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Guide To Cosmetic Surgery - Rhinoplasty Nose Surgery

Nose surgery / rhinoplasty

This is a very popular procedure which is Number 1 in the list of the top 5 procedures for men.

The medical term for this surgery is ‘rhinoplasty’ but it is more commonly known as a ‘nose job’.

Nose surgery can be undertaken to correct a range of problems which include the following:

• Breathing problems
• Nose is too large or small
• Nose is crooked or bent
• Nose is too wide or too narrow
• Drooping or enlarged tip of the nose
• Bump on the bridge of the nose
• Flared nostrils
• Uneven nose as a result of accident or injury
• Nose is out of proportion to the rest of the face

Nose surgery can reshape the bone, cartilage and even the soft tissues of the nose. Basically, the surgeon can sculpt the bone and/or cartilage of the nose to the desired shape before re-draping the skin. This will result in a new and improved you.

There are two reasons for having nose surgery: medical or reconstructive due to breathing problems and to improve one’s appearance (aesthetic).

There is another variation on this called ‘septo-rhinoplasty’: this is a double headed procedure and involves the traditional rhinoplasty and work undertaken on the nasal septum (the bony ‘bit’ between your nostrils).

This can get confused with ‘septo-plasty’ which is surgery carried out on the septum only.

Rhinoplasty is usually very successful but 5 to 12% of patients can experience problems. If so then a second or third operation is called for which is known in medical terms as ‘revision rhinoplasty’.

Suitability for nose surgery

If you are suffering from any of the conditions listed above then rhinoplasty is an option. Your age, present state of health and lifestyle will all be taken into account.

The surgeon wants to be certain that there is a very good reason for your wanting this procedure and that the benefits will outweigh any risks. There are risks with any type of surgery but these are very small and the vast majority of patients have no trouble at all.

If the surgeon feels that the surgery will be successful and will achieve what you expect it to then he or she will consider you for this procedure. This means going into the consultation with a set of realistic expectations.

Cosmetic surgeons are seeing a growing number of teenagers who see surgery as an answer to their dissatisfaction with their noses. Teenagers are at an impressionable age and are very susceptible to peer pressure. They tend to be obsessed with body image and will often compare themselves to their friends as well as images of models and celebrities.

In much the same way as an adult patient; they will have to have clear reasons for wanting surgery as well as being in good health and emotionally stable.

Most surgeons set a lower age limit for this procedure and prefer to wait until the patient has finished growing (around 15 or 16). Exceptions can be made for those patients who have breathing problems as a result of a defect.

Another factor is whether you smoke or not. Smoking is proven to have an adverse affect on the post-surgery recovery. It can starve the tissues of the body of much needed oxygen which will impact upon the recovery time.  What it does is to extend the recovery period. It can also result in poor wound healing and thickened scars.

If you do smoke then it is advisable to give up before surgery. The surgeon will not operate if you are smoking at the time of your surgery. He or she will ask you to stop at least two weeks before and wait a couple of weeks before resuming.

If you are keen to give up permanently then so much the better but if not then please stop for the period stated above.

We have mentioned that your state of health is an important factor: the surgeon will want a full medical history from you which means mentioning any allergies, medical conditions and past/current treatments. If you are taking any medication prescribed by your GP then mention this.

This includes Accutane (acne drug), aspirin, anti-inflammatories and Warfarin.

This also applies if you are taking any herbal or homeopathic remedies such as ginseng, St John’s Wort or evening primrose oil.

The surgeon will ask you to stop taking any of these before surgery and to wait for a set period of time before resuming them.

Why? These medicines can increase the risk of bleeding during and after surgery. There is also the risk of them interacting with any drugs given at the time of surgery.

Don’t worry, the surgeon will explain this and much more during the consultation. If you have decided to go ahead then he or she will arrange the day and time of your surgery. He/she will also give you a set of guidelines on preparing for your surgery.

