Nose job / rhinoplasty

Overview

People come to see me about rhinoplasty surgery because of the shape or size of their nose. Often it is obvious that at some point their nose has been broken. Many people have no memory of this as it may have happened in childhhod and gone un-noticed.

Rhinoplasty has nothing to do with large horned African animals, but the word rhino comes from the Greek for nose. There are two types of operation open with a little cut between the nostrils and closed with all the cuts inside the nostrils.

The basic principle of the surgery is to reshape the nose by repositioning and altering the shape of the bones and cartilage of the nose by both removing and adding tissue. Often people (men and women) ask to have the hump taken off, perhaps the tip made more refined or turned up or down.

The vast majority of people who have rhinoplasty surgery are pleased with the results.

Click here for Rhinoplasty FAQs


In this case the following was done

De-hump; taking the profile hump down

Tip de-rotation; tipping the tip up slightly

Alar reduction; reducing the bulk of the tip

De- projection; reducing the amount the nose sticks out from the face

rhinoplasty-nose-job-15B rhinoplasty-nose-job

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In this case de-hump, tip de-rotation, tip de-projection and re shaping the tip was performed


In this revision case the following was done

Tip de-rotation; tip de-projection, Narrowing of the bridge (between the eyes) and correction of irregularities

Primary surgeon unknown

About 15% of rhinoplasty patients will require some form of revision mostly minor to correct irregularities


Primary surgeon unknown

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In these cases the following was done, de-hump, tip de-rotation, de-projection,

Alar reduction; reducing the bulk of the tip and

Thinning of the bridge Middle of the nose from the front

rhinoplasty-nose-job-10 rhinoplasty-nose-job-15A

In this case the following was done

De-hump, tip de-rotation, alar reduction and de-projection

rhinoplasty-nose-job-11

In this case the following was done

Alar reduction; reducing the bulk of the tip

Most rhinoplasty surgery involves breaking the bones of the nose and resetting them.

 

Be-bulking of the tip and thinning of the nose

rhinoplasty-nose-job-15

Straightening the nose following an accident

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Rhinoplasty FAQs

 

Different Types of Rhinoplasty Surgery

There are two main ways of performing rhinoplasty surgery in terms of the surgical approach e.g. Open and Closed. They are both used widely and each has pros and cons.

Open rhinoplasty uses a cut inside each nostril which is joined in the middle by a short scar across the skin between the nostrils (columella). It is mainly used if tip surgery is required. A closed rhinoplasty just uses cuts inside the nostrils and is used if the surgery is to reduce a hump.

Diagram of Rhinoplasty showing four different areas operated on

rhinoplasty

Rhinoplasty Operation and hospital stay

The surgery is performed under general anaesthetic and takes about 2 hours. When you wake up you should be comfortable as local anaesthetic is used in the nose and you will remain on regular analgesia (painkillers) for several days until you are effectively pain free. There will be a splint on your nose. After the surgery you will stay in hospital overnight until it is safe to send you home. Packs are used up your nose to prevent blood collection in the tissues and these are removed the next day.

What can go wrong with Rhinoplasty

I feel it is important that anyone having surgery with me is aware of the possible negative sides of surgery and understands the small but real risks. The following paragraphs cover what happens when things occasionally don’t go as expected.

Like all surgery there are risks of complications whoever does your surgery. It is important you are aware that many of the problems you may get after your surgery if they are treated promptly have no obvious effect on the final outcome.

All operations have a risk of bleeding. In rhinoplasty there is a small risk that there may be bleeding inside the operated tissue leading to a collection of blood (haematoma), which needs to be removed under an anaesthetic (less than 2%). Infection is rare and antibiotics are given around the time of surgery to reduce the risk.

Risks particular to rhinoplasty are problems with skin sensation which may be lost or significantly reduced over the nose. Black eyes are common for 2 to 3 weeks but camouflage makeup can be worn There may be difficulty breathing through the nose after the surgery, although this normally settles, although occasionally breathing through the nose is affected in a way that requires further surgery. Rarely infection of the tear ducts can occur and this needs hospital treatment (less that 1%). In about 10% of cases further minor revisions are necessary to deal with any irregularities that appear after everything has settled and normally at 12 months. If tissue is added to improve the shape, this tissue can occasionally change shape or position needing further surgery. There can be a permanent change / loss of the sense of smell.

