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Rhinoplasty to improve the nasal tip with Mr. Jag Chana

Dissatisfaction with the nasal tip is relatively common in patients requesting rhinoplasty. There are a number of issues that can cause dissatisfaction. The most common is a tip that is too broad or ‘bulbous’. Other features include tips that are overprojecting or too long or drooping tip deformities.

The underlying problem is the size and shape of the cartilages that provide the structural integrity to the nasal tip. These cartilages are modified during a rhinoplasty using a number of techniques to reduce them in size and alter their shape.

What type of rhinoplasty is required to adjust nasal tip shape?

 Rhinoplasty can be performed ‘closed’ where the incisions are made inside the nostrils or open where there is a small opening made in the columella which is the narrow skin bridge between the nostrils. An open rhinoplasty is usually required for adjustment of nasal tip shape.

How is the open tip rhinoplasty procedure performed?

During an open rhinoplasty procedure, the skin on the tip of the nose will be lifted away to expose the cartilage beneath. This allows the surgeon better access to visualise the cartilage deformity and carry out any adjustments. These adjustments usually require a combination of structurally modifying the shape of the cartilages by reducing them in size but also altering the shape by carefully placing stitches to hold the cartilages in a new position. Occasionally, small grafts of cartilage may also be required to improve the appearance. A ‘graft’ is a piece of tissue which is usually taken from septum on the inside of the nose and used as an ‘add-on’ to enhance the shape of the tip of the nose. This is commonly known as a cartilage graft.

What anaesthetic is required?

This surgery is best performed under general anaesthetic since other adjustments to the nose usually are required in combination.  If only work to the tip of the nose is carried out with no surgery to the nasal bridge then you can go home the same day. Otherwise you will be required to stay the night.

What is the recovery from open tip rhinoplasty?

The initial recovery is approximately two weeks, during which time any bruising and swelling subsides. You should refrain from strenuous exercise for approximately 6 weeks.

The final result often takes 6 to 9 months to establish since a mild amount of swelling can persist for some time before all the detail shows through and the tissues have had time to settle.

Below is a before and after from one of Mr. Chana’s nasal tip rhinoplasty patients:

PicMonkey Collage

The structure and appearance of your face is very personal, and Mr. Chana understands that a rhinoplasty is far from ‘one size fits all’. You’ll be able to have a detailed consultation with him during which which he will assess your facial proportions and discuss what can and cannot be achieved. This will provide you with a realistic idea of the likely result that can be achieved. Mr. Chana focuses on natural looking results that are bespoke and tailored to the individual, and your subtle alteration in appearance will not alert people to the fact that you have had cosmetic surgery. You should not be surprised if too many people do not notice that you have had surgery, since this means that the new shape of your nose is in complete harmony with the rest of your face.

To book a consultation with Mr. Jag Chana, contact his clinic today to book an appointment.

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Rhinoplasty FAQ’s

Am I a suitable candidate for rhinoplasty?

Rhinoplasty has always been, and remains, one of the most popular and commonly performed cosmetic surgeries available. Many people are unhappy with the shape and/or size of their nose – not just because of the feature itself, but because a disproportionate nose can affect the way the face looks as a whole and compromises  a normal and balanced facial features  . By amending the appearance of the nose, the patient generally looks a lot more conventionally attractive, as well as feeling much better and less self-conscious about the way they look.

Rhinoplasty techniques have been well practiced and therefore refined over the years, and as a result, it is a more precise procedure as compared to standard techniques in previous year.

Who should perform my rhinoplasty?

The most important aspect about any cosmetic surgery  is finding the right person to perform it. Your surgeon should not only be someone who is fully qualified and can show you patient testimonials and previous results, but also someone you get on with and feel comfortable with. They should also be an expert in your surgery of choice, and have performed the surgery many times before. This is imperative not only for the best results, but also to minimise the risk of complications and to ensure your expectations are met. There are many types of surgeons performing rhinoplasty from Plastic Surgeons to ENT Surgeons and Maxillofacial Surgeons. The advantage of a Plastic Surgeon is the full time experience and pursuit relating to the art of aesthetics and beauty related related to facial  appearance.  Whereas ENT surgeons primarily treat the inside of the nose and breathing issues and maxillo-facial surgeons primarily treat teeth, Plastic Surgeons have devoted the whole of their training and career in techniques of improving external bodily features.

Mr Chana was chosen as London’s best rhinoplasty and facial surgeon to appear in the Sunday Times. You can read about his rhinoplasty expertise in the Sunday Times article if you click here.

 

What happens during the rhinoplasty consultation?

