Rhinoplasty is a surgical procedure performed to improve the function or the appearance of the nose. Rhinoplasty is also commonly called “nose reshaping” or “nose job”. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. Rhinoplasty can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.

Patients should be at least in their mid teens — 14 to 15 for girls, and slightly older for boys. At these ages, the nasal bone has matured and the shape of the nose has stabilized. All rhinoplasty patients should have realistic expectations for their surgery. It is helpful for the surgeon to know, prior to surgery, what the patient hopes to look like after rhinoplasty, but it is important that those expectations be aligned with what is surgically possible. Before the rhinoplasty surgery discuss your personal goals in detail with your rhinoplasty surgeon. It is important to find a highly skilled surgeon for this surgery because it is much harder to get a good result with revision surgeries on the nose. There is often less supportive cartelidge and bone to work with and so the chances of problems become statistically higher with each revision surgery. If you are seeking a surgeon for a revision it is important to seek out someone who specialises in this area. The nose is such a prominent feature of you face that it is important to get it right.

The results can also take time to see. There is usually some minor swelling for 6-12months, however this is very minimal.

Open or Closed?

There are two types of surgery performed on the nose-

Open Surgery is performed when there is incisions made inside the nostrils but also across the base of the nose. This ‘v’ or stair shaped incision helps to camouflage the scar. The skin is then able to be lifted back for clear access to the internal nose for the surgeon. This allows for maximum visibility and generally achieves a more guaranteed result.

Closed Surgery is performed with all the incisions being inside the nostrils. It leaves no visible scars and generally has less swelling post surgery (in open rhinoplasty the skin is re-draped over the cartelidge). Closed surgery sometimes requires a second operation if the results need to be revised. For example in the case of a deviated septum a second surgery might be needed if the septum is not straightened satisfactorily.

Some surgeons do only open surgeries and others do only closed. Others do both surgeries depending on the circumstance. It is important to listen to what your surgeon suggests because each case is different.

Septoplasty

This is the procedure that deals with the ‘septum’- the middle collumn in the nose that separates the nostrils. When someone has a ‘deviated septum’ this means that they have a curved or misshapen septum. This can cause breathing problems, sleep apnea, snoring, nose bleeds and chronic sinusitis. Many people naurally have some deviation in their septum and it is only a problem when the symptoms become problematic. Often a deviated septum is corrected at the same time as a cosmetic reshaping of the nose. Deviation of the septum can occur from trauma to the nose (perhaps a fall when learning to walk as an infant or being hit in the nose in sport).

This procedure can be performed with open or closed surgery.

During recovery nostril splints are often used to support the septum (these are similar to tampons and they sit in the nostril area). The recovery from this can be rather uncomfortable, especially for those that are used to breathing through their nose. It can usually not be guaranteed that the septum will be perfectly straight after this procedure and it is important to avoid any bumps to the area for several months.

Hump Reduction

This is the reuction of a prominent ‘hump’ or ‘bump’ from the upper part of the nose. This procedure involves shaving of the excess bone and cartelidge from this area to create a smoother more proportionate nose.
Usually a supportive splint is worn over the bridge of the nose for up to a week. The swelling and bruising is generally gone after 7-10 days.

(Photos By Steven Denenberg, M.D)

Nose Augmentation

In some cases the bridge of the nose needs to be built up. This might be for aesthetic or functional reasons. This can involve the use of silicone implants.

Augmentation rhinoplasty is a term used to described nasal surgery in which the shape of the nose is increased. Although many of the patients undergoing augmentation rhinoplasty are non-Caucasian this type of surgery is performed on patients of all ethnicities.

Whether the nose requires a larger bridge or a more pronounced tip region, grafts or implants are frequently necessary for the required changes. A graft is a term used to describe a material harvested from your own body, and transfered to another location. The most frequently used grafts are cartilage grafts from inside your nose (septal grafts). Septal cartilage grafts are typically the first-line option used nasal surgery.

Sometimes the amount of material needed is greater than the amount of grafting material available, in which implants may be an option. Implants are synthetic materials designed to use in the nose. There are several implants available for augmentation rhinoplasty. Common implants used include: polytetrafluoroethylene (Gore-Tex), Silicone, and porous polyethylene (MedPor). Although no ideal implant exists, these implants can be safely used in nasal surgery.

Tiplasty

The most difficult aspect of rhinoplasty is the the tip of the nose.

