A rhinoplasty (or ‘nose-job’) is an operation carried out to change the external appearance of the nose. The nose is extremely important for breathing and if the inside of the nose is bent and interferes with functionit would have to be straightened as well.
The first thing to understand is that a nose-job is not a complete change of one’s nose to get someone else’s but the improvement of one’s physical defects. Nowadays the trend is for surgeons avoid giving the patient a ‘surgical’-looking nose that looks artificial (as though the person has had surgery) and do their best to give a natural-looking nose.
The preoperative consultation is very important. Here the patient meets the surgeon to discuss possibilities and expectations. Generally most patient expectations can be met, although not all changes are possible. Sometimes the patient’s wishes may risk compromising breathing and he/she would be advised accordingly. A patient who is specific as to what he/she dislikes about his/her nose is a great help to the surgeon. Any functional surgery required (sinus surgery to remove pain or nasal discharge, correction of blocked nose) would also be discussed as this surgery, if required would be carried out at the same time. The patient should feel comfortable with and feel confidence in his/her surgeon
Occasionally the surgeon may feel that he/she may not be able to help an individual with deep-seated psychological conditions and in these cases a referral to a colleague may be the best option instead of surgery.
Preoperative blood tests and photos are done as a routine.
The Operation
There are two main ways of carrying out a rhinoplasty- first by using a completely internal approach and second by making a small incision below the nasal tip. The second option is used especially if one of the aims of the operation is to improve the nasal tip. This small incision usually disappears within a few weeks since very thin sutures are used. The great majority of surgeons have changed to this technique as it offers excellent access to nasal structures with more predictable results.After the approach is made instruments are passed up to sculpt and modify the cartilages and bone of the nose. Once the nose has been altered to the required position, it is held in place with a rigid splint. Nasal packing is very rarely used by this author so the pain and bleeding associated with their removal are hardly ever seen. The operation itself is done under general anaesthesia ,ie with the patient fast asleep and lasts around 1-2 hours depending on the extent of the work to be done. It is generally done as a day case, ie patients are generally well enough to go home that same evening.
What are the potential risks?
The rhinoplasty itself has few complications, mainly infection and bleeding. Antibiotics are used to prevent infections. One should avoid going to the gym and staying in hot sun since this increases the risks of bleeding. Not every patient heals the same way. Some take more than others for eg bruising to disappear. However very rarely, soft tissue healing may be unequal and unexpected distorsion of the nose may occur, needing further corrective surgery.
What am I to expect after the operation?
It is likely that there will be bruising around the nose. Nowadays \'black eyes\' are quite rare and the bruising and swelling is usually minor. You will experience some pain, but this is not normally very severe. Your splint will stay on for one week and then will be removed together with the sutures.Your nose will feel blocked until it is cleaned at this time although there is usually no packing inside the nose itself. You will be asked to apply some cream or ointment over the sutures. You will be advised not to lift heavy objects and stay away from smoky or dusty areas. Make sure no one accidentally hits your nose!
How long will I be off work / school?
One week off is usually required although some patients need a longer period of time before going back to work.
Will there be any scars?
No. The only cut made in the skin is small and does not produce visible scars. Patients with a history of keloid scarring are advised to let the surgeon know well in advance of this problem so that the approach may be modified.
Disclaimer: Patients are advised to discuss their medical condition and any indications for medical treatment or surgery with their general practitioner or the specialist who is delivering health care. This article is designed to help with frequently asked questions and does not take any responsibility for specific patients.
©Mr. Adrian M Agius