Mr Chana will ask you about any previous medical history but also any history of trauma to the nose and any breathing difficulties. He will then ask you specifically what you do not like about your nose. This can often be a difficult question if you simply dislike the whole shape and so one aspect often to think about is the one feature of the nose that you dislike and would make you happy if it were changed . Mr Chana will guide you through this discussion step by step . There may be other features about your nose which you dislike and Mr Chana will discuss these and how the overall shape can be changed in the context of keeping a very natural appearance which will suit your face.

 

Can you  bring photos of the types of noses you like?

The main consideration with rhinoplasty is that the new nose should suit your face and be in complete proportion to other facial features.  You may bring photos to the consultation of other noses but this may be irrelevant to your situation and in any case this may not be achievable or look appropriate for your face. Mr Chana will tailor the surgery so that it is in complete harmony with your face.

 

How is a rhinoplasty performed?

There are two main ways of performing rhinoplasty surgery – open and closed. The difference is essentially in where the incision is placed, and the effect this has on the procedure. In a closed rhinoplasty procedure, all incisions are made inside the nose. This reduces the chance of scarring and also reduces recovery time, but it does also limit the results that can be achieved. Also closed rhinoplasty cannot always address problems with the tip of the nose for which an open rhinoplasty is better suited.  During open rhinoplasty, a small incision is made in the nasal column (the bit that separates the nostrils) so that the skin can be lifted and Mr. Chana can work intricately on the tissues of the nose. The recovery period is a little longer for this, but it does allow for more refined results.

 

What is the preparation for rhinoplasty?

With any surgical procedure, there are things you can do prior to surgery to ensure that your treatment and recovery run smoothly. One of the main ones is that smokers are advised to quit before their surgery (as far in advance as is possible) to assist recovery – smoking can affect wound healing but also induces coughing after the anaesthetic which increases the risk of bleeding. Also you must not take aspirin like tablets for two weeks before surgery since this also increases the risk of bleeding.

 

What is the recovery for rhinoplasty?

After rhinoplasty, you will be required to wear a splint for one week, which will be provided by Mr. Chana at the time of your surgery. This helps to keep the tissues in place during the healing period of the first week. You should sleep upright for the first few nights after your treatment, again to avoid any swelling that may occur from knocking or disturbing your nose immediately after treatment.

You should take two weeks off work for allow recovery, after which time the majority of the swelling and bruising will have gone down (and any excess bruising can easily be covered with makeup). You should wait six weeks before resuming any vigorous activity like sport. Rhinoplasty surgery often causes temporary  mild swelling  – while it is not usually visible – can affect the appearance of the nose for a few months after surgery. Therefore, you can expect to see your best results between 6 and 9 months after surgery.

How do I learn more about rhinoplasty?

The best way to learn about any cosmetic procedure is to book a consultation with n expert rhinoplasty surgeon. During this consultation, they will be able to tell you not only about the procedure, but specific details about the likely result you can expect to achieve and any potential risks .

It is also an excellent opportunity for you to get to know Mr. Chana and build a rapport with him prior to your treatment.  Quite often Mr Chana will see patients twice for consultation prior to surgery. Many patients report that being able to discuss their issues in this way without being rushed and being fully informed  before they undergo a rhinoplasty procedure makes them feel more at ease and comfortable, which in turn enhances their overall experience with cosmetic surgery under the care of Mr Chana. If you are interested in booking a consultation with Mr. Chana – either to learn more about rhinoplasty surgery or for information on any other surgical or non-surgical aesthetic treatment, please call or email his clinic today.

Ethnic rhinoplasty

Rhinoplasty is one of the most intricate cosmetic surgery procedures requiring a delicate manipulation of tissues, technical skill and an appreciation of facial harmony in order to produce natural results.
With ethnic rhinoplasty particularly, it is vitally important that you find a surgeon that you can trust. Mr. Jag Chana is a highly qualified plastic surgeon and one of the best rhinoplasty surgeons with a huge experience in ethnic rhinoplasty. A carefully considered and individualised rhinoplasty treatment plan is critical to achieving a natural result during ethnic rhinoplasty.

The appreciation of facial proportions is particularly important when operating on individuals from different ethnic backgrounds. The underlying anatomy of the nose may be different in different ethnicities but also the method of surgery will need to take into account the underlying differences facial anatomy. This requires a level of technical skill but also experience in operating on many patients from different ethnic backgrounds. The common populations requesting rhinoplasty include Jewish individuals, Asians and Mediterranean patients. All of these populations present unique differences in their underlying anatomy which are important to recognise prior to planning a rhinoplasty and maintaining the racial identity of the patient.

