What is rhinoplasty surgery?
Rhinoplasty is a plastic surgery procedure performed on the nose to correct, reconstruct or enhance the shape, commonly known as nose surgery.
Mr Chana is well known for his Rhinoplasty ‘nose’ surgery. You can read about his expertise in The Sunday Times.
Rhinoplasty is a delicate procedure which requires very careful planning to achieve a result which is harmonious with the rest of the face. The most common request is to reduce the size and shape of a large nose, but occasionally an increase in profile is appropriate. Various other aspects of the nose can be changed in terms of refining the tip, narrowing the nose or shortening or lengthening the nose. Occasionally patients may have sustained nasal injuries which have caused deformities requiring correction nose surgery.
During the consultation for rhinoplasty surgery, you will be asked a general medical history including details of previous nasal injury or surgery and undergo a careful examination. Mr Chana will discuss which features of the nose make you unhappy before making an accurate plan for Rhinoplasty surgery.
What happens during the nose surgery operation?
Rhinoplasty is carried out under general anaesthesia. In a ‘closed’ rhinoplasty the incisions are inside the nostrils, so there are no external scars. In an ‘open’ rhinoplasty there is a very fine scar across the columella which is the column of skin between the nostrils. The choice of technique is dependent on what is required during the surgery and the level of refinement requested.
In a ‘reduction’ rhinoplasty the nose is made smaller or a ‘hump’ is removed to give the new profile. If nothing else were to be done the bridge line would be too wide and so it is usually necessary to fracture the nasal bones, in a carefully controlled way, and move them to meet in the midline to make a narrow bridge line again. A small plaster cast is required for seven days to support and protect the bones while they set into their new position.
The tip of the nose is shaped by cartilages underneath the skin and these are adjusted in size and shape to refine the nose so that it matches the new profile. When surgery is complete, small dissolvable stitches are used inside the nostrils and the tapes and plaster cast are applied.
Sometimes it is necessary to implant tissue into the nose to obtain the desired result. This procedure is termed “using a graft”. The tissue may be obtained from the nose itself, from the cartilage of the ear or occasionally from a rib.
Unusually, if the size of the nostrils reduced in size (alar base reduction), there will be small scars inside and under the nostrils in the furrow between the nostril and lip.
Nasal packs may be necessary to prevent bleeding and ensure that the lining of the nose adheres correctly. Consequently you will need to breathe through the mouth until they are removed which is usually within 24 hours (a simple procedure). Even if packs are not used you will feel blocked up and unable to breathe fully through the nose due to normal post operative swelling. If the breathing passages have been operated upon, it may take longer for the nose to clear.
What is the recovery?
Pain is surprisingly uncommon after this operation and is easily relieved by mild analgesic tablets which will be prescribed. Aspirin or aspirin like medication (non-steroidal anti-inflammatory tablets) must not be taken.
After surgery you should avoid stooping or vigorous activity for a few days to reduce the swelling and the possibility of a nosebleed. It is also important to sleep upright at night to reduce the swelling. As the nasal bones have to be reset in a rhinoplasty operation you will have ‘black eyes’ after surgery and your eyes and face may be swollen. If this occurs most of the swelling will settle in two weeks and you may use makeup to cover any bruising as soon as the plaster has been removed after the first week.
In the event of incisions being made under the nostrils or across the central strut (columella), the sutures will be removed at the same time as the cast is removed. The scars may be a little red at first but are hidden in the natural shadows of the nose.
It is normal for the nose to feel a little numb after surgery but the sensation recovers as the nerve supply to the skin regenerates over a period of a few months.
It is essential that every patient realises the shape of the nose when the cast is removed is not the final one.
Scar tissue forms underneath the skin of the nose, and although it is not visible it may have an effect on the initial shape. The process of this scar maturation takes on average six months, and sometimes much longer. It is generally observed that the thicker the nasal skin, the longer the period of scar resolution. Therefore it can take at least six months before the final result of a rhinoplasty can be seen.
What are the risks of nose surgery?
Serious complications following rhinoplasty are rare. Infection and bleeding are possible complications.
There is a definite incidence of approx. 10% of patients who may require a refinement following surgery. This problem is most frequent in noses that have been the subject of severe injury, or in the case of a very large reduction in nasal size. If the chances of needing a secondary procedure are much higher than normal, Mr Chana will inform you. Secondary procedures are usually a case of minor adjustments, but you should bear in mind that surgery of this nature cannot be carried out immediately as the nose must be allowed to settle before further surgery is safe, or desirable. Any refinement is undertaken after 6 to 9 months following surgery.
Mr Chana will provide you with a comprehensive information leaflet following consultation