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Rhinoplasty (nose job)

A rhinoplasty or nose job is an operation that improves the appearance of your nose and sometimes your ability to breathe through your nose.

The nose is a complex structure consisting of thin skin in its upper portion and thick skin at its tip, overlying the nasal bones, upper and lower nasal cartilages. The lining of the nose is made of skin and mucosa which curls over internal bones and cartilages. These internal structures also play a significant part in the way your nose looks as they are the hidden scaffolding that supports your nose. Patients seeking a rhinoplasty can be concerned by one or many of the following:

  • a hump of their nose
  • a saddle hump
  • a broad nose
  • twisted nose
  • overly large tip of their nose
  • hanging tip of their nose
  • a long nose
  • change in appearance of the nose after an accident
  • noisy breathing
  • difficulty breathing through the nose

The consultation

The goal of rhinoplasty is to change the shape of the nose to suit your face.
Your surgeon will ask you to describe the problems you have with your nose, including its appearance and any breathing problems. A thorough medical history is taken in order to make sure you can safely have a rhinoplasty operation. It is important to bring a list of your medications with you to the consultation. Medications which increase your chance of bleeding eg aspirin, ibuprofen are stopped for one week before the surgery. Your surgeon will examine the structure of your face and nose and then take photos of your nose so that you can agree together on the surgical plan. The expectations and risks of the procedure are discussed, and

The surgery

A rhinoplasty is a one to three hour operation performed under general anaesthetic in hospital. Most patients require one night in hospital. Once asleep, your surgeon will make a small incision at the columella (the bridge of skin between your nostrils) that is continued into the lining of the nostrils. The skin of the nose can then be gently lifted away from the underlying cartilages and bone. The bones and cartilages are reshaped surgically according to a very specific plan determined during your consultation. Some patients require additional reinforcement of their new shape with cartilage struts. The cartilage struts are borrowed from the nasal septum. This can have an additional benefit of straightening the nasal septum. The skin is replaced over the newly shaped bony and cartilaginous skeleton and the small wound is closed with fine stitches. All stitches inside the delicate lining of the nose are dissolving and do not need to be removed. The new shape of the nose is supported with a thermoplastic splint sitting on top of the nose and nasal packing. These also help to control any post-operative bleeding.

After surgery

In the recovery room, an ice pack will be placed on your face and your head will be elevated to help control bruising and minor bleeding. You will be asked to breathe through your mouth until the nasal packs are removed the morning after surgery. On discharge from hospital, your face will be bruised and swollen. The bruising of your face improves over the next week. The swelling of your nose persists for up to three months, when you will finally be able to see the new shape of your nose.

It is advisable that you do not work for two weeks following the surgery. Exercise and heavy lifting should be avoided for six weeks after surgery to ensure that accidental trauma does not occur to your new nose while the scarring settles.

Over time, the shape of your nose can continue to change. Approximately ten percent of patients will require a “revision rhinoplasty” in order to re-establish the structure of the nose.