How is ethic rhinoplasty performed ?

Most ethnic rhinoplasty surgery is performed as open rhinoplasty, which means that an incision will be made on the column of skin in between the nostrils (the collumella). This approach allows greater control and precision to alter the shape of the cartilages of the nose. Often the tip of the nose has a different structure in certain ethnic types and this can result in the need for grafts to be used and these grafts can be more precisely positioned using an open approach. Other smaller changes may be required such as narrowing the flare of the nostrils. This is quite common in Afro-Carribean patients whose nasal base is wide in which case the nostrils are reduced but this will need a scar at the base of the nostrils. Despite these very small openings in the skin the nose heals with almost imperceptible scars

What is the recovery ?

After your rhinoplasty surgery, there will be detailed aftercare to follow – this is more or less the same for most patients, and does not differ based on the ethnicity of the patient. You will be required to wear a cast after your surgery which will remain in place for approximately a week– Mr. Chana will outline exactly how long this must be worn for. You should avoid bending or stooping for a couple of days, as this might cause extra swelling or bleeding, and you should sleep upright for the first few days. You must not exercise for 6 weeks after the surgery.

Swelling after surgery always takes some time to subside. Once the cast is removed the nose will be a new shape but it can take a few weeks for most of the swelling to settle. However, it can often take 6 months to 9 months to see the final result . Often the tip refinements can take this much time or even longer to completely settle.

The more complex the rhinoplasty the more likely is the possibility of ‘touch-ups’ or rhinoplasty revisions; this is due to the fact that when surgery requires more extensive changes to the bones and cartilages there is more tissue to heal long term. Occasionally this can result in minor imperfections which are outside the control of surgery and do not even become visible until many months after the procedure. If any refinements are required Mr Chana will offer this free of charge.

The rhinoplasty consultation

The most important part of any rhinoplasty procedure, and especially ethnic rhinoplasty, is the consultation. A meeting with Mr. Chana prior to surgery will allow him to assess your individual situation and to discuss a bespoke plan for your rhinoplasty.

Of course, there may be some limitations on attainable results, depending on factors like your skin thickness, skin texture and existing nose shape. Mr Chana will very carefully discuss the likely result that can be achieved and any limitations. This usually takes more than one consultation . Mr Chana does not charge for second consultations since the most important factor is that you are fully informed about the procedure and that you feel comfortable with the proposed surgical plan. To book a consultation with Mr. Chana, please call or email his practice today.

Correcting problems after nose trauma

Nasal trauma can be caused by a number of things, and can affect the bone or the cartilage in the nose. Often, patients with nasal trauma will find that their nose is broken or fractured, and this usually dramatically affects the appearance of the nose, and of the overall face. Occasionally breathing through the nose may also be affected. 

Early diagnosis is important

The nose may break on severe impact, be that through a fall, playing contact sports, or violent trauma. The alignment of the nose will probably be affected, and you may also experience a lot of swelling and bruising.

After nose trauma, is it important to visit an emergency department or you can contact Mr Chana’s office directly. It is important that a diagnosis is made early so that problems such as septal hematoma, which is a build-up of blood around the septum, can be treated early. It is also possible that the nose fracture can be re-aligned immediately. If the diagnosis is not made early and a lot of bruising and swelling has commenced it is then difficult to make a diagnosis of a fracture and it is best left alone for the swelling to subside over 7 to 10 days before attempting a re-alignment.

Post-traumatic rhinoplasty

If you do not have your broken nose corrected it can heal leaving a deviation, a bump on the bridge of the nose and occasionally cause breathing problems.  This situation will then need a corrective rhinoplasty.

Corrective rhinoplasty following trauma will involve a number of technical procedures to correct the visible deformity as well as straightening internal structures such as the septum if this has been damaged or dislocated following the trauma. These manoeuvres involve repositioning the bones and the septum if this is deviated. It will also involve correcting any irregularities of the bone or cartilage which might contribute to a bump on the bridge of the nose. The procedure can be carried out ‘closed’ with all incisions inside the nostrils or ‘open’ with an incision on the nasal column depending on the extent of damage. In general nose trauma rhinoplasty usually requires an open approach.

What is the recovery after post-traumatic rhinoplasty ?

Rhinoplasty surgery is performed under general anaesthetic, and usually takes around two to three hours to complete. You will have to stay in hospital overnight.

There will be a cast on the nose which acts to provide protection and maintains the position of the nasal bones. There is usually bruising which will be most prominent under the eyes and this lasts approximately two weeks.

