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Nose Reshaping (rhinoplasty)

Rhinoplasty is the operation to change the size, shape and appearance of the nose. This type of surgery is extremely precise and demands much expertise. It can change the lives of those who have hidden behind an ugly nose and reveal attractive faces which were previously ignored.

Rhinoplasty has been carried out successfully for many years and techniques are constantly evolving and results improving. The vast majority of patients undergoing rhinoplasty gain a feeling of increased self-confidence with improvement in their body image and a softer, more attractive facial appearance.

 

Nose reshaping: frequently asked questions 

What can I expect to achieve from nose surgery?

In western racial groups a rhinoplasty most commonly involves reduction in nasal size especially large humps and bulbous tips to obtain a refined nose taking care to keep all parts in proportion.  

In south east asian peoples an increase in the size of the nose bridge and tip is common. In people of african origin it is common to make a wide nose narrower at the bridge and also make the tip more prominent whilst at the same time making the nostrils smaller. 

Following traumatic injury it may be necessary to straighten the nose or correct a broken and collapsed septum. Past cocaine use can also cause a collapsed septum.
Blocked airways from a bent septum and other problems may also need adjustments further back in the nose.

Men with a nose which is very large or bent through trauma often get fed up with irritating jokes and being thought of as a “bruiser”. On a woman a nasal hump and prominent tip are masculine features giving a harsh appearance. Many refuse to be photographed in profile and some hide behind long hair.

In the vast majority of cases, men and women alike wish to have a normal, average nose, which will blend into their face rather than dominate their features. It is also however possible to go beyond average and finely adjust the result to make the nose an extremely attractive feature. This is especially true in women.
 


What happens during the nose reshaping operation?

A rhinoplasty is performed when you are asleep under a general anaesthetic.

There are two ways of performing this operation. They are called ‘open’ and ‘closed’.
An ‘open’ rhinoplasty is the gold standard operation. It gives a result with great precision. It modifies and controls the shape of all parts of the nose and in good hands it delivers superb results. 

The operation involves a staggered incision across the central strut under the nose tip (the ‘columella’) which then passes around the inside of the nostril on each side. The skin of the nose is then lifted up so that the framework of all the structures of the nose can be easily seen and modified. 

Cartilage is taken from the deeper part of the septum (the cartilage which divides the two airways) and is used as ‘grafts’ to precisely shape the new frame work. These ‘grafts’ provide good support to allow complex changes in shape and secure the nose tip in it’s desired projection. The new shape is then permanent and does not change with time.  

If the nose tip is very prominent or bulbous then adjustments are needed to reduce and reshape it. The boney bridge which causes a large hump can also be filed to make it smaller and the sides moved inwards with precise breaks to make it narrower. 


Closed Rhinoplasty
A ‘closed’ rhinoplasty involves two incisions on the inside of each nostril. By tunnelling upwards from these two incisions the skin of the nose is separated from the bone and cartilage. With the skin held upwards like a tent, various manoeuvres can change the shape of the bone and cartilage underneath. 

The view obtained in this procedure is limited and so the complexity and precision of the changes which can be undertaken is less. So there is not ‘total control’. Without ‘grafts’ there is also the possibility that the shape of the nose after a closed rhinoplasty can change and deteriorate over time. Nevertheless the technique is used for simple procedures and achieves satisfactory results in good hands.


How long will it take to recover from nose surgery?

This is not a painful operation. Discomfort is easily relieved by standard pain killers such as paracetamol.

Sleep propped up in bed with several pillows for the first week to keep swelling under control. You should avoid vigorous activity for two weeks to reduce the possibility of a bad nose bleed. You must not blow your nose. However, you may loosen and remove any crusts or clots on the insides of the nostrils. You can do this by using a little Vaseline or just water on a cotton bud rolled around the inside of the nostril margin.

You may have ‘black eyes’ after surgery and your eyes and face may be swollen. Most of the swelling will settle in two weeks and you can use make up to cover any bruising as soon as the plaster has been removed after the first week.

Stitches under the nose tip across the central strut (columella) are trimmed at the time the cast is removed at 7 days. The scar may be a little red at first, but is hidden under the nose tip and will not be obvious. Stitches inside the nostrils are dissolving and will fall away in about 2 weeks.

It is normal for the nose tip to feel a numb after surgery. Sensation recovers as the nerve supply to the skin regenerates. This can take several months.

The shape of the nose when the cast is removed is not the final one. Expect to see the general shape of the new nose after about two months. Those with thick skin will have more swelling, especially at the nose tip, and the final result will take longer. This can be up to 1 year. Scar tissue forms under the skin of the nose and, although it is not visible, it may have a profound effect on the final shape. The internal scars gradually change their shape. The process of this scar maturation takes at least six months and sometimes longer.

 

 

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