If I have operated on your septum there is a risk of a hole in the septum. This can cause annoying whistling or at the limit need reconstructing.

As this is a surgical procedure to deal with appearance no guarantee can be given to the final appearance, but if we agree it is an unsatisfactory result correction will be offered at no additional cost.

All operations can result in longterm discomfort.

All operation have a small risk of Deep Vein Thrombosis (DVT), chest infection and Pulmonary embolism. Death following elective surgery is exceptionally rare (1:250,000 in fit and well people)

After Rhinoplasty

Expect to feel washed out for a few days after the surgery and to tire quickly although you will return to your normal energy levels in a few weeks.

The packs will come out in the next one or two days depending on the extent of internal surgery. The skin sutures need removing at the one week follow-up. The same appointment will be used to take the splint off and make sure everything is OK.

Blowing your nose, picking your nose bending stooping straining, sneezing should be avoided for the first 3-4 weeks.

What to expect from Rhinoplasty

Rhinoplasty surgery makes an immediate and dramatic difference. It may take some time to adjust to your new appearance so be prepared to take some time to come to terms with your new appearance. There may be some discomfort for a few weeks, headaches being common and breathing may be difficult. As said above, expect to feel washed out for a few days after the surgery and to tire quickly although you will gradually return to your normal energy levels. The swelling reduces quickly over the first few weeks, but continues to reduce slowly up to 12 months. By 3 months you can see your new nose properly but it takes 12 months to be confident that there are no minor irregularities.

The majority of people who undergo rhinoplasty surgery are very pleased with the result and feel it makes a very positive change to their lives.

Cost of Rhinoplasty Surgery

-from £4750
This includes all required follow-ups and in the unlikely event you require further treatment due to post-operative problems any further treatment is also included

(prices updated Feb 2018)

What to bring to hospital

If you would like, bring a family member or friend. Bring some easy to put on bed wear, preferably with front buttons and your own clothes and toiletries and something to pass the time like books, puzzles or some music . The rooms have televisions and there is free Wi-fi.

What to look out for after you have gone home

Before you come into hospital, you will get a package that contains a set of post-operative instructions and a thermometer.

Watch out for redness, swelling, pain, discharge, opening of the wound, fevers, sweating and shaking. Whatch to see if your temperature is above 37.2C and you feel unwell or it is above 37.6C.

If any of the above are seen or any of the information of the instruction sheet call the numbers on the instruction sheet or the hospital you had your operation.

Things to Avoid

The following are medications or herbal medicines to avoid before surgery.

Please disclose all medications (including self prescribed and herbal and vitamin supplements) during the consultation. The following increase the risk of post operative problems.

Roacutane or other vitamin A skin preparations / aspirin / steroids / warfarin / clopidogrel / Brufen / alka-seltzer / Fish oil / Flagyl / anti-rheumatics-arthritics / blood thinners eg persantin / St John’s Wort / Aloe vera / Cimetidine / Vitamin E (>600mg/day) / Vitamin C (>1000mg/day) / alfalfa / arnica / bromelain / calendula / celery / chamomile / cloves / Evening primrose / garlic / ginger / ginko / goji berries / licorice / meadowsweet / diabetes medication / blood pressure medication / diuretics

Most fruit and pickles have aspirin like chemicals in them so avoid large quantities in the two weeks before surgery.

Please remember that if you have any questions or concerns to ask during one of your consultations. Writing questions down is sometimes helpful.

Driving

Normally you can re-start driving at around 2 weeks. You are fit to drive if you feel you are fit. I recommend you have someone take you to an industrial zone or supermarket car park late at night so you can attempt driving without risk to others. If you find you can drive without problems you are safe to go out on the road

Work

Depending on how physical the work you do is, you can start working from between 1 and 3 weeks.

If in doubt remember you can always ask for advice.

Exercise

At home rest is necessary for one week and any strenuous activity, bending, and lifting etc. is to be avoided. You can shower once your dressings are reduced after your first appointment.

Physical exercise more than a gentle walk should be avoided for the first least 3 weeks and then only undertaken if comfortable. After 3 weeks I allow swimming and cycling and more vigorous walking. After 6 weeks you can, if it is comfortable, return to full activities.