A rhinoplasty or nose job is an operation performed to reshape the nose. It is the most individual of all aeshetic surgery procedures requiring the most dexterity, skill and understanding of the patients wishes, the technical possibilities and the underlying anatomy. There are several different ways of performing nose job surgery and the exact way is very dependant on how the surgeon best thinks it is possible to achieve the look requested by the patient.
Of all the surgical procedures we perform as plastic surgeons, a rhinoplasty (or nose job) is probably the most complex. A rhinoplasty can be performed with all the surgical incisions on the inside or with some on the skin; it can be performed with or without using cartilage or bone grafts; it can be performed for breathing difficulties and can also be performed completely non-surgically using injections of skin fillers to fill out some of the nose skin to hide minor imperfections in the nose.
Before you have a rhinoplasty, your surgeon will assess your nose. You will need to say what you would like to achieve and what you do not like about your nose. It is quite important to be very clear about this, because there is so much we can do on a nose, and being very specific is helpful to the surgeon. Your surgeon will ask you about your general health and whether you have any previous relevant issues with your nose (operations, injuries, breathing difficulties, and so on). The examination involves looking and feeling the nose internally and externally along with a breathing assessment. Your surgeon will also have a look at the skin of the nose and will assess the size and shape of the rest of your face. Most people are looking for a nose that is in harmony with the face. If, for example, the chin is too small, this may give the nose an apparently prominent appearance in the face. So, sometimes your surgeon may talk about other additional procedures.
How we perform a rhinoplasty To do a rhinoplasty, we need to get access to the cartilages and bones that form the structural framework of the nose. Together, the cartilages and bones form the skeletal support of the nose, and a rhinoplasty changes these structures. Your skin then redrapes across the new skeletal framework. A “closed rhinoplasty” is one in which the incisions are made on the inside of the nostril, and an “open rhinoplasty” is one in which a small incision is made in the skin under the tip of the nose which separates the two nostrils. Some surgeons do more open rhinoplasties as they feel they can predict the final outcome more readily, but other surgeons do more closed rhinoplasties as the final result is achieved with less swelling and a shorter recovery period in a procedure that already has a notoriously long recovery period before the final results are seen. Whichever method is used, the surgeon will reshape the bones and cartilages and expect the skin to redrape over the new shape without too much swelling. If the skin is too thin, then any minor imperfections will come through into the skin, and if the skin is too thick, then the skin will not drape well across the new shape of the new skeletal framework. You will usually have a plaster on your nose for about a week, and have a couple of packs inserted to prevent nose bleeds for a day or so.
Expected and unexpected results The commonest complication of a rhinoplasty in my hands is to have minor surface irregularities along the nose particularly at the junction of the bone and the cartilage of the nose. If this happens you may wish to consider fillers for this, as this is usually not an indication for surgery. Although the final results are not seen for at least a year after a rhinoplasty, there are some things we expect during the recovery and some things we hope not to see. We expect a change in the shape of the nose; we want this to be your expected outcome, but everyone needs to be realistic about the exact size and shape of the final result. Most of the time we cannot give someone the ideal nose they have pictured in their mind as their perfect nose. We often aim for improvement rather than perfection. Some of the after effects we hope not to see include things like infections, abnormal bleeding and swelling, over and undercorrection, cartilages and bones moving after they have been set in a particular position, asymmetry, healing problems and breathing difficulties. Sometimes, also, the nose needs a further operation to tweak the final results. Finally, your nose actually continues to grow throughout your life so it will change shape as the years go by.
Recovery time The final results of a nose job aren't seen for up to one year once all the swelling settles down. Even then, the nose continues to change as time goes on and as we age. It becomes longer and more drooped as we age.
Swelling You will have nasal packs for 24 hours and a blocked nose for a few days after a nose job. Black eyes last for around 2-4 weeks, but the tip and bony portion of the nose will stay swollen for several months after the operation, with the last of the swelling taking several months to resolve completely. Very rarely, some people report permanent swelling around the lower eyelids after a rhinoplasty.
Plaster You may have a plaster and dressings on the nose, and may have stitches in the undermost part of the nose, if you are having a particular type of nose job. These will usually stay in place for around 5 days. You may also have small incisions made on the side of your nose depending on whether the bones need to be reset and how this will be performed.
Other complications These include: infection, bleeding, scarring, overcorrection, undercorrection, asymmetry, numbness, prominent veins developing on the nose, skin damage, impatience with the recovery process, dissatisfaction with the final result.
Complications in secondary (repeat) rhinoplasty These include: those from taking cartilage or bone grafts from the rib, head or ear, persistence of the abnormality, and moving of grafts after they have been put into place. Secondary rhinoplasty is associated with a longer recovery time, more swelling and less predictable results.
Revision rhinoplasty There is always a revision rate associated with rhinoplasty; if you are having a revision rhinoplasty after a primary rhinoplasty performed by us we will not charge the surgeon fees, but you will still be liable for paying the hospital and anaesthetist for their fees.