery does not usually help them. Hearing "no" or "not yet" from a surgeon is a sign they are taking care with you.

How it is done

Rhinoplasty is usually done under general anaesthesia, so you are fully asleep. It typically takes two to three hours, longer for revision or complex cases.

Open and closed approaches

In open rhinoplasty, the surgeon makes a small cut across the columella (the strip of skin between the nostrils) and joins it to cuts inside the nose. The skin can then be lifted to show the cartilage directly. This gives a clear view for detailed work on the tip or for revision cases. The scar usually becomes a fine, faint line.

In closed rhinoplasty, all cuts are inside the nostrils, so there is no visible scar. The surgeon works with a more limited view, which can suit smaller changes such as reducing a hump.

What the surgeon may change

Depending on your plan, the surgeon may shave down a hump of bone or cartilage, reshape or support the tip cartilages, narrow the nasal bones by making controlled breaks (osteotomies), straighten the septum, or add cartilage grafts to support or build up parts of the nose. Grafts usually come from your own septum. Sometimes ear or rib cartilage is used, which the surgeon will discuss with you beforehand.

At the end, a splint is taped or glued to the outside of the nose to protect it. Some surgeons also place soft splints or light packing inside the nostrils.

Recovery and how long you stay

Rhinoplasty is often done as a day case or with one night in hospital. Expect to breathe through your mouth for the first few days, with a dull ache rather than sharp pain for most people, and some bleeding that slowly settles.

Swelling follows a fairly typical pattern, although everyone heals at a different pace:

• Days 1 to 3: bruising and swelling around the eyes and cheeks are usually at their worst.
• About day 7: the external splint and any internal splints are removed. Most visible bruising fades over the next week or two.
• Weeks 2 to 6: the nose still looks swollen, though most people feel ready to be seen in public.
• Months 3 to 12: the remaining swelling slowly goes down. The tip is the last part to settle, and in thick skinned noses it can take more than a year.

Surgeons usually advise sleeping with your head raised, not blowing your nose for a couple of weeks, avoiding strenuous exercise for several weeks and contact sports for longer, and keeping sun off the nose. Risks include bleeding, infection, a change in the sense of smell, numbness of the tip, breathing that is no better or worse, and a shape that is uneven and may need revision.

Most patients stay 8 to 10 days in the destination, which covers a consultation and tests, surgery, and the splint removal. Flying soon after surgery raises the risk of blood clots in the legs, and your surgeon decides when you can fly. Patients often travel to Turkey, Thailand or Mexico for rhinoplasty, and it is also done in India and Malaysia. MediCurage books your return flight only after the surgeon confirms the splint removal date, and your coordinator can arrange a quiet room near the clinic for that first bruised week.

Questions to ask your surgeon

Bring clear photos of your nose from the front, both sides and below, and ask:

1. Will you use an open or a closed approach for me, and why?
2. Does my septum or anything else inside my nose affect my breathing?
3. Will you need cartilage grafts, and where would they come from?
4. Will you break and reset the nasal bones?
5. What can my skin type and anatomy realistically allow, and what can they not?
6. Which medicines or supplements should I stop, and when?
7. When will the splint come off, and when will you clear me to fly?
8. If I need a revision later, how would that be handled?

Ask to see the surgeon's own drawings or computer imaging only as a way to agree on goals, not as a picture of the result. Your nose will settle in its own way over the following year.