You should take two weeks off work following your procedure, and should wait at least six weeks before partaking in any physical exercise. The results of your surgery will continue to develop after your surgery, as your swelling subsides and your new nose is allowed to ‘settle’. It may take six to nine months to see your best results.

What are the risks of rhinoplasty?

As with any surgery, corrective rhinoplasty does come with some potential risks. These include infection and bleeding. There is usually some degree of loss of sensation on the skin of the nose but this usually returns over a period of few months. There is a small risk of a ‘touch up’ or revisional procedure in approximately 5 % of cases. If this is required then it is best performed 6 months after the initial procedure. There can be some minor degree of asymmetry and following nasal trauma this may not be corrected completely although there should be a very significant improvement.

The rhinoplasty consultation?

Booking a consultation with Mr. Chana will allow you to understand exactly what is involved with the procedure.  Mr Chana will examine your nose carefully and listen to your concerns before discussing the exact procedure required. You should also take a photo with you showing how your nose looked before your nasal trauma as this will allow Mr. Chana to see the shape of your nose before it was broken.

If you were not happy with the shape of your nose to start with, your consultation is also a good opportunity to talk with Mr. Chana about altering the appearance of the nose from the way it looks naturally.

It is often a difficult decision to contemplate corrective nasal surgery but in experienced hands the surgery is carried out in a safe and controlled manner with predictable results. Mr Chana has an excellent reputation for rhinoplasty surgery and has often been invited in the media to discuss his rhinoplasty techniques, in publications like the Daily Telegraph and the Sunday Times. For a consultation, get in touch with Mr. Chana’s practice.

Nasal tip surgery

Ask most people who they think are suitable candidates for nose surgery, or who was most likely to seek it, and they will probably imagine someone with an obviously large nose, or someone who has had their nose broken several times . In short, they will think of problems with the bridge of the nose – a hooked or lumpy nose, for example. However, this is not always the case since there are many other features of the nose which can be adjusted.

What is a tip rhinoplasty?

A dislike of the tip of the nose is often related to an appearance of the tip being too wide, too boxy or too bulbous. Other adverse features can be a nose with excess tip projection or a tip which droops downwards. All of these factors can be corrected and a very careful analysis of the overall anatomy of the nose is required to plan an effective rhinoplasty in these cases. The nasal tip is a complex structure containing various cartilages which require a meticulous approach to provide a more refined tip appearance.

How are nasal tip refinements carried out?

An open rhinoplasty is required to correct the tip of the nose since this will allow Mr. Chana a higher level of control over the intricacies that affect the final result. During open rhinoplasty, a small incision is made at the narrowest part of the columella (the skin bridge between each nostril) and the skin is lifted away from the nose to expose the cartilages beneath. The cartilages are then adjusted in various ways which can include trimming them to reduce them in size and combining this with stitches to adjust the shape of the cartilages.  Occassionally small grafts of cartilage may be required to further refine the new shape and if this is the case the cartilage from the septum may be used. If this is not possible for any reason then cartilage from the ear may be used and this will leave a very in conspicuous scar behind the ear. Any such requirements will be discussed very carefully at consultation.

The anaesthetic and recovery?

Nasal tip surgery is performed under general anaesthetic, and will take approximately 1-2 hours to complete. An overnight stay in hospital is usually required and a cast on the nose may be required for approximately one week. It will take about 1-2 weeks for any bruising and swelling to subside . Normally heavy exercise  should be avoided for 6 weeks.

Your rhinoplasty consultation?

When you attend a consultation with Mr. Chana, he will be able to assess your nose and the proportions of your face in order to provide you with a realistic  expectation of the likely result following the nasal tip surgery. Mr Chana will also explain any potential risks and the long term recovery. Often it can take 6 to 9 months to see the final result following any rhinoplasty procedure since the nasal tip can take some time for the tissues to settle completely.

During the consultation, Mr. Chana will explain the treatment plan including any pre-operative advice (for example, smokers are strongly advised to quit a few weeks before undergoing any cosmetic surgery), what to expect on the day of your surgery and how you should take care of yourself afterwards to minimise the risk of any adverse side-effects as a result of your procedure.

Your consultation is also an excellent opportunity for you to meet Mr. Chana and discuss all your concerns. It is helpful to see before and after photographs and Mr Chana will show you representative examples of similar patients.  Mr Chana has one of the best reputations as a rhinoplasty surgeon and you can be rest assured that you are in good hands. Some of his patients have even been in the national media as a result of this reputation and you can read about their stories here, and here. Also, he has often been asked to operate on members of staff and medical colleagues at the hospitals where he works which is a testament to his good reputation.

