Surgery to reshape the nose is a very common plastic surgery procedure and can be done for aesthetic or reconstructive purposes. The goal of rhinoplasty is to improve the proportions and appearance of the nose and overall facial balance. We can enlarge, reduce or straighten the nose. The shape of the tip, the bridge and also the nostrils can be reshaped, and the angle between the nose and the upper lip corrected. It is also possible to shorten the nose and to reduce a bulky tip by removing some of the cartilage from the end of the nose. The position of the plate of bone and cartilage which separates the nasal cavity can be adjusted to facilitate breathing through the nose. A properly planned and precisely executed rhinoplasty should give good aesthetic result and allow the patient to breathe well. The size of the nose as a central facial feature is influenced by the proportions of the other features, such as the chin and the cheek bones. Sometimes to harmonize the appearance we alter these features as well.
The nose is the central feature of the face and has a significant influence on the appearance. The characteristics of the nose are inherited and develop during adolescent years. People considering rhinoplasty think their nose is too big, too small and disproportioned to the overall shape of the face. They may dislike a bump on the nasal bridge in profile or excessively flared nostrils. Some feel their nose is too wide and asymmetrical or wish to change a drooping, broad or thickened nasal tip. Others may have difficulty breathing because of septal deviation or internal nasal issues. Accidents can change the shape of the nose leaving unsightly bumps or flattened areas. Patients who already had nose surgery may be unhappy with the final outcome due to some of the most common pitfalls, including saddle nose deformity, a scooped out profile, excessively pointy tip, parrot beak or collapsing asymmetrical areas.
Nose reshaping techniques have evolved and improved considerably in the last years. Pinched upturned noses that were regarded as ideal in past decades are not universally acceptable anymore. People do not want a nose like someone else. They want to look like themselves after surgery, only better. Final outcome should not be a surgeon’s signature, but rather natural looking result that preserves the individual’s unique characteristics. With a modern rhinoplasty approach, using advanced techniques we are able to deliver subtle and customized changes that are unique to each patient. All alterations to nasal shape and structure should be appropriate for the individual’s facial features. Therefore, a detailed understanding of long term results and good communication between patient and surgeon is essential. Patients should be an integral part of decision making and must be able to show, what they would like to change about their nose and what they would like to leave. Using computer generated images we are able to formulate a customized preoperative plan and an impression of the final outcome can be discussed with the patient.
To create unique nose in harmony with patient’s face, a detailed preoperative planning and consultation is of utmost importance. Open discussion with the patient is crucial, and patients must be able to describe what features they dislike about their nose. The quality of skin, the size and shape of the nose, its symmetry and relationship to other facial features will be carefully examined. Details of history including prior nasal trauma, nasal deformity and nasal surgeries and history of difficulty breathing through the nose will be discussed. With the help of computer simulated images, your options will be described in detail and alterations in nasal shape and size recommended. A good surgical plan prior to surgery also significantly decreases operative time.
A rhinoplasty is usually performed under general anesthesia for optimal safety and comfort. Depending on the extent of surgery and patient’s preferences it can also be done under local anesthetic. Either way prior to making incision local anesthetic is injected to minimize bleeding and decrease postoperative discomfort. Nose reshaping surgery is performed either through incisions hidden inside the nose (closed rhinoplasty) or through additional incision in the skin between both nostrils (open technique). Rhinoplasty is a three dimensional procedure. The soft tissues of the nose are gently raised and separated from the bone and cartilage to reduce, reshape, augment or reposition the components of the nasal framework. The nose can be reduced by removing cartilage and bone, or it may be augmented by adding grafts (bone or cartilage) from the nose, ear or rib. Bent or crocked nasal wall can be realigned (septoplasty). Rarely additional incisions in the nostrils may be necessary to reduce them. This will leave fine scars on each side. Incisions are closed using dissolving sutures wherever possible.
After surgery absorbent gauze is applied inside the nose to reduce swelling and bleeding. It is removed after a couple of days. To keep it stable while healing the new frame is protected by a firm splint (plastic cast) over the nasal skin. Once the splint is removed after approximately one week, the nose should be handled gently for the first six weeks. Mild painkillers might be required during the first week. There is always some bruising and swelling, particularly around the eyes, which can take up to three weeks to completely disappear. Sleeping with a few extra pillows to elevate the head can speed the resolution of the swelling. The nose will feel rather numb and stiff for several months, particularly around the tip. Most patients can return to work after about ten days especially if they cover the bruises with cosmetics. Scars after open rhinoplasty are rarely noticeable while closed rhinoplasty incisions are completely hidden inside the nose. Small asymmetries immediately after the procedure are due to swelling and will normalize as healing progresses. It will take at least three months for reshaped nose to mature and the final result cannot be assessed for at least half a year.
The most usual complication associated with this procedure is not achieving the expected result. Therefore, open preoperative consultation and realistic expectations are crucial. It should however, be remembered, that most patients who had nasal surgery are satisfied with the final outcome and have no desire to further modify their nose. Very occasionally, the operation can be complicated by nose bleeding, which can occur even ten days after the procedure. Bleeding is never life threatening but sometimes may require treatment in hospital. The risk is around two percent and higher if septoplasty was performed. Thanks to the rich supply of blood vessels the infection after nasal surgery is extremely uncommon. An infection may require antibiotic treatment or removal of the source of infection. Many patients experience reduced sensitivity in the tip of the nose during the first months, but this almost always disappears.
Revision or secondary rhinoplasty is a surgical procedure to correct or further improve the appearance of the nose after a primary rhinoplasty. Patients may opt for secondary rhinoplasty if they are unsatisfied with the function or appearance of their nose. The final outcome of the primary procedure may either be too subtle or too dramatic, asymmetrical or uneven. Revision rhinoplasty is technically more complicated and unpredictable. It carries a higher risk of complications and should always be approached with extreme caution. If the nasal framework was reduced too much during the first procedure, bone or cartilage grafts are sometimes needed to correct the deformity. As it takes at least a year for the final nasal shape to emerge after rhinoplasty, it is not recommended that secondary surgery is attempted any sooner.