Rhinoplasty

Introduction

During the consultation, you will be asked a general medical history including details of previous nasal injury or surgery. Anthony will wish to know why you are unhappy with the shape of your nose, whether you have a hump on the bridge, a prominent tip or any other deformity. The most common request is to reduce the size and shape of a large nose, but occasionally an increase in profile is appropriate. Feel free to bring photographs of the nose you wish to have, but remember, everyone is different. For instance, skin thickness varies enormously, so a small delicate nose cannot be made from a large thickened one. Computer simulation may be used to better appreciate your expectations and to clarify what is feasible.

Procedure Details

A “closed” rhinoplasty is carried out under general anaesthesia through incisions inside the nostrils. If the tip of the nose requires considerable re-shaping, a small scar under the nose may also be necessary – an “open” rhinoplasty. In rhinoplasty, firstly the hump is removed to give the new profile. If nothing else were to be done, the bridge-line would be too wide and so it is usually necessary to fracture the nasal bones in a carefully controlled way, to allow them to meet in the mid-line to make a narrow bridge line again.

A small plaster cast is required for seven days to support and protect the bones while they set into their new position. Cartilages underneath the skin shape the tip of the nose. These are adjusted in size and shape to refine the nose so that it matches the new profile. When surgery is complete, small dissolvable stitches are used inside the nostrils and the tapes and plaster cast are applied.

Sometimes it is necessary to implant tissue into the nose to obtain the desired result. This procedure is termed ?using a graft?. The tissue may be obtained from the nose itself, from the cartilage of the ear, occasionally from a rib or by means of a man-made implant. Nasal packs may occasionally be necessary to prevent bleeding and ensure the lining of the nose sets in correctly. Consequently, the patient has to breath through the mouth until they are removed which is usually within 24 hours (a simple procedure). Even if packs are not used, you will feel blocked up and unable to breath fully through the nose due to normal post-operative swelling.

Summary

Patients need patience. Remember, it takes at least six months – often longer for the final result to be revealed. Please discuss fully, your requirements, with the Anthony. Make sure that both you and he have discussed what you wish to see and whether it is possible in your case.  Secondary procedures are usually a case of minor adjustments but you should bear in mind, that surgery of this nature cannot be carried out immediately. The nose has to be allowed to settle before further surgery is safe or desirable. Rhinoplasty has been carried out successfully for many years and this is one of the most sought after procedure amongst men and women. The vast majority of patients undergoing rhinoplasty gain a feeling of increased self-confidence with improvement in their body image.

Aftercare

Pain after this operation is not usually a problem and is easily relieved by an injection for the first few hours and a mild analgesic such as Paracetamol as necessary afterwards (Aspirin must not be taken). You should avoid stooping or vigorous activity for two or three days to reduce the possibility of a nosebleed. It is imperative not to blow your nose for about a week after surgery; however, you may loosen and remove any crusts or clots on the insides of the nostrils. This is done using a little Vaseline or just water on a cotton bud rolled around the inside of the nostril margin.

As the nasal bones have to be re-set in a rhinoplasty operation, you may have some mild bruising and your cheeks may be swollen. If this occurs, most of the swelling will settle in two weeks and you may use makeup to cover any bruising as soon as the plaster has been removed after the first week. The scars may be a little red at first but are hidden in the natural shadows of the nose. It is normal for the nose to feel a little numb after surgery but the sensation recovers as the nerve supply to the skin regenerates.

It is essential to realise that the shape of the nose, when the cast is removed, is not the final one. Scar tissue forms underneath the skin of the nose and although it is not visible, it may have a profound effect on the final shape. The internal scars gradually change their shape. The process of this scar maturation takes on average six months and sometimes much longer. It is generally observed that the thicker the nasal skin, the longer the period of scar resolution.

General advice

You should arrange for someone to drive you home from hospital. You will experience mild to moderate discomfort after your surgery and it is recommended that you take one or two pain relieving tablets (such as Paracetamol) on a regular basis for the first few days. DO NOT TAKE ASPIRIN OR ANY PRODUCTS CONTAINING ASPIRIN as this may prolong or cause bleeding in the early post operative period. There maybe some swelling and bruising following surgery, though this should settle over the first week. You are advised to sit upright throughout the day and prop yourself up with a couple of extra pillows at night for the first two weeks, post operatively. You should avoid getting the operation site wet for the first week.

Post surgery meeting

The nasal splint will remain undisturbed for 7 days. You will then be seen by the Anthony in the dressing clinic who will remove this and inspect your nose. The stitches use are dissolving and so do not need to be removed.

Bathing

Once the splint is removed you can get your nose wet in the shower each day, as this will speed up the healing process.

Smoking

I always advise that it is very important to stop smoking prior to your operation in order to reduce the risks of complications such as infection or slow healing of the wounds, DVT or PE. You should avoid smoking for the first two weeks post operatively.

Returning to work

Following surgery, the type of job that you do determines when you can return to work. If you mainly confined to deskwork, you may feel able to return to work after one to two days, however, more physical occupations may require a week of recuperation before you feel able to return to work.

Exersize

It is important to rest as much as possible for the first 48 hours after surgery, after which you can recommence gentle activities and household chores, but should refrain from undertaking sustained exercise for at least two to three weeks. You are encouraged to move around at home as much as possible and not lie in bed for protracted periods as this would increase the chance of a post-operative thrombosis in the leg or lung (DVT or PE). For the first 4 weeks post operatively I advise to avoid doing any contact sports.

Skin care

Massage and moisturise the nose gently 3 times a day with a good quality moisturiser.

Complications

Though the vast majoity of patients experience an uneventful post operative recovery, if you develop any of the following you should contact Mr Armstrong’s team:

  • Temperature greater than 38.5°
  • Severe pain not alleviated by simple painkillers
  • Fresh bleeding, not stopped by sitting upright for 30 mins with firm pressure on the nose
Before and After Gallery

Patient Journeys

  • I feel completely refreshed and although some people did not see why I wanted to have it done I did and it has made me feel renewed. Well done to Anthony and his team for their support and care. So recommended.

  • I feel so appreciative of my surgery and I would like to highly recommend the expertise of Mr. Armstrong and his professional and caring team.

  • Once the bandages came off my ears, I was able to see just what a fantastic job Mr Armstrong had done.