Nose Surgery (Rhinoplasty)

The Operation: What Happens during Surgery?

Rhinoplasty is a one- or two-hour operation for most people, under general anesthesia but can be performed under local anesthetic and sedation, though this is not common.

Incisions depend on what aspect is being corrected, but can be made from within the nasal lobes  - closed surgery – which is more difficult for the surgeon but which leaves no scars; or with ‘open rhinoplasty’ which entails making a small incision across the columella (between the nostrils) as well as some incisions within the nose.  Open rhinoplasty is used for more complicated surgery as it allows greater visibility.   Ensure you are familiar with the technique your surgeon prefers. 

During the operation, the skin of the nose is separate from the nasal structure (bone, cartilage) and then sculpted and repositioned.  Some operations require the removal or addition of cartilage while others involve the resetting of bone.  Skin is then reset, or draped, back over the underlying structure and secured with absorbable sutures. 

Recovery / Convalescence

What to expect immediately

When the surgery is over, a splint is applied to your nose to stablise its shape.  This is removed at around a week following surgery.  You may have nasal packs or malleable plastic splints placed inside the nostrils to support the septum.  These nasal packs also help prop up the divide between your air passages.  These aren’t that comfortable, but are generally removed fairly soon (even within two days) after surgery. 

In addition, you will be advised to use ice packs around your eye area to reduce swelling and to rest and sleep with your head elevated.  You will have regular pain-relieving medication once the anesthetic wears off. 

As with all cosmetic surgery, you will need to be patient and go through some immediate discomfort before you can see the full results of your rhinoplasty.  It is not uncommon in the first days to feel a little dejected as you will have a splint and be swollen.  Be kind to yourself and take time to get over the immediate convalescence before you assess your surgery.  Also, since the nose is fragile, ensure you follow all post-operative care instructions fully.  You will be given information on how to bath, wash your face carefully and so on. 

The extent of your discomfort depends on the nature of your surgery – if you had bones broken, you will obviously have more swelling and skin discoloration and a longer recover period.  In most instances, you will feel significantly better by around a week after surgery and start to see the results at around two weeks.

You are advised to refrain from medium and strenuous exercise for up to six weeks; in fact, anything that raises your heart rate too much as this may cause bleeding.  You can assume you can return to near normal work-social life within a week.  You will have a dressing on your nose for up to a week though. 

You can wear contact lenses, when you feel sufficiently comfortable to do so, but glasses are more problematic.  You will need to tape them so they don’t rest on the bridge of your nose.  You can return to wearing make up within around 10 days – 3 weeks of your operation.  These are general guidelines, and you must ask your consultant about your particular situation. 

Long-term Care

Rhinoplasty is permanent, and the immediate results are usually clear at two weeks.  But it is worth noting that your age, skin type, and propensity to heal will affect how your nose adjusts over time.  There may be small, almost imperceptible changes for up to six to 12 months. 

It is possible you will experience some numbness in the upper lip and tip of your nose even in the months following surgery.  Inform your surgeon and keep abreast of any abnormal signs or changes.

You may feel like you have a permanent cold as your nasal passages may feel blocked for several weeks.  Avoid the temptation to blow your nose or pick as this could lead to bleeding and undermine the healing process.

A little bleeding is common in the first weeks, but be careful with your nose and note any unexplained, or excessive bleeding in later weeks.  

Safety

With Rhinoplasty it is difficult to predict how you will feel about the outcome prior to surgery.  There are no guarantees in any cosmetic surgery, but rest assured that the majority of people find the benefits of rhinoplasty are long term and they feel physically and psychologically better having opted for it.  

Be aware that in around 20 per cent of cases, people do feel the need to have revisionary surgery to complete the look they hoped to achieve.  This is a risk you need to be happy about taking before considering rhinoplasty.  Any revisionary surgery will be carried out not sooner than a year after your initial operation. 

Most complications from rhinoplasty surgery are temporary and relate to possible infection or are due to immediate pain and swelling. 

All cosmetic surgery carries the risk of:

• Infection
• Allergic reaction to anesthetics or analgesics
• Lack of wound healing (excessive bleeding – hematoma)
• Blood clot (possibly deep vein thrombosis, or cardiac or pulmonary risk)
• Fluid accumulation
• Ongoing, excessive pain
• The need for further, possibly corrective, surgery
• Absorbable sutures causing skin ruptures and uneven healing of the scar tissue

What are the risks in Rhinoplasty surgery?

Immediate side effects

These include: temporary swelling, bruising around eyes, nose and headaches and some light bleeding

Immediate risks

Possible infection caused by bursting of small blood vessels which can result in permanent tiny, red spots.  This might require corrective surgery.  These spots are rare, but possible.  

Complications

No list can be exhaustive, but this includes some the possible, though mostly rare, complications of rhinoplasty:

• Assymmetry or undesired abnormality of shape of the nose possibly requiring corrective surgery and possibly also an implant.
• Reduction or obstruction of the nasal passages
• Ongoing, persistent bleeding
• Burst blood vessels
• Depression
• Discoloration
• Uncomfortaby raised scarring (keloids) or Internal scarring /lesions / bumps
• Reduced or complete loss of sense of smell
• Weakened nasal structure – less support than required
• Damage to nerves – causing temporary, and possibly permanent numbness (less than 1% risk)
• Perforation of septum
• Sinusitis (treated with antibiotics and medications that shrink the nasal lining)
• Skin irregularities
• Skin necrosis or skin death (this risk is far higher in smokers or those with diabetes)