If you’re considering nose reshaping surgery, or a ‘nose job’, Mr Alok Misra, Consultant Plastic and Cosmetic Surgeon at One Hatfield Hospital, has the answers to some of the questions you are likely to be asking.
What is a rhinoplasty?
A rhinoplasty is the name given to the surgical procedure designed to change the shape of the nose and/or improve nasal breathing. One of its specific aims is to alter the nasal appearance to achieve an overall natural balance with the rest of the face.
Patients who have consultation for rhinoplasty frequently mention appearance concerns relating to their nose. It can sometimes be one thing or a combination. For example, it could be a bump on the back of the nose; a bent nose, a boxy nasal tip, a droopy tip, wide nostrils; one that sticks out too much, not enough or a mixture of features. Rhinoplasty can alter any of these concerns to improve a patient’s confidence and self-esteem.
Rhinoplasty can also improve nasal breathing. A blockage in one or both internal nasal passages from injury or due to normal anatomical variations can impact on nasal breathing. In a bent nose the septum may need straightening (septo-rhinoplasty). Sometimes an ENT specialist may be needed to assess your breathing before your rhinoplasty can be done.
Can I choose any shape for my new nose?
A good starting point when consulting with your surgeon is to describe what your ideal nose shape is. You are encouraged to bring along photographs of your ideal nose to the consultation. Your surgeon will then assess your nose and discuss what nose might suit your face best. Often a compromise has to be reached between your ideal nose and what is realistically achievable. However, by learning about what your nose assessment shows, the surgical plan needed and looking at before and after photographs, it is usually possible to get to a place where you can have a good idea about what your new nasal shape will be, after having your rhinoplasty procedure.
What does a rhinoplasty involve?
There is no one rhinoplasty that suits all. Your rhinoplasty will be tailored to your specific requirements and the anatomical changes needed. Commonly it can involve removing a bony hump, breaking the nose, making the nostrils smaller, lifting the nasal tip or reducing it or straightening a bend in the nose (septo-rhinoplasty). Most rhinoplasty procedures will be done under general anaesthetic with an overnight stay in hospital.
Is the procedure always done in the same way, or are there different techniques?
Currently, there are many types of rhinoplasty: non-surgical rhinoplasty using dermal fillers, ultra-sonic assisted rhinoplasty and preservation rhinoplasty. These options will be discussed at your consultation if they apply to you. Traditionally, however, there are two categories of surgical technique that still apply to all rhinoplasty patients: open rhinoplasty and closed rhinoplasty.
With an open rhinoplasty, an incision is made on the outside skin (columella) and on the inside of the nostrils. This technique allows the surgeon to see directly and alter any structures that need to be altered. It helps the surgeon make precise changes at the time of the procedure, that otherwise would not be possible to see.
A closed rhinoplasty involve only incisions in the inside of the nostrils. Scarring is well hidden but access to all nasal structures can be more limited. It is a good option to use when only certain parts of the nose need adjustment.
What is the minimum age for this surgery?
Nose development is complete by the age of 16, but it is unusual to perform rhinoplasty in anyone below 18 years of age. However if breathing issues need correction, surgery may be considered earlier.
The commonest age group of patients who have rhinoplasty is from early 20s to mid 30s.
How long will it take to fully recover?
The first week usually requires rest indoors and dealing with dressings and a nasal splint. Stitches may need to come out at the end of the first week. Most rhinoplasty patients will take time off work beyond 1 week after the procedure to allow time for swelling and bruising (commonly black-eyes) to settle. Although, not always predictable, it may take 2-3 weeks for a lot of the swelling to subside and the bruising to begin to fade, such that going back to work at a desk, for instance, is possible. More hands-on type jobs (eg. involve heavy-lifting) may need more time off. Driving should be avoided for 2-3 weeks.
In most patients, it will take 6-8 weeks for most of the healing to take place and the swelling and bruising to disappear, such that the recovery is complete. It is advisable to avoid contact and ball sports until the nose has fully recovered.
A small proportion of patients may take longer to recover, especially at the tip of the nose. It is not unusual for tissue swelling and for a return in feeling to take up to 1 year in some situations.
How much pain should I expect?
The majority of rhinoplasty patients wake-up from the operation pain-free.
If you are prone to headaches, the first week to 10 days can feel like a bad head cold and may aggravate your usual headache symptoms. Simple pain-killers (e.g. paracetamol and ibuprofen) will usually help. Skin and internal nose healing can be sensitive for months afterwards, but firm massage tends to decrease the sensitivity over time.
Are there any risks?
No surgical procedure is ever risk free and rhinoplasty is no exception. Common early ones are bleeding, bruising, swelling, altered nasal breathing and headaches. Later ones include persisting swelling, numbness at the tip, septal perforation and unsatisfactory result.
Most patients who have rhinoplasty are happy with their results. About 10% of patients will need a revision operation, mostly from unexpected healing changes like scar tissue, swelling or imbalances.
The guide price for a rhinoplasty at One Hatfield Hospital is £4,945. As you have read there are many variations in the requirements of the patient and the surgeon’s approach, so a final price will be confirmed following a clinical assessment.