For a consultation with Mr Chana please contact his office by e-mail or telephone .

Why is rhinoplasty requested?

For people who feel their nose is the wrong shape, size, or simply not ‘right’ for their face, accepting their natural face can be difficult. Many individuals feel that their nose is detrimental to the rest of their face, and their overall appearance. For a long time, rhinoplasty (nose re-shaping) has been associated just with have a large nose, or a hump on the bridge of the nose but this is not the case: it is actually an intricate procedure that can offer bespoke results to each and every patient, depending on their complaint and desired results.

Nose reshaping was the second most requested procedure in 2014, according to a survey taken by whatclinic.com. It’s a consistently popular treatment, not least because the nose is the focal point of the face and therefore plays a large contributing role to general attractiveness. Moreover, plastic surgeons have become very well acquainted with rhinoplasty procedures due to their popularity, allowing them to refine their technique and produce reliable and natural results.

How is Rhinoplasty performed?

Rhinoplasty is performed under general anaesthetic, which means you will be required to stay in hospital overnight. Mr. Chana works with highly experienced Consultant anaesthetists to ensure the maximum patient comfort and safety. The procedure itself will take between 2 to 3 hours depending on what is required.

Open or closed rhinoplasty?

Rhinoplasty can follow two routes: open rhinoplasty, or closed. The difference lies in the way the incision is made. During open rhinoplasty, Mr. Chana will make an incision on the nasal column (columella) in order to lift the skin away from the tip of the nose. This leaves a very inconspicuous scar on the columella which is the narrow skin bridge between the nostrils. Open rhinoplasty allows for a more precise and intricate procedure, and is particularly helpful for work on the nose tip. In a closed rhinoplasty procedure, the incision will be made inside the nose, meaning any scarring will usually be hidden. In addition, closed rhinoplasty may heal faster than open rhinoplasty.

Whether you are most suited to open or closed rhinoplasty depends on each individual case, and is subject to a consultation with Mr. Jag Chana. During this consultation, he will assess not only what kind of rhinoplasty will be most suitable for you, but also what course of aftercare, anaesthesia and whether any pre-surgery precautions should be taken in your specific case.

Recovery after rhinoplasty?

After the procedure, you should take around two weeks off work in order to recover. During the first week you will have to wear a cast on the nose, which will be provided for you by Mr. Chana’s practice. You should sleep upright, and avoid stopping of vigorous activity for the first few days. This will reduce swelling, as well as the chance of bleeding or excessive bruising. Although you may have black eyes and swelling after you have first had the surgery, the majority of this should subside by the time you return to work if you properly follow the aftercare. The remainder of the swelling or bruising will be easily coverable by makeup at that point.

You should be careful with your nose until you are sure it is completely healed (a follow up consultation with Mr. Chana will help you to track your progress) and you should wait at least six weeks before resuming any sporting activity, like the gym or team sports. The best results of rhinoplasty will usually show between six and nine months after surgery.

Mr. Chana is highly experienced in facial surgery with a reputation for achieving excellent results for his expertise in rhinoplasty surgery. He was chosen by the Sunday Times to feature in their magazine as one of the best rhinoplasty surgeons and you can read this article here. If you would like to talk to Mr. Chana about rhinoplasty surgery, please call or email his practice to book a consultation.

surgeon

More and more people are ‘doubling up’ and having a combination treatment at the same time as their facelift.

Face lift surgery can be combined with a variety of other face procedures including blepharoplasty (eyelid surgery), rhinoplasty (nose surgery), otoplasty (ear pinning surgery), forehead lift (brow lift), neck lift, BOTOX® Cosmetic, or dermal filler injections. Laser skin resurfacing can also be combined with the face lift surgery to improve the quality of the skin. This treatment is effective in reversing the effects of sun damage or smoking.

girl

The American Society for Aesthetic Plastic Surgery (ASAPS) has reported that the most common cosmetic plastic surgical procedures for teens were rhinoplasty or nose reshaping, followed by breast reduction, correction of breast asymmetry, gynecomastia, in which breast development occurs in boys, and chin augmentation – often performed with rhinoplasty to achieve a balanced look in the face.

The most common nonsurgical cosmetic procedures among teens were laser hair removal and chemical peels.

For teens, cosmetic surgery, both surgical and nonsurgical, may provide a positive effect on physical and emotional development, says the ASAPS. However, all patients, and teens especially, must undergo a careful screening and evaluation.


© Jag Chana 2014