Table of Contents
Rhinoplasty is the medical term for a nose job. This procedure aims to change the size or the shape of your nose. This rhinoplasty overview will provide you with more information on this surgery and what it can achieve.
Your nose is the central feature of your face. In addition, its size and shape contributes to your facial balance. While you inherit the features of your nose from your parents, these features usually only begin to develop during your teenage years. A wide variety of nose shapes and sizes can be found on the faces of those around you and everyone has different ideas about what they think a ‘good’ nose looks like.
Consequently, some people are unhappy with the size or shape of their nose. As a result, they may consider having a rhinoplasty. Some people may have experienced trauma or injury that has damaged their nose, and they may, therefore, wish to fix this. Others may experience difficulty breathing because of their nasal structure and would like to have a nose job to fix this.
What can a rhinoplasty achieve?
This procedure can achieve a number of things, including:
- Improving breathing difficulties. Another term for this is a functional rhinoplasty.
- Reducing the size and profile of the nose. Another term for this is a reduction rhinoplasty.
- Increasing the size and profile of the nose. Your surgeon may refer to this as an augmentation rhinoplasty. This surgery may require the use of a graft or a nasal implant.
- Re-modelling the shape of the tip, bridge and/or nostrils of your nose. This may involve breaking the nasal bone and rearranging the cartilage.
- Altering the angle between the nose and upper lip.
Who are the best candidates for a rhinoplasty?
Rhinoplasty is a popular cosmetic procedure in the UK for both men and women. Another name for this surgery is a nose job, and it involves altering the size and/or shape of your nose. Rhinoplasty candidates may choose to have this surgery because of an issue with the appearance of their nose. They may also opt to have this procedure done because they are experiencing breathing issues. These can include loud, noisy breathing which is caused by a structural obstruction. In addition, these candidates can also snore very loudly when sleeping due to the same structural issues.
You may be a suitable rhinoplasty candidate if you:
- Are unhappy and conscious of your current nose shape or size.
- Would like to correct damage or injury which has occurred to your nose.
- Have breathing difficulties because of your nose.
- Snore loudly.
- Have a healthy BMI.
- Are relatively fit and well.
- Have no serious health conditions.
- Have realistic goals for your surgery.
- Feel mentally and emotionally ready for the procedure.
Why have a rhinoplasty?
As mentioned above, there are a number of different reasons you may consider having a rhinoplasty. These reasons include the desire to make changes to how you look and to make changes to improve your health. A rhinoplasty can, therefore, achieve the following changes:
- Change the size of your nose.
- Change the shape of your nose.
- Improve the confidence you have in yourself.
- Fix any damage caused by previous trauma or injury.
- Change your nasal structure to help with breathing difficulties.
A rhinoplasty can alter your whole facial balance, therefore we recommend you take time after your consultation to make sure this procedure is definitely what you want. Furthermore, you should consider how changing the appearance of your nose will affect the dynamics of your other facial features like your eyes, your mouth and your chin.
How is a rhinoplasty procedure performed?
A rhinoplasty procedure usually takes anywhere from 90 minutes to 3 hours to perform. Often the anaesthetist uses a general anesthetic to put you to sleep for the procedure, however, they can use local anesthetic with sedation too. After the procedure is complete, you may have to stay in hospital for 1 or 2 nights.
You will meet your surgeon to sign your consent form before the procedure takes place. This may happen at your pre-operative consultation or on the day of your surgery. Although you may be aware of the risks and complications, we advise that you read the consent form fully before signing your consent. Your surgeon may use a marker to draw some lines on your nose and may also ask for permission to take some before and after pictures.
You will meet your anesthetist on the day of your surgery. They may decide to use a general anaesthetic to put you to sleep for the surgery or they may decide to use local anaesthetic with sedation. The choice of which to use will be made during your initial consultation. If they use a general anaesthetic, you may feel drowsy for a while after.
Your surgeon can perform a rhinoplasty by using an open or a closed approach. Your surgeon will decide which approach will best suit your nose when examining you at your consultation.
