Nose Reshaping (Rhinoplasty)

Nose Reshaping (Rhinoplasty)

It is quite common for people to be self-conscious about the shape of their nose.  It is, after all, the central feature of the face. An individual may think their nose is too big, or too small. They may dislike the general shape of the nose, the size of the nostrils, or there may be one particular characteristic they are unhappy with.

The characteristics of the nose are genetically determined, and the size and shape will continue to develop until the age of 16.  It is not advisable to have surgery before this age.

Sometimes, rhinoplasty is performed for reconstructive purposes following injury, or to correct breathing problems.

Treatment

The surgical procedure to change the shape of the nose is known as rhinoplasty and usually takes 60-90 minutes to perform. If the aim is to make the nose smaller, it is called a reduction rhinoplasty. The precise procedure will vary according to what it is about the nose that a patient wishes to change. 

The framework of the nose is made up of bone in the upper half, and cartilage in the lower half. 

In order to change the size and/or shape of this structure, the surgeon makes small incisions inside the nostrils (closed rhinoplasty), and separates the soft tissues of the nose from the underlying bone and cartilage.  Some surgeons will also make a small incision across the bit of skin that separates the nostrils (the columella), known as open rhinoplasty.  This method makes it easier for the surgeon to see the nasal structures. Although this leaves a small external scar, it is inconspicuous, and barely visible in a month.

The bridge of the nose can be reduced or straightened by cutting or filing the bone. To keep the nose in proportion, and to avoid a very flat, wide appearance, the bones of the nose are cut on either side, where they join onto the cheek bones, and the two sides are pushed together, thus narrowing the width of the nose. The overlying skin does not need to be reduced, as the skin’s elasticity allows it to adapt to the new size and shape of the nose frame.

Wide nostrils may be reduced by cutting out a small piece of skin in the floor of the nostril, and suturing the incision together to give a narrower opening.

If someone feels their nose is too long, or bulky at the tip, it may be possible to improve this by reducing the amount of cartilage at the end of the nose.

Limitations

The appearance of your nose may not be what you had anticipated following surgery.  Therefore, at the pre-surgical consultation, it is important that you discuss with your surgeon exactly what it is about your nose that you wish to change. Then the surgeon will be able to tell you what it is possible to achieve through surgery, and the result you can realistically expect. A thick, bulbous nose may be difficult to improve surgically, as thinning the skin would leave scars. If your nose is particularly large, or you are middle-aged or older, the degree of reduction in size may be limited by the capacity of the skin to adapt and reduce to the smaller frame.

Rhinoplasty usually achieves an improvement in the appearance of the nose rather than perfection. By listening carefully to the surgeon’s explanation, you should gain a realistic expectation of  the outcome of surgery. It can take some time before you become accustomed to your new appearance. The final result of how your nose looks may take a year. Approximately 10% of patients may not be satisfied with the end results.

 Post-surgical care

You will have some gauze packing in each nostril for the first 24 hours or so. You will usually be in hospital overnight, and the packs will be removed the next day before you go home.

If the bones have been broken to narrow the width, a splint will be placed over your nose to keep the bones in place. This will be removed at your first follow-up appointment, 5-10 days following surgery. Dissolvable stitches will disappear on their own by about 10 days. Non-dissolvable stitches will be removed 5-7 days following surgery.

You will be encouraged to keep your head up as much as possible following surgery – in case of bleeding and to reduce swelling. 

Nursing staff will give you pain killers if you need them. However, most patients are surprised at how little pain they experience following rhinoplasty.

What to expect following surgery

The packs in your nostrils will stop you breathing through your nose in the first 24 hours. You will still feel some nasal congestion for the first week or so while the splint is on, and due to some swelling. Breathing through your mouth can lead to dry or cracked lips, which can be alleviated with petroleum jelly.

You may experience nose bleeds for a few days. You can reduce the risk by avoiding hot baths, keeping your head upright, and not drinking alcohol. Do not blow your nose in the first week. Any dripping should be wiped away gently. If you need to sneeze, open your mouth to reduce the impact on your nose. Nose bleeds, if they occur, are usually minor and resolve without treatment. 

If bleeding persists for 10-15 minutes, or is heavy, seek medical advice. You will have some swelling and bruising, particularly around the eyes. This can take up to one month to resolve.

You can return to work and light activities after a few days. However, most people prefer to stay off work until the splint is removed and the bruising has cleared. Strenuous activities and sports should be avoided for six weeks.

Before leaving Sancta Maria Hospital, all patients are given a discharge sheet which contains any special instructions your surgeon has advised you to follow, along with the details of your first follow-up appointment.

Risks

As with any surgical procedure, rhinoplasty carries an element of risk, such as pain, bleeding, infection, bruising and thrombosis.

Difficulty in breathing through the nose resolves in most cases once the swelling has subsided, but could persist if there has been damage to the septum, which divides one side of your nose from the other. Adhesions (scar tissue bridging the nasal cavity) could also result in obstruction to your breathing.

Stiffness and numbness of the nose is common, and can sometimes take months to resolve. Some patients may have impaired, or complete loss of sense of smell, which can be permanent.

The shape of the nose may alter due to scar tissue formation. Further surgery to adjust the shape of the nose may be necessary in 5-10% of patients.

The information contained in this website is not exhaustive. A full consultation with a suitably qualified surgeon is essential so that you may have your individual requirements and risk factors assessed, and to ensure that this type of surgery is suitable for you.

Sources/further information

. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

. The British Association of Aesthetic Plastic Surgeons (BAAPS)

. The British Association of Otorhinolaryngologists – ENT UK