Rhinoplasty

Rhinoplasty

Have you noticed that children’s noses are all small and even? It’s at puberty that all the genetic and ethnic variations are expressed and childhood nasal injuries are magnified.
“Abnormality” is in the eye of the beholder. At one extreme your nose might be so “bad” that most would agree that improving its shape is justified; at the other extreme the feature that you don’t like (that you see first whenever you look in the mirror) may be unnoticed by anybody else.

Rhinoplasty

Nasal abnormality can be naturally occurring or the result of injury. Fixing your nose may be covered by ACC.
Before any surgery can be contemplated:

  • Your idea of what is “wrong” and my idea of what is “wrong” have to coincide.
  • I have to be reasonably sure that I can achieve the desired change.

The bone and cartilage of the nasal skeleton determine the shape of the nose. In simple terms, rhinoplasty involves separating the skin from the nasal skeleton, modifying the shape of the skeleton, and allowing the skin to re-drape over the refined shape.
Access to separate the skin from the skeleton is via incisions inside the nostrils. While the whole operation can be done with these incisions alone, more often than not these two incisions are joined with a small external incision across the columella (the bridge of skin that separates the nostrils). This allows a direct view of the skeletal structure and precise modification of its shape – so-called “open” rhinoplasty. The external scar is very inapparent.

Post operative care

In some cases, only the tip cartilages need modifying, typically to correct a bulbous tip. Others may have an adequate tip but an ugly bridge line. If a prominent bridge line is to be lowered the nasal bones need to be “in-fractured”. Commonly both tip and bridge line need refinement.
Less often the tip or bridge line will need the addition of cartilage, bone or an implant.

This surgery is done under general anaesthetic.
Post-operatively there is not normally much pain (patients tell me). You wake up with a plaster or plastic splint applied externally but only rarely do I place packing in the nostrils. Nevertheless, the lining of the nose inevitably swells and stops you breathing through your nose for the first few days. The external splint is left on for about 5 days. When it is removed you will have an idea of the new shape but there is still some swelling.

Be aware

Over about three weeks most of the swelling settles. Likewise, it takes several weeks for the nasal airways to clear.
However, the tissues overlying the nasal skeleton stay rather “woody” for longer and don’t soften completely for about six months so the final appearance takes this long to be completely manifest.

You can expect to have some numbness of the skin of the tip of your nose. This normally gradually recovers over 6 -12 months.

Your skin quality will determine how sympathetically it re-drapes on the modified skeleton. Thin, dry skin will ultimately show everything (including any imperfections!). Thick, oily skin may to some extent “remember” how it was preoperatively and not fully reflecting the changes underneath. Ideal skin quality for nasal surgery lies somewhere between these two extremes.

Failure to completely recover normal feeling on the tip of the nose.
Impaired nasal airways.
Aesthetic result less than expected. NB Deviated noses are easy to improve but hard to get perfectly midline!

Coming from
out of town?

Ideally a consultation should be face to face but is certainly possible to arrange a telephone consultation. If you can email the photos first so much the better. If it is clear what procedure is required then the in-person consultation can be the day before or the morning of the surgery.