Rhinoplasty

HOW DOES IT WORK?

Once you have decided to pursue a rhinoplasty, you will need to undergo an initial consultation with your surgeon to begin planning your treatment.

There are a variety of types of rhinoplasty and techniques, which are suitable for different goals:

• Reduction Rhinoplasty: Reduction rhinoplasty is designed to reduce the size of nasal features: bumps on the bridge, elongated or twisted nasal tip, or particularly wide nostrils. The doctor removes small amounts of bone or cartilage to achieve the desired results. The overall goal is to give the patient a nose that is more proportionate to their other facial features.

• Augmentation Rhinoplasty: Augmentation rhinoplasty aims to alter the shape of nasal features. This involves bone or tissue grafting to build up the nasal tip and/or bridge. Often this will use cartilage from other parts of the nose, usually the nasal septum, but if a patient does not have enough tissue in this area the doctor will often use rib bone, or cartilage from the ear or rib.

• Post-traumatic Rhinoplasty: Post-traumatic rhinoplasty addresses both the appearance and function of a patient’s nose, usually after they suffered a broken nose. Generally this involves straightening the nose and correcting the nasal septum, after re-fracturing and re-setting the nose.

• Reconstructive Rhinoplasty: Reconstructive rhinoplasty is a specialised surgery for patients who have lost all or part of their noses to an accident, skin cancer, or another serious illness. This involves the surgeon rebuilding the nose with skin grafts, flap techniques, and other advanced methods. Due to the complex nature of this procedure, patients may require multiple surgeries over a period of several months. Additionally, reconstructive rhinoplasty is a specialised procedure, and patients should look for surgeons who have extensive experience in this area.

Rhinoplasty can also be combined with the following procedures:

• Septoplasty: A surgical procedure to correct a deviated septum, where the septum falls further to one side, leaving one nasal passage that is considerably smaller than the other. It can cause breathing difficulties and facial pain, but a septoplasty straightens the septum, allowing for better airflow through your nose.

• Alar Base Reduction: This reduces the size or flare of nostrils that are larger in comparison to one another, the tip or overall size of the nose.

• Cartilage Transplantation: This is a particularly advanced option, where cartilage from the patient’s nose, ear or rib is used to reconstruct or sculpt the nose where there isn’t enough tissue, or the existing tissue is too weak to support significant changes. This is option is generally best when the nose has been previously operated on and a large part of the nasal skeleton is missing or the tissue that remains is damaged.

The surgeon will need to discuss your general health and desired results to determine your eligibility and best surgical option.

You should consider the following:

• Are you on any medications?
  
• Do you have any pre-existing conditions?
  
• Do you smoke?
  
• What is your desired result? And why?
  

The surgeon will also assess skin quality and thickness, the amount and position of tissue, septum condition, tip shape and more to determine what rhinoplasty procedure and surgery technique suits you best.

How does the procedure work?

Because there are so many types of rhinoplasty and different goals for the treatment, the procedure varies widely for each person. However, there are certain steps that are common to all nose reshaping surgeries.

Anesthesia

Doctors perform rhinoplasty using one of two sedation methods:

General anesthesia: Administered with a mask or IV, general anesthesia puts patients completely to sleep. IV sedation: A doctor numbs the face with local anesthesia and administers a powerful intravenous sedative. The patient experiences a "twilight sleep" and will remember little, if anything, about the surgery when the medication wears off.

Doctors work with each patient to determine the best type of anesthesia for his or her needs. With both methods, patients do not experience any discomfort during the surgery. However, some individuals may experience less anxiety, knowing they will be completely asleep.

The Surgical Process

After the patient is sedated, the surgeon creates tiny incisions inside the nostrils or on the columella (the area of cartilage between the two nostrils). They then carefully lift the skin to access the underlying bone and cartilage.

If reshaping the nose structure, the surgeon will remove or graft tissues, as needed.

If correcting a deviated septum, the surgeon will cut and straighten the septum to improve breathing.

When the reshaping process is complete, the doctor lays the skin back down over the new contours of the nose and close the incisions.

What is the recovery process like?

While rhinoplasty is an outpatient procedure in some clinics, most will have you stay overnight following the procedure to be safe.

Recovery can take several weeks, with patients recommended to take at least one week off work and regular activities.

Patients should make arrangements to be picked up after the procedure, and ideally assist with daily tasks for a few days.

If you will be alone, take note that simple tasks like chewing and bathing can cause pain or discomfort in the first few days, so it is important to be patient and gentle with yourself.

Week One

The first week of recovery is the most severe, where patients feel uncomfortable from In the first week following surgery, expect to:

• Wear a cast on your nose
• Feel sore and congested
• Have a piece of gauze taped under your nose to catch any excess fluid/blood
• Experience discomfort from packing inside of the nose
• Feel slight discomfort from swelling, in particular in the first 3 days
• See dark bruising

Week Two

You will have your cast and packing removed after one week and can expect the following progress:

• See the dissolvable sutures in your nose start to disappear
• Improvement or complete disappearance of your bruising/swelling
• More “normal” appearance, which helps patients feel comfortable being seen in public
• Return to most normal, light activities (e.g. no physical labour/exercise
• Reduction is size/appearance of incision

Week Three

By week three, you are through the worst of the recovery period and the results will start to show:

• Swelling reduces to show subtle changes in your nose
• Normal activities can be resumed, including most forms of exercise
• You can easily hide your incision, which may still be a bit red, with makeup.

Week Four and Beyond

By week four, the majority of swelling has reduced but full results can take up to a year, with an 85% reduction in swelling by month three and 95% by month six.