FREQUENTLY ASKED QUESTIONS
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, and reduction of the dorsum or bridge, 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 in many cases, and the tip is refined using tip sutures. In some patients adjustment to the nostril widths may be needed using alar base reductions.
Steristrips and a plaster are applied to protect the new shape, and an internal pack added which is removed a day post op.
HOW LONG DOES RECOVERY TAKE AFTER A RHINOPLASTY?
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, although they can work from home after a few days. There is little discomfort or pain after rhinoplasty surgery.
By 4-6 weeks the swelling is much more settled, but the final result of the rhinoplasty is not usually fully apparent for at least 9 months until the swelling around the tip has completely settled.
HOW SHOULD I PREPARE FOR RHINOPLASTY SURGERY?
Smoking and all 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 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 a series of photographs are taken. A recommended plan for surgery is then discussed with the patient. 3D Crisalix photography may also be used to demonstrate the likely results.
The patient is usually seen over several consultations to discuss the different aspects of the procedure ahead of surgery taking place.
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 only.
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.
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, often 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.
HOW IS THE PIEZO ULTRASONIC TECHNIQUE USED TO REDUCE SWELLING AND SPEED RECOVERY?
The Piezo ultrasonic technique is used in many patients to reduce swelling and accelerate recovery. This uses a vibrating ultrasonic instrument (Piezotome) to sculpt the nasal bones very precisely rather than using the osteotomes and mallet commonly used. It reduces trauma to the surrounding soft tissues, minimising swelling and bruising post-op, and speeds recovery.
WHAT IS A TIP RHINOPLASTY?
Some patients may desire correction of the tip of their nose, whilst being happy with the bridge. The tip may be overly large/bulbous, have excessive length or be asymmetric. For these patients a tip rhinoplasty may be suitable to correct these tip issues whilst not requiring adjustment to the bridge.
HOW IS AN ETHNIC RHINOPLASTY PERFORMED?
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 tends to be wider and usually needs to be narrowed in the bridge and nostril areas with infracture and alar base reduction.
CAN A CHIN AUGMENTATION BE COMBINED WITH RHINOPLASTY SURGERY?
Some patients discussing rhinoplasty surgery may benefit from a chin augmentation to balance their facial proportions if they lack 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?
A significant proportion of the patients we see have had previous rhinoplasty surgery elsewhere, are dissatisfied with their results, and are requesting revision surgery.
Assessment requires discussion of the original aims the patient had for their surgery and where the results have differed from that which was expected.
Careful examination and measurements are used to assess the current situation and to produce a precise plan to achieve the results desired by the patient.
The surgical plan will vary between patients, depending on the previous surgery performed and the desired results. It usually requires a combination of adjustment to the tip cartilages, the nasal dorsum with infracture in many cases, and the length of the nose. It may be necessary to add additional support to the nose using cartilage grafts taken from the ear or rib when sufficient skeletal support is lacking. In some cases where the nostrils are too wide or asymmetric alar base reduction may be recommended.
This plan will be discussed with the patient usually over a number of consultations to ensure that their desired result is produced with the revision procedure.