The tip of the nose is the most variable aspects of the nose. Cartilages that makes up the tip varies in each patient in regards to the...

Changing one aspect of the nasal anatomy can have a complex and cascading effect on other aspects of the nose. Sometimes a patient may think that they only want the dorsal hump removed, but in doing so realise that the tip now seems out of place.

A good surgeon will look at the overall result and assess what would best suit a patients desires.

This area involves refining the tip of the nose. That may be making it more narrow or reducing the droop or projection of the tip.

Genetic Characteristics

Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends that apply to patients of certain ethnic backgrounds, due to their similar anatomic features.

East Asian patients often want their noses to appear narrower and their bridges higher. If very little elevation of the bridge is desired, the nasal bones can be cut and moved towards the midline. This technique will narrow the bridge and also cause a slight elevation in the dorsum.

East Asian patients who seek greater augmentation of the bridge of their nose require implants. A variety of alloplastic implants including Gore-Tex, Med-Por, or silicone can be used. Tissues from the patient’s own body (autologous) can be used for augmentation, in order to reduce the risk of complications such as infection or extrusion. Septum cartilage, rib cartilage (costal cartilage), ear cartilage (auricular cartilage), and fascia are being often used. In non surgical rhinoplasty, filler materials such as hyaluronic acid or calcium based microspheres can be injected under the skin, in the bridge of the nose. These injections however, are non permanent lasting between six months to a year.

Patients of African descent commonly seek narrowing of wide nostrils in a procedure known as alar base reduction. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. Risk of keloid scar formation is very low, if the patient has not had keloids in the past. The tip of the nose can be restructured by removing tiny sections of cartilage to give the nose more definition, or adding cartilage grafts to provide additional structure to the nasal tip.

Non-surgical

Non-surgical rhinoplasty refers to reshaping the nose with injectable substances rather than surgical means of altering the shape and structure of the nose. It is also called a “non-surgical nose job”, and can be performed in the outpatient setting without anesthesia. Another non-surgical option used by some people are flexible “nose inserts” that are placed in the nostril area between the nose tip and back of the nose. The nose inserts reshape one’s nose only while worn.

Recovery

Depending on the type and extent of the surgery you may have day surgery or you may require 2 days in hospital after surgery. Most surgeons recommend antibiotics, pain medications, and steroid medication after surgery. Most people choose to remain home for a week, although it is safe to be outdoors. If there are external sutures, they are usually removed 4 to 5 days after surgery. The external cast is removed at around one week. If there are internal stents, they are usually removed at four days to two weeks. The bruising usually lasts one to two weeks. Due to wound healing, there is moderate shifting and settling of the nose over the first year.

You can expect some black eyes, as the blood often drains back into the eye area post-operatively. You may need ice packs for the first day or two to help minimise the swelling. It is good to sleep elevated for some time after the surgery to help with the draining of fluids. You may be told to sleep on your back to prevent bumping the area for the initial weeks/months. Ask your surgeon about whether or not you are able to wear glasses after the surgery as they may damage the soft forming tissues.

The first week can be fairly uncomfortable, depending on the amount of splints and packing. Avoid stenuous activity and bending down, as this may increase the blood flow and cause congestion of the area. Also check with your surgeon about blowing your nose post-op. Do not ‘pick’ at the area. Often the area is very delicate and can easily be disrupted and damaged by excessive touching.

Health risks

Although rhinoplasty is usually considered to be safe and successful, several complications can arise. Post operative bleeding is uncommon and often resolves without needing treatment. Infection is rare and can occasionally progress to an abscess that requires surgical drainage under general anesthetic. Adhesions, which are scars that form to bridge across the nasal cavity from the septum to the turbinates, are also rare but cause nasal obstruction to breathing and usually need to be cut away. A hole can be inadvertently made at the time of surgery in the septum, called a septal perforation. This can cause chronic nose bleeding, crusting, difficult breathing and whistling with breathing.

If too much of the underlying structure of the nose (cartilage and/or bone) is removed, this can cause the overlying nasal skin to have little shape resulting in a “polly beak” deformity. Likewise if the septum is not supported, the bridge of the nose can sink resulting in a “saddle nose” deformity. The tip of the nose can be over-rotated causing the nostrils to be too visible and creating a pig-like look. If the cartilages of the tip of the nose are over-resected, this can cause a pinched look to the tip. If an incision is made across the collumella (open approach rhinoplasty) there can be variable degree of numbness to the nose that may take months to resolve.