Rhinoplasty surgery is performed under general anaesthesia in a fully accredited private hospital with the assistance of a qualified anaesthetist. Expect the operation to take three to four hours and you are often fine to go home the same day.
After we carefully make the incisions to gain access to the nasal skeleton, the nasal hump is first removed by shaving down the cartilage and bone to give a straight dorsum on profile. It is usually necessary to fracture the nasal bones in a careful fashion to allow them to meet in the midline and create the new narrowed nasal dorsum. This also narrows the bony base of the nose at the bridge to enhance the frontal profile of the nose.
Next the cartilages under the skin that shape the tip of the nose are adjusted in size and shape to refine your nose to match your new profile. In some cases an additional incision across the base of the nose at the nostrils is used to narrow the base of the nose. This incision is usually imperceptible once it has fully healed.
When surgery is complete, small dissolvable stitches are placed inside the nostrils and tapes and a splint are applied. A small splint is required for seven days to support and protect the bones while they set in their new position. Frequently, internal silicone rubber nasal splints are used to ensure the lining of the nose sets correctly. This means you will most likely have to breathe through your mouth until they are removed.
Types of Rhinoplasty
A mistake people often make is assuming that simply reducing the size of the nose will produce a positive outcome. It is important to appreciate that when the chin projection is insufficient, the profile seems to be dominated even by a small or average nose, but the solution in that case may be to augment the chin and possibly do a smaller reduction or no reduction to the nose.
In some patients, only modification of the nasal tip and nostrils is desired. With many complain that their nasal tip is too bulbous or boxy in appearance, too projecting, too wide, over-rotated (turned up) or under-rotated (plunging nasal tip). In some cases, the muscles of the upper lip can also affect the appearance of the nasal tip with smiling.
Modification of the nasal tip can be achieved using suture techniques, cartilage grafting, and cartilage resection; often requiring multiple techniques used in combination to achieve the desired result. The exact method used is determined by a number of factors, such as the condition of the cartilage, the severity of the deformity, the thickness of the skin, and the relationship between the appearance of the nose and the face.
Augmentation Rhinoplasty (Ethnic Rhinoplasty)
Augmentation Rhinoplasty, involves increasing the projection of the bridge and the tip of the nose, is more commonly requested by patients from ethnic groups that have a softer cartilage support to the nose and a less defined nasal bridge. This is frequently combined with alar reduction (reduce the width of nostrils) to give a more refined nasal projection.
Materials used to support the tip and augment the bridge can be artificial, or taken from the patient’s own tissues (autologous bone or cartilage). The use of artificial implants for augmentation, while widely popular as it is a simpler procedure, also carries with them higher risks of infection and failure requiring revision. So in our practice we prefer to use autologous cartilage as it has shows excellent long-term stability.
In a number of instances, the outcome of rhinoplasty is unsatisfactory as a result of technical errors, healing problems, or injuries after the first operation. While often the area of concern may seem minor, the undertaking of revision rhinoplasty cannot be underrated. Even a small correction requires a formal open rhinoplasty technique that is more complex perform than the original surgery with a longer period of time to settle down postoperatively.
Revision rhinoplasty requires experience and dedication from your surgeon, as well as an understanding of the type of changes that the first operation would have created. Revision rhinoplasty often involves use of grafts, commonly cartilage from inside the nose but also from other areas (rib, ear).
Closed Rhinoplasty Surgery
All incisions required to reshape the tip and bridge of the nose are placed inside the nostrils. As a result there are generally no external scars.
Open Rhinoplasty Surgery
In addition to the incisions inside the nostrils, there is a small incision placed on the columella – the small bridge of skin between the nostrils.
Many surgeons prefer this approach because it provides the best access to the underlying cartilage and bony elements of the nose to enable greater control for the delicate reshaping which is required in rhinoplasty surgery.
The nasal septum can have a profound influence on both the appearance of the nose as well as the function of the nasal airways. A deviation or curvature of the nasal septum can create the appearance of a crooked nose and also change the appearance of the nasal tip. Septoplasty is often done in conjunction with a rhinoplasty.
A septoplasty may also be performed when extra cartilage is required during a rhinoplasty to help strengthen the cartilage structure of the nose to maintain its shape and prevent collapse.
After your Rhinoplasty Surgery
The splint placed over the nose at surgery completion is generally worn for a week or so. You may also have internal nasal splints that need to be removed after five to seven days, which can make breathing through the nose difficult during this period.
You must not blow your nose for at least two week. You may clean the internal part of your nostrils to remove any crusting or blood clots using a little Vaseline or saline on a cotton bud. Avoid hitting or rubbing your nose and be very gentle washing your face.
External sutures (across the columella) are removed at five days post op. Bruising is variable but always more evident in men than women. Most of the bruising subsides in about 3-4 weeks and any remaining bruises can be covered with make-up after a week.
Patients report minor post-operative pain, which is treated with oral medication. You will be given a prescription for pain management and antibiotics. Have someone fill the prescription, drive you home and take care of you as you recover during the first few days after your surgery.
Some results will be seen when the cast is removed. However it takes about a year before the final result can be fully appreciated. It is very normal for the tip of the nose to feel numb after surgery and recovers as the nerve supply to the skin regenerates.
Contact lenses can be worn immediately, however if you wear glasses they must not put pressure on your nose for the first 4-6 weeks.
Risks Associated with Rhinoplasty Surgery
As with any surgery, it is important that you are fully informed of the potential risks associated with rhinoplasty surgery. While all care is taken to minimize these complications, they may and do occur despite the best medical care.
It is important that you carefully read and understand the potential risks and they will be discussed in further detail when you have your consultation with Dr Turner.
Risks associated with Surgery
• Bleeding or haematoma
• Postoperative infection
• Poor Scarring including keloid scars
• Unsatisfactory results
Risks associated with Rhinoplasty Surgery
• Postoperative nose bleeds
• Cartilage grafts (donor sites – additional scars)
• Nasal septal perforation
• Nasal airway alterations
• Chronic pain
In a small but significant number of cases (about 10%) both the patient and surgeon feel the shape of the nose after six months is not quite that which was intended. A second procedure (revision rhinoplasty) may be called for. It is important to remember that they revision surgery cannot be carried out immediately, the nose has to be allowed to settle before further surgery is safe or desirable.