WHAT DOES A RHINOPLASTY INVOLVE?
The aim of a rhinoplasty is to produce a nose of more ideal shape and size in relation to the rest of the face. This usually involves adjustment to a number of different parts of the nose. Usually there is some adjustment to the tip cartilages to optimise tip shape, reduction of the dorsum, or bridge follows, to remove any ‘hump’ and straighten the profile.
The nose is usually narrowed to some extent at this stage. Often the length of the nose is reduced and the angle of the lower nose with the upper lip corrected.
Additional support may be added to the tip, with a cartilage graft, in many cases and finally the tip is refined using tip sutures.
Steristrips and a plaster are applied to protect the new shape, and an internal pack added which is removed a day post op.
WHAT IS DISCUSSED IN A RHINOPLASTY CONSULTATION?
At consultation there is a detailed discussion of the patient’s concerns regarding their nose shape and requirements for surgery, together with any history of injury, breathing problems and previous surgery.
A number of detailed measurements of the nose and face, and photographs are taken. A recommended plan for surgery is then discussed with the patient. The patient is usually seen over several consultations to discuss the different aspects of the procedure ahead of surgery taking place.
Smoking and Nicotine must be avoided for at least a month before and after surgery to maintain adequate blood supply to the nasal tissues for safe healing. Non-steroidal anti-inflammatory drugs should also be avoided for 2 weeks before and after surgery. Arnica can be used for a week before and 2 weeks after surgery to minimise swelling.
WHAT IS THE DIFFERENCE BETWEEN AN OPEN AND CLOSED RHINOPLASTY?
There are a number of different types of rhinoplasty techniques. With the closed technique incisions are made inside the nostrils. With the open technique a small incision is made across the skin between the nostrils in addition which is not normally visible post-op.
This allows the full skin envelope of the nose to be raised, the skeleton of the nose to be visualised directly, and very precise adjustments to be made. The open technique is our preference in most cases as it produces the most optimal, precise results.
WHAT IS A SEPTORHINOPLASTY?
Some patients may have a degree of deviation of the nose, such that is not visibly straight, or deviation of the septum which can interfere with breathing. For these patients a septorhinoplasty procedure is required to straighten the septum and nose, in addition to the other adjustments described previously where required.
This procedure is normally longer as the nasal septum needs to be visualised and straightened. This can be a complex process requiring cartilage grafts to be placed to support the septum and hold it straight. In some cases this cartilage can be obtained from the septum itself, in others cartilage needs to be taken from other sites eg rib cartilage.
WHAT IS AN ETHNIC RHINOPLASTY?
A number of different techniques are used for the various forms of ethnic rhinoplasty such as
Asian or Afro-Caribbean rhinoplasty. The noses of patients in these groups are usually flatter and require augmentation of the bridge – this is commonly achieved using cartilage grafts from the rib or ear. Additional support and definition of the tip is usually required also. For Afro-Caribbean patients the nose usually needs to be narrowed in the bridge and nostril areas also with infracture and alar base reduction.
WHAT DOES RHINOPLASTY RECOVERY INVOLVE?
The surgery is performed under general anaesthetic either as a day case or with a stay overnight. The pack is removed the following day, a small number of stitches removed at day 5-7 and the plaster removed at day 7-10.
At this stage the new shape of the nose is visible but there is some swelling, and bruising in some cases. Steristrips are applied for a further 4-5 days to help this settle quicker. Patients should allow 2 weeks away from work and social activities for this procedure.
By 4-6 weeks the swelling is much more settled, but the final result of the rhinoplasty is not usually apparent for at least 9 months until the swelling around the tip has fully settled.
WHAT DOWNTIME CAN I EXPECT AFTER A RHINOPLASTY?
After the procedure a nasal splint will need to be worn for around seven to ten days.
There will also be some swelling which should disappear after a few weeks. It’s worth noting that swelling around the tip could take a few months to go down and for the final full results to be evident.
WHY A CHIN AUGMENTATION MIGHT BE COMBINED WITH A RHINOPLASTY?
Some patients discussing rhinoplasty surgery may benefit from a chin augmentation in order to balance their facial proportions if they have a lack of chin projection, This will be discussed with the patient where appropriate to see if they would like to undertake this treatment also.
WHAT DOES REVISION RHINOPLASTY INVOLVE?