Rhinoplasty is a term which covers several procedures to reshape the nose. Surgery can be used to alter the height, length and width of the nose; to straighten a bent nose; to change the shape of the bridge-line, tip or nostrils and/or alter the angle between the upper lip and nose. Sometimes breathing difficulties can be corrected at the same time - a “septoplasty”.

Rhinoplasty may be performed for cosmetic and/or functional reasons which may arise from “normal” variations and deformities after trauma; both may be associated with breathing difficulties, which may require a septoplasty. Common problems leading to a request for rhinoplasty include prominent dorsal hump, wide bridge and/or wide tip, the long nose, the large nose.

Anaesthetic

Most Irish surgeons prefer to carry out rhinoplasty under general anaesthesia.

Technique

Most rhinoplasty operations can be done using cuts made inside the nostrils so that there are no visible scars. Some surgeons use a technique known as “open rhinoplasty”; with this technique an additonal small cut is made across the nasal columella (the bridge of skin and cartilage in the midline between the two nostrils). Via these incisions the surgeon reshapes the bony part of the nose and the nasal tip. Any bridge line hump is cut away.

To straighten and narrow the nose the nasal bones are cut from where they join the cheek bones - the bones are then moved closer together. The length of the nose and the shape of the tip can be adjusted at this stage by reducing the amount of cartilage which shapes the end of the nose.

Narrowing the nose may make the nostrils seem too wide; if this is the case then they can be narrowed by cutting out a small triangle of nostril skin. It is occasionally necessary to add tissue to alter the shape of the nose; mostly this is as a graft of cartilage taken from the nose itself or from an ear via a cosmetic incision. If there are breathing difficulties then a septoplasty can also be performed using the same incisions.

At the end of the operation the incisions are stitched, sticky tapes are placed over the nose and a splint is applied to keep the nasal bones in the corrected position. Packs are often placed inside the nostrils for 24 - 48 hours. Folded gauze (drip-pad) is placed beneath the nostrils to soak up any minor bleeding which may occur. The splint and drip-pad are held in place using sticky tape applied to the face and forehead.

Length of Operation: 1 - 2 hours.

Time in Hospital: Usually an overnight stay

Post operative Discomfort/Limitations

Pain is usually mild and can be controlled by simple pain-killers. There is some discomfort because packs prevent breathing through the nose. There will be bruising and swelling especially around the eyes. Bruising may take 2-3 weeks to settle, most swelling has gone by this time; but a small amount of residual swelling exists for several months. The splint is left in place for 7-14 days. The nose should not be blown, nor crusts removed from inside the nose for about two weeks. The nose will be numb and feel “stiff” for several months following rhinoplasty.

It is essential that the surgeon understands what the patient thinks is wrong with their nose; unless a patient can decide what they dislike about their nose and can explain this to the surgeon, the surgeon will not be able to explain what is surgically possible and what is not. It is important to understand that the procedure has some limitations - for instance if the nose is very large there may be a limit to the amount of reduction that is possible; if the skin is very thick and oily it may not be able to reduce the bulk of the nose as much as wished for; if the skin is very thin irregularities after the operation may be very visible and if the nose is bent after an injury then it may not be possible to make it perfectly straight.

Time off Work

It is possible to return to work after a few days; however, in view of the bruising, swelling and splint most will stay off work for about 2 weeks until bruising has settled.

Risks and Complications

General anaesthesia is safe; but in a tiny proportion caries a very small risk of serious complication.

The most common problem after rhinoplasty is an unsatisfactory cosmetic result - about 10% of patients are not happy with the result (see below); excessive fullness just above the nose tip (“polly-beak” deformity) is the commonest problem.

Heavy bleeding may occasionally occur after rhinoplasty; this may be shortly after surgery or after about 10 days. Infection is very unusual and responds to antibiotics if recognised early enough. Difficulty with nasal breathing is common in the first few weeks following rhinoplasty - this usually settles with time; occasionally this is a permanent problem.
Outcome

About 10% of patients are not happy with some aspect of the result following rhinoplasty. This is may not be apparent for a few weeks when the swelling has settled. In most of these cases it is possible for the surgeon to carry out a second operation to try and correct the residual problems. This second operation should wait until all swelling has settled and the suppleness has returned to the tissues of the nose - this is usually after one year.