For a closed rhinoplasty, your surgeon will make an incision inside each one of your nostrils, through which they will perform the surgery. An advantage of this technique is that there will be less swelling and no visible scarring after surgery.
In an open rhinoplasty, your surgeon will make incisions inside the nostrils, and an extra incision on the outside along the columella, which is the area of skin between your nostrils. The benefit of this approach is that it allows greater alteration of the nose shape, which may not always be possible with a closed approach. This technique is most useful when you want to increase the frame of your nose.
Grafts and Implants
Surgeons do not always require the use of a graft or implant in all rhinoplasty procedures. However, they may use them to define and build the nose in an augmentation rhinoplasty.
A graft is when your surgeon uses tissue from your own body and moves it to another part of your body. For a rhinoplasty, this may involve taking cartilage from the ears or bone from the hip, elbow or skull to build up the nose. This means that your graft will consist of your own tissue. Therefore, there is less chance your body will reject it. There is, however, the risk that it may absorb or shrink to some extent with time.
In some cases, your own tissue may be too small or weak to support the changes you would like for the procedure. Consequently, your surgeon may choose to use a synthetic nasal implant. These implants are made out of approved materials such as silicone or Gore-Tex, and have the advantage of not shrinking or changing over time.
4. Closing of incisions
Next, your surgeon will use sutures to close the incisions. In addition, they will pack both nostrils using dressings and will apply a splint to your nose to hold it in its new position.
5. Return to the ward
Finally, once your surgery is over, the medical staff will take you back to the ward. If you have had a general anaesthetic you will wake up gradually and may feel drowsy for a few hours. You will be able to return home after 1 or 2 nights, depending on how well your recovery is going.
What should I expect from my rhinoplasty consultation?
You will meet with your surgeon for a consultation before having your rhinoplasty. During this meeting, your surgeon will examine your face and nose and may ask for permission to take some before and after pictures. Your rhinoplasty consultation will usually last between 15 minutes to 1 hour. It will be an opportunity for your surgeon to discuss the procedure with you and find out more information about you. They will ask for:
- Your current health status
- Any medical conditions you have
- Your past medical history
- Your past surgical history
- Any medications you take. This includes prescription, over-the-counter and herbal medications
- Your alcohol consumption, smoking, and recreational drug use
- Any allergies you may have
- Your goals for the surgery.
We strongly advise that you are as honest with your surgeon as possible at this consultation so they can gather accurate information about you. Being open and honest allows your surgeon to formulate a clear picture of your health and in turn, allows them to make decisions that are appropriate for you. If the information you provide is not accurate, you may hinder their ability to make good decisions about your care. Furthermore, it is in your best interests for your surgeon to have a true idea of your personal goals for your rhinoplasty. This way, they can assure you whether or not your goals are realistic and as a result, you are more likely to be happy with the final results.
What questions should I ask during my rhinoplasty consultation?
While your consultation is an opportunity for your surgeon to ask you questions, it is also the time when you get to ask any questions you may have. We recommend that you spend some time thinking of questions beforehand and writing them down. Consequently, you will feel prepared and you are less likely to forget to ask the things that are important to you! Below is a list of questions you may like to ask:
- Is a rhinoplasty suitable for me?
- Which surgical approach do you think is best for me?
- Will I be in pain after the surgery?
- Will there be any scarring and if so, where?
- How long will it take me to recover from my rhinoplasty?
- Do you think my expectations are realistic?
- Have you got any before and after pictures of rhinoplasties you have done previously?
- What are my options if I am not happy with the results?
Risks & complications
What are the main rhinoplasty risks and complications?
Before you consent to having a nose job, you should take time to consider the risks and complications of the procedure. Many of the rhinoplasty risks and complications are rare, and you may, therefore, think it is unnecessary to know about them. It is, however, vital that you fully educate yourself on them.
Our surgeons strongly recommend that you wait at least two weeks after your consultation before you agree to have the surgery. This will give you time to make an informed decision about the procedure.
