Nose Correction

Rhinoplasty is the operation to reduce or refine the nose, and it is one of the most frequent facial surgery requests. The reason may be simply that the person is self conscious of a large hump or a prominent tip or it may just be that this is the subject of irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. For men, it can mean that the nose disturbingly dominates the face. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.Any plastic surgery operation is a very personal choice and understandably there are a number of questions that naturally arise. This brochure has been produced by us as a helpful introduction if you are considering surgery. Changing the shape or reducing the size of the nose (rhinoplasty) is a common operation and was one of the first cosmetic procedures performed in the early 1900’s.The aim of a good rhinoplasty is to provide a harmoniously shaped nose with regards to the other features of the face, with an un-operated look which does not draw attention to itself.
At the first consultation you will be asked what exactly you feel is wrong. Your face will be evaluated to see if it is symmetrical, to determine whether you have a blocked nose or if there is a problem with the airway. The inside of the nose will be examined to look at the septum which is often bent and then we look at the bone and cartilage which form the external shape. Sometimes the chin is too long or too small compared with the nose and you may be advised how it could be altered. Sometimes the nose is much damaged and building blocks of cartilage or bone may be required from other parts of the body. Finally by using computer imaging it will be possible to discuss with you the practicalities of what can, and cannot, be sensibly achieved. Remember the computer image is not, and can never be, an exact picture of how your nose will be, as unfortunately scarring and the thickness of the skin of the nose will ultimately decide how things turn out. However, the computer imaging will allow a discussion with you on what you mean by the top or the side of the nose and give us both an idea of how we should try and change things.Many plastic surgeons only perform surgery on the nose by making their incisions inside the nostrils (endonasal). In straightforward operations it is usual to perform the operation endonasally. However, an open procedure will be undertaken in more complicated cases and a small incision will be made across the base of the nose on the columella, which is the vertical strip of tissue separating the nostrils (external). This scar is rarely visible.The operation of rhinoplasty usually takes between one and two hours depending on whether any added procedures are being performed such as an operation to improve the breathing or if at consultation it has been decided that further procedures on your face such as to the chin are required.

Surgery can be undertaken in many cases under a daycase general anaesthetic or with a one night stay in hospital. Any external stitches are removed at four days and frequently the plaster is removed at about 11 days after surgery (sometimes less).

Usually about one and a half weeks is required before you return to work, at which time there should be little to give away that you have had an operation. Any bruising at this time can be disguised by cosmetic camouflage.

Pre-operative Preparation

Before your operation you should note that smoking undoubtedly leads to more swelling around the eyes and to more problems with the anaesthetic. Please let us know about any medication you take, no matter how infrequently. Aspirin, which is contained in many medicines e.g. Alka-Seltzer and Nurofen, should not be taken for two weeks pre-operatively. I recommend that patients take Arnica for 7 days pre-operatively and 7 days post-operatively as this will help with your post-operative bruising.

If you have any doubts or queries then please arrange a second consultation. We do not charge extra for this and it allows us to again go over your pre-operative photographs and to answer any of your questions.

If your operation is in the morning you will be asked to have nothing to eat or drink from midnight the night before and if it is in the afternoon you should just have a light breakfast and nothing to eat or drink after 7.00am. Arrange for someone to drive you to hospital.

Post Operative Care

When the surgery is completed a splint is applied to your nose which will maintain its new shape. I use nasal packs particularly when I have undertaken septal surgery. You will be left with a little bib across your nose which can be removed the following day. You should insert nothing, especially Q tips, up your nose for at least three weeks. Please leave the surgery to me!

Once you are around from the anaesthetic we will sit you up with your shoulders being supported on three to four pillows as this helps to reduce the swelling around the eyes. At the same time you will be given ice packs to apply to the eyes. As and when you go home you should try and sleep upright for at least a week.

Operations on the nose are not painful which surprises most people. You will have discomfort if packs are placed in the nose. This is the same discomfort you get from a blocked nose with a cold. On discharge from hospital get someone to take you home and stay with you for at least a further two nights. An appointment will be given for you to reattend four or five days after surgery if you are to have stitches removed and ten days after surgery for removal of the plaster.

For the first few days after surgery try and avoid sneezing vigorously, very hot baths, hot food, drink and exercise. You will have bruising around the eyes which is more marked if you are a heavy smoker and sometimes swelling in the upper lip. Usually the swelling reaches its peak two days after surgery and then subsides. When the plaster is removed at ten days all visible swelling will usually have disappeared, but there will be a feeling of numbness and stiffness in the tip of the nose which means that some swelling persists. It will take the swelling several months to subside completely but it will not be visible to anyone else but you. In patients with thick, oily skins the swelling is slower to resolve. While many patients want to see the final result immediately upon removal of the plaster, the presence of early swelling can be misleading and a premature judgement should not be made. At this stage your hair can now be washed and it is now safe to blow your nose and clean its lining gently with cotton and salt water.

The nose will be delicate for some weeks and potential harmful activity such as contact sport should be avoided for this period as well. Glasses can be worn while the cast is on and after it is removed they can still be worn but they should not rest on the nose. Contact lenses can be worn as soon as the swelling goes down from around the eyes.

It is common for relatives and friends not to comment on any difference after a nasal operation. Do not consider such a reaction as an indication of failure, on the contrary if it looks better and natural it will go unnoticed. The intention is after all to create a new nose that draws little attention to itself and that blends into the overall features of your face in proper proportions.

Long Term Results

Complications are fortunately rare. If you follow the advice given, the most common is swelling around the nose which settles on its own and we will show you some massage exercises. Occasionally the dark colour of bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. Should a nosebleed occur, then the first aid treatment is to sit with the head held up and backwards and plug the nostrils with some lint. If there are any problems please get in touch with a member of my team.

Very occasionally, in about one in fifteen cases, a small secondary adjustment will be required. It is difficult for the patient to understand that all the scarring on the nose must be allowed to mature and soften before this can be safely undertaken. This means at least one year.

Hopefully this information will give you a better understanding about nasal surgery. I am sure it will not answer all your questions, but it will help us during our further discussons.

Rhinoplasty, Shailesh Vadodaria, Testimonial