Rhinoplasty (nose surgery)
If you are considering rhinoplasty there may be some questions you would like answered. Rhinoplasty, or nose surgery, is one of the most common of all plastic surgical procedures. You may consider rhinoplasty for the following reasons:
To reduce or increase the size of your nose
To change the shape of the tip or bridge, or to narrow the span of the nostrils
To change the angle between your nose and your upper lip
To correct a birth defect or injury, or help relieve breathing problems
The following frequently asked questions (FAQs) and answers will give you a basic understanding of the nose surgery or rhinoplasty procedure - when it can help, how it is performed, and what results you can expect. These may not answer all of your questions, since a lot depends on your individual circumstances. Your surgeon will be able to help you with any further concerns you have about how the procedure will affect you personally.
What should I consider before having rhinoplasty?
Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes - to correct birth defects or breathing problems. For aesthetic purposes, rhinoplasty can enhance your appearance and your self-confidence but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have nose surgery, think carefully about your expectations and discuss them with your surgeon.
Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they have completed their growth spurt - around 14 or 15 for girls, a bit later for boys.
The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you are physically healthy and realistic in your expectations, you may be a good candidate.
How do I plan my nose surgery?
At your initial consultation, your surgeon will ask what you would like your nose to look like and what you currently dislike about it, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age and your expectations.
Your surgeon will talk to you about anaesthesia during your consultation. After your initial consultation with your surgeon, you will meet the Practice Manager who will explain a little about the hospital where the surgery is performed and the various costs involved. As most insurance companies do not consider rhinoplasty to be medically necessary, they do not generally cover the cost of this procedure. If the procedure is being performed for reconstructive purposes, or to correct a breathing problem or marked deformity, it is possible that your Health Insurance company will cover all or a percentage of the costs associated with the procedure.
Be sure to tell your surgeon if you have had any previous nose surgery or an injury to your nose - even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you are taking any medications, vitamins, or recreational drugs, and if you smoke.
Your doctor will be happy to answer any questions you may have, especially those regarding your expectations and concerns about the results.
How do I prepare for nose surgery?
Your surgeon will give you instructions to help you prepare for nose surgery. These may include guidelines on eating and drinking, not smoking, and taking or avoiding certain vitamins and medications.
Whilst making preparations for surgery, you should arrange for someone to pick you up on your discharge from the hospital and drive you home. It is also advisable to have someone to help you around the house for a few days.
Where will my nose surgery be performed?
The nose surgery is performed at one of several of London's best private hospitals, according to your preference and the availability of operating time.
You will usually be admitted on the day of surgery. An overnight stay in hospital is not always necessary but sometimes advisable, and you would be discharged home the following day at about 10:00am. If you have the surgery as a day case you will be discharged later the same day. You will need a friend or relative to accompany you home after your stay in the hospital.
What type of anaesthetic will be used?
Rhinoplasty at LPSA is usually performed under a general anaesthetic, so you'll sleep through the entire operation. Newer types of anaesthetic that reduce the risk of nausea after surgery are used at LPSA, and the experience is usually safe and comfortable.
What takes place during the nose surgery?
During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the skin is redraped over the new framework.
Plastic surgeons at LPSA sometimes perform rhinoplasty from within the nose, making their incision inside the nostrils. In other patients they prefer to use an 'open' rhinoplasty, especially in more complicated cases. This involves making a small incision across the columella, the vertical strip of tissue separating the nostrils. The difference bears little relevance upon the final shape of the nose, and clear indications exist for each approach.
When the nose surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilise the septum, the dividing wall between the air passages.
How long will the surgery take?
Rhinoplasty usually takes an hour or two, though secondary rhinoplasty (a "re-do") and complex reconstructive procedures may take up to four hours.
What can I expect after the surgery?
For around the first twenty-four hours it is likely that your face will feel puffy, your nose may ache, and you may have a mild headache. However, any discomfort can be controlled with medication prescribed by your doctor. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.
You'll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you'll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so.
How long will it take for life to return to normal?
Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you feel completely back to normal.
Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.
You can wear contact lenses as soon as you feel like it, but glasses are more difficult. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.
Your LPSA surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't hesitate to call your doctor.
How will I feel about my new look?
In the early days following surgery, when your face is still bruised and swollen, it's understandably easy to forget that you will look better eventually. But gradually, your nose will begin to heal and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery.
However, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.
In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't see a major difference in your nose. Or they may seem resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you've met your goals, then your surgery is a success.
Does rhinoplasty carry any risk?
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with all surgery there is always a possibility of complications such as infection, nosebleed, or a reaction to the anaesthetic. You can reduce your risks by closely following your surgeon's instructions both before and after surgery.
When rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not conspicuous.
In about one case out of twenty, a second procedure may be required - for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery - known as revision rhinoplasty - is usually minor.