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Rhinoplasty - (Nose surgery)

Rhinoplasty surgery is the medical term used to describe nose surgery or a 'nose job', a procedure usually performed to enhance nasal shape. It is one of the most popular cosmetic procedures performed in the UK every year and Mr Chana is one of the country's leading London based Rhinoplasty plastic surgeon specialists utilising the latest techniques  including ultrasonic rhinoplasty and preservation rhinoplasty. Mr Chana was one of the first surgeons to use Ultrasonic rhinoplasty techniques in the UK and has a vast experience with these new technologies which benefit patients considering rhinoplasty.

In view of his reputation as a leading London based Rhinoplasty plastic surgeon, Mr Chana is frequently invited to make comment, or have his work featured, in the national press. Here are three articles:

Mr Chana in the Sunday Times

Mr Chana in the Daily Telegraph

Mr Chana in the Daily Express 

Many people are self-conscious about the shape of their nose and choose to undergo a Rhinoplasty procedure for cosmetic reasons. Very often personal and emotional reasons play a role too. It may be that they dislike the overall shape of their nose and want it made smaller. Or it may be that they want a 'dorsal hump' (bump) removed. They may dislike the width of their nostrils, or want the tip of their nose to be more refined. Other patients may choose to have Rhinoplasty surgery because of an injury to the nose or because they are having breathing issues.
Whatever the reason, Rhinoplasty surgery is a delicate procedure which requires careful planning to achieve the desired result, one which is harmonious with the rest of the face.
There are limits to how much a nose can be altered. Different physical characteristics, your age and ethnicity also effect how a Rhinoplasty procedure is performed. Renowned as being a leading London Rhinoplasty surgeon, Mr Chana will always take your facial features into account when planning any surgery. During an initial consultation with him, you will undergo a full examination and discuss your nose features in detail so he can make an accurate plan for the surgery you require. You will also be asked about your general medical history, including details of any previous nasal injury or corrective surgery.
You can read more about Rhinoplasty Surgery in the sections below and on the related pages on Ultrasonic rhinoplasty and Preservation Rhinoplasty.

The Rhinoplasty surgery procedure

There are different techniques used in Rhinoplasty surgery. These are known as a closed Rhinoplasty approach or an open Rhinoplasty approach . They are all carried out under general anaesthetic. The latest techniques for bone reshaping use the ultrasonic rhinoplasty method which utilises a device called a piezotome. This avoids the use of hammers and chisels, reducing the trauma to the nose and therefore patients have an enhanced healing with much less bruising. Another modern form of rhinoplasty involves a method called preservation rhinoplasty. This is the concept of reshaping and preserving important structural elements rather than removal. Such preservation techniques have advantages since they help with the long term stability of the nose,

In a closed Rhinoplasty surgery, the surgical incisions are made inside the nostrils so that there are no visible external scars. However, whilst a visible scar is prevented, there are considerable surgical challenges to this type of procedure as access into the nose is limited and a great deal of experience and skill is required by the surgeon.

An open Rhinoplasty surgery employs a small bridging incision across the columella (the column of skin between the nostrils), which allows the nasal skin to be folded up (a bit like a car bonnet) so that access inside the nose is uninhibited.

Following surgery surgical tapes and/or a small plaster cast are required for about a week to support and protect the nose, especially if the surgery has involved bones while they set into their new position. Small dissolvable stitches are used inside the nose during a Rhinoplasty procedure . You may also have stiches on the outside, which are normally removed within a week.

Reshaping the tip of the nose is achieved by cartilages underneath the skin and these are adjusted to refine the nose so that it matches the new profile. Sometimes it is necessary to implant tissue, called 'a graft', into the nose to obtain the desired result. The tissue may be obtained from the nose itself, from the cartilage of the ear or occasionally from a rib.

Nasal packs may be necessary to prevent bleeding and to 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 and involves a very simple procedure. Even if packs are not used you will still feel blocked up and unable to breathe fully through the nose. This is due to post-operative swelling and is very normal. If the actual breathing passages have been operated upon, it may take longer for the nose to heal and fully clear.

The recovery following  Rhinoplasty surgery

In most cases, Rhinoplasty surgery involves an overnight stay in hospital. The following morning you will be assessed and the nasal packs (if used) will be removed. All being well, you should be able to go home. Most patients will take two weeks off work for recovery.

Your nose will feel tight and sore after surgery, but surprisingly pain is uncommon. If you require painkillers, they can be prescribed by Mr Chana. Aspirin or aspirin-like medication (non-­steroidal, anti-­inflammatory tablets) must not be taken.
It is important, not to blow your nose or to sneeze through your nose. You should avoid bending over or doing any activity for at least a week or so to reduce the swelling and avoid any possibility of a nosebleed. Sports or vigorous activity should not be returned to for 6 weeks. 
Sleeping elevated using extra pillows will also help reduce the swelling. You will also have bruised eyelids after surgery and your eyes and face may be swollen. Most of the swelling will settle in a couple of weeks and delicate make ­up can be worn to cover any bruising as soon as the plaster has been removed.
If you have had a closed Rhinoplasty there will be no external stitches, however with an open Rhinoplasty there will be stitches across the central strut (columella). Although these stitches are dissolvable the nurse may trim the ends of them. If you have had have a nostril reduction there will be external stitches that will need to be removed after about a week. The scars will be a little red at first, but are hidden in the natural shadow of the nose. They will heal with time.
Following surgery surgical tapes will cover the outside of your nose. A small plaster cast may also be required for about a week to support and protect the nose. After it is removed you will still need to have tapes applied across your nose for a few more days to help control the swelling as the nose heals.
It is normal for the nose to feel a little numb after surgery, but sensation will return as the nerve supply to the skin regenerates itself over the next few months.
It can take several months for all the swelling to settle, so it's important to realise that the shape of your new nose after 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 can effect the shape. The process of this scar maturation takes on average six months, sometimes longer, therefore you need to give your body the time it needs before the final result of your new nose becomes apparent.

