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Nose

Nasal Re-shaping (Rhinoplasty)

Re-shaping the nose is sometimes performed to correct changes that have occurred as a result of injury but is more commonly requested to change aspects of nasal shape that are not pleasing. Common complaints are of noses that stick out too far and noses with bulky/boxy tips. Rhinoplasty surgery may be performed either through entirely hidden incisions within the nose (closed rhinoplasty) or with an approach that involves making a short incision across the columella, the fleshy part between the nostrils, which typically heals extremely well leaving a faint and inconspicuous scar (open tip rhinoplasty).

Nasal re-shaping surgery usually involves adjusting the cartilages of the nasal tip, and also the skeleton of the bridge of the nose to reduce its projection, which in turn involves breaking and resetting the nasal bones.

Surgery is always performed under general anaesthesia and patients will be expected to spend one night in hospital. At the end of the surgery, a supportive external splint is applied to the nose and a nasal pack is inserted into each nostril to provide internal support and compression; this makes it impossible to breath through the nose until the ribbon is removed a day after surgery.

Risks & Complications

Troublesome post-operative bleeding may be an indication to replace nasal packs, which in some cases is best performed under a brief general anaesthetic. Occasionally, significant bleeding that is not controlled by nasal packing may require more active surgical treatment. Nasal bleeding of a minor type is typical on the day of surgery and following the removal of nasal packs. The risk of nasal bleeding is increased by strenuous activity, which should therefore be avoided for the first few days after surgery.

It is inevitable that the skin over the nasal tip and bridge of the nose becomes very numb following surgery due to damage to minor cutaneous nerve branches. This tends to partially recover over a period of many months.

Infection would typically present with increased swelling, redness, pain, running a fever and possibly a purulent discharge. This is a rare complication of rhinoplasty surgery and would typically be treated by antibiotics, and may, rarely, require re-hospitalisation.

Breathing is always restricted in the initial healing phase but typically returns to normal over a period of weeks. Breathing can occasionally be permanently restricted and may require additional treatments.

Because of the need to break and reshape the nasal skeleton, i.e. fracturing the delicate bones of the nose, there is normally quite a lot of swelling after surgery, which largely settles over 4-6 weeks. I tell patients to expect some further gradual albeit subtle improvement in the appearance as swelling resolves right up to the first year after treatment.

It is normal to feel irregularities in the early stages after surgery. Provided these are not visible, my advice to patients is not to fiddle and interfere!

For most patients in whom the surgery goes well, the early and late results will remain pleasing. There is always unpredictability though and a small percentage of patients with unsatisfactory shape and contour of the nose may require secondary surgery to achieve a good outcome.

Post-Operative Care

Patients are advised to refrain from strenuous physical activity for the first 3-4 weeks, mainly to avoid the risk of bleeding. I am always happy for patients to take Arnica to help control bleeding and bruising. Because of the use of a splint on the nose, returning to work within 7 days is impractical. Most patients take a fortnight off work and even after that may require makeup around the eyes or glasses to hide any residual bruising. It is better to avoid picking at the inside of the nose – breathing usually recovers very well without interference!

Key Points – Rhinoplasty

• Rhinoplasty surgery may be open or closed.
• At the end of the procedure, performed under a general anaesthetic, a splint or plaster cast will be applied to the nose.
• Greasy packs are often introduced to the nasal passages at the time of surgery and are typically removed after one day
• The nasal splint or plaster is usually removed after one week
• Breathing through the nose is always restricted initially, it usually settles to normal over 2-4 weeks
• Swelling persists for the first 4-6 weeks in particular, with gradual improvement up to one year.
• Patients generally return to work after 10-14 days