Rhinoplasty (Nose Re-shaping)

If you feel your nose is too prominent or not in balance with the other parts of your face, you may wish to consider a nose re-shaping procedure or rhinoplasty (also known as a nose job). Right in the centre of our face, the nose can be the focus of our concerns with appearance. During the teenage years, the nose undergoes quite rapid changes but with the onset of maturity, towards the end of that decade, it has attained most of its growth potential. From then on our noses subtly change throughout life. A Rhinoplasty or nose reshaping can do much to restore confidence at any age.

When considering nose re-shaping, try to be clear in your mind which elements of your nose displease you and convey that to your surgeon in the all important consultation. Look at the bridge, the tip and the nostrils. Feel too, the texture of your nose skin. Is the skin very thin or very thick? How do you feel about your nose? The psychological aspects are very important. You will find your BPS surgeon very approachable, sympathetic and able to give you an experienced assessment and sound advice. They have met with similar concerns and noses before and you need not feel self conscious.

To book a consultation with a BPS surgeon phone us today on 0117 910 2400.

Preparing for Surgery

Please adhere to all the information in the General Advice Section. Ensure that there is no local infection and if a spot should flair up on or near your nose, let BPS know immediately.

The Procedure

The operation will be carried out under general anaesthesia. With BPS your anaesthetist will also be a consultant and an expert in the special requirements of aesthetic plastic surgery anaesthesia. This is particularly important in a rhinoplasty.

Your surgeon will alter the skeleton of your nose by removing a bony hump, refining the softer cartilage and then making several controlled surgical fractures. Grafting of bone and cartilage to build up areas can also enhance the shape and improve airway function. Any irregularity of the airways can be addressed at the same time.

To gain access to the bones and cartilage the surgeon must make several incisions. Most of these are on the inside of the nostrils but small discreet scars may be required across the columella (the dividing structure between the nostrils), and in the groove at the side of the nose if a reduction in the nostril size is required. After several weeks, these scars are usually very hard to see.

The skin must now be encouraged to re-drape over the re-shaped supporting skeleton and a splint applied.

Aftercare

You may remain in hospital over night and before you are discharged home, The Bristol Plastic Surgery Team will ensure that you have instructions, contact numbers for support and a follow up appointment.

Perhaps surprisingly, a rhinoplasty is not a painful procedure but your throat is likely to feel a little sore and your nose congested after your operation. Drinking plenty of fluids will help alleviate these symptoms.

You will need to sleep propped up on four pillows for the first five nights, and avoid bending. This helps to reduce any swelling.

It is important not to blow your nose for two weeks following the operation. If you feel your nose is running then sniff rather than blow, and gently dab your nose if necessary. Do not place anything inside your nostril. Avoid dusty environments or anything that you know will induce sneezing. If a sneeze cannot be avoided, do keep your mouth open to reduce the pressure through the nose.

After re-shaping and re-draping the skin, the “new” nose needs to be protected, for a few days, with a splint. Nasal packs can help support the tissues from the inside but they are uncomfortable and we usually manage to avoid them. If they are required they can usually be removed after a few hours. There may be stitches in the external scars which require early removal.

Depending on your occupation, you may consider returning to work in 7 to 10 days, bearing in mind that the bruising and swelling will not have settled completely by this stage. For the first month, try to avoid situations where your nose may get knocked, for example dancing and carrying or playing with children. Contact sports should be avoided for 3 months.

Implications

Bruising and swelling are inevitable to some extent, but the combination of expert surgery and expert anaesthesia will minimise this. As soon as the nose splint is removed, you will be able to see the changes achieved. You will be aware of the residual swelling, on and around your nose, but most observers will not. It may take several months to settle completely. Bruising may take up to three weeks to disappear completely.

There will be numbness particularly of the nasal tip and a feeling of stiffness which may take several months to return to normal. It is wise to wear sun block and avoid burning in the first few months.

Expectations

Your happiness with the result is paramount and this will be the outcome for the great majority of patients. It is important to appreciate that there are limits to the refinement that can be achieved, particularly if the nose is very large and if the skin is stiff and inflexible. In your consultation you will receive guidance on what can be achieved while keeping the risk of complications low. While we do our utmost to achieve the desired result, we cannot guarantee that it is possible to make your nose the shape you wish for. If subsequent revision procedures are required, there may be additional fees. The surgeons at Bristol Plastic Surgery enjoy a high patient satisfaction rate.

Complications

Infection rates are surprisingly low but if you are aware of any existing infection in this area, you would be advised to postpone your surgery. Nose bleeds are fortunately uncommon but may require some intervention in the form of nasal packing and even a return to the operating room. Rarely, the sense of smell may be impaired following surgery but is very uncommon with modern techniques.

In striving to achieve the desired outcome it is possible that the cartilage support becomes too weak to hold the nostrils open on forced inspiration (breathing in). This is called "valving" and secondary supporting cartilage grafts inserted under the skin may be required. Secondary on-lay grafts to build up hollowed or depressed areas may also help further refine the shape in a challenging nose. During your consultation the need for certain incisions and possible grafting can be assessed.

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