The risks associated with Rhinoplasty surgery

Infection and bleeding are possible, but the healing process is normally straightforward. Serious complications are very rare. If you do develop an infection, Mr Chana will prescribe a course of antibiotics.
It is very important that you do not have a cold or cough at the time of your operation. If you have any doubts or concerns, please discuss them with Mr Chana. 
Nose surgery is a very specialised procedure and requires a great deal of time to heal. As a result, around 10% of patients will require a further refinement at a later date. This is particularly apparent with noses that have been the subject of severe injury, or in the case of a very large reduction in nasal size. If there is a high chance of needing a secondary procedure, Mr Chana will inform you.
Most secondary procedures are usually a case of minor adjustment, but you should be aware that any surgery cannot be carried out until it is safe to do so, normally between 6 to 9 months after your initial operation.
Mr Chana will provide you with a comprehensive information leaflet on Rhinoplasty following your initial consultation.

Is Rhinoplasty surgery right for me?

Rhinoplasty surgery creates a permanent change in the the shape of the nose, so before embarking on surgery, it is very important to consider your motivations for wanting surgery and to what degree a new nose will improve your confidence and well being. If you are considering a Rhinoplasty, it is usually because you have a specific feature of your nose which you dislike. At an initial consultation with Mr Chana, this will come to the fore and be fully discussed along with the likely result that can be achieved. He will always strongly advise a patient that following the consultation, they reflect on what was discussed in order to make sure they are fully informed on whether surgery is the right course of action for them. Very often patients elect then choose to have a second consultation to help them confirm things and to ask additional questions. You will not be charged for a second consultation with Mr Chana.

How do I choose he best Rhinoplasty surgeon?

Nobody needs urgent Rhinoplasty surgery, so it is advisable to take your time and find a surgeon you like and can trust. Only go to a surgeon that is properly trained and registered on the General Medical Council. The most important factor is the experience of your surgeon. It is often difficult to truly appreciate the experience of a surgeon from just qualifications alone, so it is therefore important to research as many examples of their work as you can, read patient testimonials and look at other areas of their facial and reconstructive plastic surgery experience. It is also very important not to choose a surgeon based on price alone. More experienced surgeons tend to command a premium for obvious reasons. At a face to face consultation you will also get a good sense of whether the surgeon is right for you. They should be caring and offer reassurance, as well as understanding all your reasons for wanting a Rhinoplasty.

What results can I expect with Rhinoplasty surgery?

You can only get a full picture of the likely results you can achieve after you have had a thorough consultation with an experienced surgeon. During the consultation you should discuss what you dislike about your nose so the surgeon can get an accurate picture of your condition. Your surgeon will advise on the procedure and the refinements that may be required to keep the final result in proportion with your overall facial aesthetics. Reviewing case studies in patients with similar problems will also help provide you with an a good idea of what can be achieved, particularly if you can see before and after photographs.

What makes an attractive nose?

An attractive nose depends on many factors, including ethnicity. Specifics such as size, shape, bridge line and tip need to combine with full facial features to create ideal symmetry and harmony. Sometimes patients bring photos of a nose shape they aspire to but soon discover it cannot work with their particular face. Above all, it is important to listen to the advice of an experienced surgeon as they will offer the very best advice on creating harmony with your existing facial features.

What is the difference between closed and open Rhinoplasty proocedures?

A closed Rhinoplasty is a surgical procedure using incisions made internally within the nostrils. An open Rhinoplasty requires a scar in the columella, the skin bridge between the nostrils. The limitations with a closed Rhinoplasty mean that it may not always be possible to address certain nose issues particularly a crooked or deviated nose. An open Rhinoplasty procedure will allow much greater access to the inside of the nose and provide better results for these conditions or to correct a broad or bulbous nasal tip. It is important that your surgeon explains both types of Rhinoplasty since each approach offers different things. An experienced surgeon is crucial in determining which kind of procedure will suit you best.

Is Rhinoplasty painful?

Surprising Rhinoplasty causes very little pain. It is in fact one of the least painful cosmetic procedures. If there is any discomfort, it can easily be controlled with mild painkillers.

What is the minimum age for a Rhinoplasty?

In the UK it is not possible to operate for cosmetic reasons alone on an individual until they are 18 years old.

What is the recovery after Rhinoplasty?

Recovery will very much depend on the extent of the procedure, but in general you will have to wear a nasal cast for a week and some facial bruising will be apparent for a couple of weeks. It is very important to refrain for physical exertion for approximately six weeks after surgery as swelling is always slow to resolve itself. After 4 to 6 weeks the majority of initial post surgical swelling will have gone down, however the long term result can take several months to see. In some cases it can take as much as a year for all the tissues to completely settle and the final result to be fully appreciated. If extensive work has been performed on the nasal tip this can be particularly slow before the final result can be fully seen.



Result from Ultrasonic Rhinoplasty
Rhinoplasty, dorsal hump , droopy tip and elevation columella
Hybrid ultrasonic and preservation rhinoplasty result
Ultrasonic rhinoplasty - short term and long term results
rhinoplasty bulbous tip and dorsal hump
An ultrasonic rhinoplasty result

Rhinoplasty Surgery
Surgery time
1.5 to 2.5 hours
Hospital stay
1 night
Time off work
2 weeks
Full recovery
6 weeks
Best results
6 to 12 months
Price from
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