Nose Reshaping (Rhinoplasty)Contact Us |
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11 March 2010
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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
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Nose Reshaping (Rhinoplasty) © Sancta Maria 2010. All rights reserved. Sancta Maria Hospita, Fynone Road, Swansea, SA1 6DF
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