Preparing for nose surgery

These guidelines are a standard set of instructions which can be applied to all forms of surgery. They will include advice on stopping smoking, what the surgery will entail and what to expect afterwards.

This procedure is carried out under a general anaesthetic which means advice about what to eat and drink beforehand (time of last meal) and how you will feel after anaesthesia.

Other features include arranging time off work and recovery time at home. This last item means having things put in place so that all you have to do is rest and take it easy for the first week afterwards.

This can mean asking for help so that you don’t run the risk of straining or overtiring yourself. You will feel under the weather for the first couple of days which is normal after a general anaesthetic. Your nose will be swollen, bruised and sore and this is the time to allow that to heal.

Making a ‘To Do’ list can help. It may be a good idea to do this in advance of your surgery so that you don’t miss anything important such as ensuring you order in enough painkillers and/or medications.

This list can include doing your food shopping in advance; cooking and preparing meals (or buying ready made meals); buying bottled water, light snacks and a good supply of reading material (books or magazines). It can also include making sure that any everyday items you use such as kitchen utensils or bathroom items are placed within easy reach.

Include on this list asking someone to drive you to the clinic or hospital, and to pick you up afterwards. See if that person will be able to help you out for a few days afterwards.

The rhinoplasty procedure

This procedure is usually performed under a general anaesthetic and can take around 2 to 3 hours to complete. It will mean an overnight stay in hospital; however, if the surgery only involves minor corrections to the tip of the nose then it can be performed as day surgery.

There are two types of procedure:

• Closed technique
  
• Open technique

The closed technique involves making the incisions inside the nose.

The open technique requires the surgeon to make the incision in the vertical strip between the nostrils.

Briefly, the procedure requires the surgeon to reshape the bone or cartilage of the nose before re-draping the skin. 

The procedure itself will depend on what the patient is having done to their nose. So, it can include any of the following stages:

• Trimming the septum (the bit which separates the nostrils) to achieve a shorter nose.
  
• Removing a part of the cartilage to reduce the ‘roundness’ of the nose.
  
• Shaving the upper cartilage and septum to reduce the height of the bridge.
  
• Adjusting the septum and cartilage to reduce the length of the nose.
  
• Removing a wedge of bone or cartilage from the nose to narrow the nostrils.
  
• Increasing the size of the nose by grafting cartilage – to highlight the bridge or tip.

The incisions will be closed with stitches. A plastic splint will be applied to the nose to help maintain its new shape. Both of these will be removed at the end of the first week after surgery.

Recovery

You can expect to feel groggy and tired after a general anaesthesia but this will wear off after 48 hours. This is why it’s important that someone drives you home and stays with you for the first night.

Your nose will be swollen, bruised and sore. Your face will feel puffy and there will be bruising and swelling around the eyes. You will look as if you have two black eyes! Pain medication will be prescribed to deal with any discomfort.

This bruising and swelling will last for 2 to 3 weeks although this can vary from one person to another.

There will be a small amount of bleeding afterwards but this is very common. Try to avoid blowing your nose during this time.

This is where that ‘To Do’ list comes in handy. All the usual household jobs will be carried out by your partner or someone else whilst you recover. It is important that you allow your nose to heal so make sure that you arranged for someone to help you at home. This includes looking after your children – if you have any, or your pet (same applies), doing any shopping, cooking and the housework.

You will be spending this time reading, watching television or listening to music. Wear loose, comfortable clothing and keep a few blankets close to hand as surgery can cause you to have the chills.

All patients are different when it comes to the length of their recovery but you are looking at 1 to 2 weeks. Most patients find that they are back on their feet after a couple of days. Avoid any strenuous activities and contact sports for 6 weeks.

What if something goes wrong? Most people find that their recovery goes well but if you notice any of these symptoms contact your surgeon:

• Sudden increase in pain (becomes severe)
• Excessive bleeding
• Signs of infection
• Rapid or irregular heart rate
• Chest pains and shortness of breath
  

There will be a series of after care visits which are designed to check on your progress.