Rhinoplasty (Nose Surgery)

WHO WOULD CONSIDER A NOSE JOB?

The shape of a person’s nose is largely an inherited characteristic. The shape is determined by the bone and cartilage which make up the skeleton of the nose, over which the skin is draped. Some people are unhappy with the size or shape of their nose. Injury can also lead to an unsightly appearance. A rhinoplasty can help in all of these situations. However, rhinoplasty is not an effective treatment for snoring or for sleep apnea. The nose doesn’t stop growing and changing until age 16 and it is therefore inadvisable to consider surgery before this.

WHAT IS INVOLVED IN THE OPERATION?

Surgery is performed under a general anesthetic and usually takes between 3-5 hours. To change the shape of the nose, the underlying bone and cartilage need to be adjusted. Small cuts are made on the inside of the nose or in the skin under the nose. This allows the surgeon to reach the bone and cartilage under the skin and to reduce or reshape as required. The bridge of the nose, the nostrils and the tip of the nose can all be adjusted. In some situations areas of the nose need to be built up. This is known as an augmentation rhinoplasty, using bone, cartilage or synthetic materials. Bone can be taken from another area of the body such as the hip or ribs. Cartilage may be taken from the ear or from another part of the nose. If you decide on surgery you will be required to undergo some simple health checks and photos will be taken to record the shape of your nose before surgery.

WHAT ARE THE RISKS AND COMPLICATIONS?

There are general risks associated with a general anesthetic such as aspiration of stomach content into the lungs which can cause serious illness or death. Therefore, to help prevent this it is mandatory that you do not eat or drink anything (usually 8 hours) preceding your surgery. Other risks include DVTs, (clots in the veins of the legs) which can break off and travel to the lungs, this is known as an embolus and although very rare, can be life threatening; especially in smokers. You will be encouraged to get up and walk around as soon as possible to reduce these risks. Bleeding, particularly heavy nose bleeds, can happen shortly after the operation or even up to 10 days later. This may require hospital treatment. Infection may require antibiotics and if any synthetic material has been used to build up the nose, this might have to be removed. Specific to rhinoplasty, it is possible that there may be altered sense of smell after the operation or difficulty breathing through your nose. In a few cases these problems can be permanent. The sensation in the skin of the nose may also be changed and in particular the tip may feel numb. Even after surgery, some patients will be dissatisfied with the outcome and a second operation may be required to make adjustments. The size of your nose and nostrils may limit the amount of adjustment that can be realistically achieved. You should discuss your expectations and the limitations of the operation with your surgeon before the operation.

WHAT HAPPENS AFTER THE OPERATION?
You will need someone to drive you home and stay with you the first 24 hours after surgery. You may experience some discomfort which should be alleviated by the pain medications. There will be a splint over your nose which must be worn for up to two weeks. You will also have packs in your nostrils and you may need these for a few days. This means that you cannot breathe through your nose. You should expect that it may also be difficult to breathe through your nose at first, even after the packs have been removed, due to swelling. You should not remove the packing, dressings or the splint until advised by your surgeon. It is normal to experience minor bleeding from the nostrils in the first few days. This should simply be dabbed away. You must avoid blowing your nose and you will be advised not to have hot baths as this can increase the risk of a serious nosebleed.

WHEN CAN NORMAL ACTIVITIES BE RESUMED?

You can go back to work after a few days but you must expect significant bruising, especially around the eyes and many people prefer to take a couple of weeks off until the bruising has settled. Once the splint has been removed, your nose is very vulnerable and contact sports should be avoided for a few months and you should generally try to avoid activities that might lead to your nose being knocked for six weeks.

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