Rhinoplasty is the operation to reduce or refine the nose, and it is the most frequent facial surgery request. The reason may be simply that the person is self conscious of a large hump or a prominent tip or it may be that this is the subject of irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.
Am I suitable for this surgery?
Only a consultation can establish this. A consultation will determine a few things. You will be asked about your general medical history, which will include questions about any previous nasal surgery or injury.
If you require corrective surgery to the nose as a result of a previous rhinoplasty it is important to wait at least 1 year before any further surgery is attempted. Enquiries will also be made as to your breathing patterns and whether you suffer with any nasal obstruction.
Rhinoplasty
Many times this can also be addressed at the same time as a rhinoplasty. The most common request is to reduce the size and alter the shape of a large nose. Dr Skarparis will try always to give a nose that is attractive and proportional in size and shape to the rest of your face.
What does the Operation involve?
The operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required. If alar base reductions have been performed then the scars will be found between the edges of the tip and the cheeks. These are generally well hidden by the natural shadow cast by the position of the nose. In complex tip surgery, you may require an external incision carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately.
Any bump on the bridge is removed with a delicate chisel to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) is altered accordingly.
Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. When the surgery is complete, small dissolvable stitches are used inside the nostrils and small jelly nasal packs are inserted. These packs are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. Indeed it is exceedingly rare for significant bleeding to occur following a rhinoplasty. Finally a plaster cast is placed on the bridge and held in place by tape on the forehead and cheeks.
What type of anesthetic is used?
A rhinoplasty is usually performed using a general anesthetic, and frequently requires an overnight stay in hospital. Occasionally a local anesthetic can be used . In the latter instance then this can be performed as a day case.
How long does it take?
A rhinoplasty takes approximately 1 hour to perform.
What happens after the Surgery?
After the surgery you will notice that you will be propped up in bed with a couple of pillows in order to elevate your head and thus reduce the swelling around your nose. You will also notice that it will be difficult to breath through your nose. This will be because you will have packs placed inside each nostril. So try to remember to breathe through your mouth. Most patients report that the packs are the most unpleasant part of the whole operation. This is not because these are painful, but because you are forced to breathe through your mouth until these are removed, the following. However even once these are removed, your nasal passages will still feel somewhat blocked for the first couple of weeks due to normal post-operative swelling.
The bridge of the nose is usually protected after the operation by a plaster cast, which is worn usually for about 7-10 days. During this time you should avoid blowing your nose, stooping, and any vigorous activity for next three weeks. After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure.
What kind of after effects should I expect?
As the nasal bones are usually broken and reset, you should expect to have "black eyes" and some swelling of the face. This usually settles by 2-3 weeks although as soon as the plaster cast is removed you may, in fact, apply light make up to mask this.
It is very important to realize that even once the plaster cast is removed from the bridge of the nose there will almost certainly be a significant degree of swelling still present. Therefore the shape of the nose at this stage is not the final one. This obvious swelling will rapidly decrease in the ensuing 3-4 weeks. However, it is important to remember that even after this time, the shape of the nose is still not the final one. This is partly because of scar tissue which will form underneath the skin of the nose, as a result of the surgery, and which will have a subtle volume effect on the final shape. These internal scars gradually change their shape (called scar maturation) and resolve in time. It is important that the tip of the nose in particular is regularly massaged in order to prevent the internal structures from becoming fixed by this scar development, in an undesirable position. You will be instructed in this. The process of scar maturation will take up to one year, sometimes longer, to complete and therefore only after this time is the final ultimate shape of your new nose apparent. As a simple guide in assessing the progress of your nose, you should gently squeeze the tip of a normal nose, and then your own to compare the firmness. The firmer it is, the more time is required for it to settle. Bear in mind of course, that it is possible for an unacceptable result to occur because of the sometimes-unknown effects of healing and settling.
During the initial weeks, and sometimes months, the nose tip usually feels numb. This invariably recovers as the nerve supply to the skin regenerates.
Is it painful?
Remarkably enough, pain after this operation is not usually a problem and is easily relieved by an injection in the first few hours and a mild analgesic such as paracetamol as necessary afterwards.
What are the Scars like?
In most instances, all the incisions for a rhinoplasty, are placed within the nostrils and therefore cannot be seen. However as mentioned already, in some instances external scars may be needed to reduce the nostril size or to perform more complex nasal tip work. Although these scars are usually red and lumpy for the first few weeks, they do tend to settle in time. However, you must bear in mind that it is impossible to predict the final appearance of any scar.
What could go wrong?
All surgery carries some uncertainty and risk. When rhinoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Infection, as in any operation can occur but is thankfully quiet uncommon. Occasionally though, a "blind boil" type infection may occur on the skin of the nose. These can be quite uncomfortable and may take a week or so before they finally settle.
After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure.
Irregularities of skin, bone or cartilage may occasionally appear following surgery. These may show up on the surface as slight depressions, dips of bumps. Although through conservative measures and time, most of these situations improve, additional surgery may be required for correction.
Following a rhinoplasty it is possible, but again quite rare, for a series of thread or spider type veins to occur. These are permanent. However, laser can treat them effectively. It is also quite possible that surgery on a badly deviated or bent nose may not result in a perfectly straight, well-aligned nose. Many reasons may be responsible for this but it is conceivable, in particularly difficult situations, that two or more procedures may be required to remedy these noses. You will be advised at the consultation what the likelihood of this occurrence will be with you.
Overall however, there is a definite incidence of about 5% of patients who, along with their surgeon, feel that the shape of the nose at the end of 9-12 months is not quite what was intended. This happens more frequently in noses that have been the subject of severe nasal injury or previous nasal surgery. In these situations further procedures may be necessary to achieve correction. When secondary or revision surgery is carried out however, a higher incidence of complications and a higher degree of uncertainty with respect to the final results can be expected.
How long before I'm back to normal?
Most patients like to stay out of the public eye while their plaster cast is on. Once this is removed however, you will gradually start to resume your daily activities. This will largely depend on the amount of bruising and swelling you will experience. Most bruising has dissipated by about 2 weeks, although there may be some slight residual bruising present. This can usually be masked quite easily with makeup. Most people are back to work by about 10 days. Although slight swelling may still be present at this time, it is not usually noticeable to the majority of people. By 3-4 weeks most people are back to their normal routine and are enjoying their new nose. You will however need to avoid any contact sports for 3 months, while the nasal bones heal completely.
Summary
Having described many of the possible effects from rhinoplasty surgery it is important to bear in mind that the vast majority of procedures go according to plan. The chances are excellent that you'll be happy with your surgery, especially if you realize that the results may not be immediately apparent. By changing the most prominent feature on their face into a more desirable shape, many patients gain a feeling of increased self-confidence, improvement in body image, and general well being.
These notes are for guidance but you must realize that every patient is different with a different healing capacity. You should contact your surgeon in case of any specific concerns.
These notes are for guidance but you must realize that every patient is different with a different healing capacity. You should contact your surgeon in case of any specific concerns.