The rhinoplasty risks and complications include:
Minor bleeding is common after this procedure. It is common to experience mild nosebleeds. Your surgeon will be able to give you advice on how to manage these if they occur and how best to avoid them.
Heavy bleeding is rare but is possible and may be severe. This can happen directly after the procedure or a few weeks after and requires immediate medical attention.
Surgery is invasive and introduces the risk of infection to your body. If you develop an infection because of your surgery, you will notice that things are not settling down as expected.
Signs of infection to look out for are:
- A temperature of 38° C or over
- Redness at the wound line that begins to spread away from the wound
- Yellow pus-like or foul-smelling fluid from your wounds
- An increase in pain or discomfort that is your pain medication does not help.
Mild infections (often wound infections or delayed wound healings) usually settle down with antibiotics. There is a small chance that an infection may affect the final results of your operation. If this were the case, you may require further surgery.
It is quite common to have difficulty breathing through your nose during the first week after your operation. This may be due to the swelling within the nostrils. This is because the swelling reduces the area of the nasal airway. Although uncommon, these breathing disturbances may continue and become permanent. This should however, not be the case as all rhinoplasty procedures try to optimise your breathing.
Altered sense of smell
A change in your sense of smell is temporary in most cases and is usually only noted when tested for by a doctor. A total, permanent loss of smell is a very rare complication of a nose job.
Damage to the nasal septum
Damage to the cartilage wall in the middle of the nose (the septum) may occur during this procedure. Depending on the extent of damage, medical and/or surgical options are available to fix this. You may like to ask your surgeon about these options at your consultation.
Graft or implant migration
In cases where an implant has been used in an augmentation rhinoplasty, there is a small risk that the implant may make its way out through the skin of the nose or its lining. This may occur out of the blue, months or years after your operation. It may also happen if there is an injury to your nose. You may require another operation to fix this.
Scarring from your nose job is normally not visible, especially if your surgeon uses a closed incision approach. However, the extent of scarring is highly dependent on the ability of your skin to heal. You may like to ask your surgeon about the scars specific to the technique that they choose for you.
There is always the risk that you will be unhappy with the result of your procedure and the appearance of your nose. We, therefore, advise patients to choose their surgeon carefully and make sure he or she fully understands your goals before you have your surgery.
In patients who require further rhinoplasty-related surgery, there is a risk that the structure of the nose may collapse. This is because the nose is a delicate structure. Therefore, re-operation is only recommended in a small number of cases.
Preparing for your treatment
How can I prepare for a rhinoplasty?
After your surgery, you will want to be able to relax as much as possible to aid your recovery. Getting things prepared before your surgery can help you to do this. We have put together a list of rhinoplasty preparation tips that we hope you will find useful!
We appreciate that getting on top of household chores can sometimes be difficult on a normal day! Therefore, we recommend that you try to get some of the big jobs out of the way before your surgery. For example, you may like to do the laundry, take out the bins and do a general clean the day before your procedure. This way, you will hopefully not have to stress or worry about doing these things in the first few days of your recovery.
It is likely that you will not feel like going to the supermarket to do a food shop in the first few days after your rhinoplasty. Therefore, we advise that you do a big food shop and stock up the fridge a day or so before you come into the hospital for your surgery. You may even like to make some meals and freeze them. This will mean that you won’t need to worry about cooking for a few days, as your nose begins to heal.
Children and pets
To minimize your stress levels during your recovery, you may like to organize that some family or friends help you to look after your young children and pets.
It is important that no pressure is applied to the nasal bone in the weeks following your rhinoplasty. Consequently, if you normally wear glasses, you should avoid using these for the first 6 weeks after surgery, at least. You may like to purchase some prescribed, temporary contact lenses for this period of your recovery before your operation.
You will be unable to drive yourself home after your surgery. You may like to ask a family member or friend if they will be able to collect you from the hospital.
After the surgery, your surgeon will recommend that you eat high-protein, low-sodium foods, including fresh fruits and vegetables. You should try to stay hydrated with water and caffeine-free beverages. We recommend that you avoid consuming high amounts of salt and sugar during your recovery time.
Following your rhinoplasty, you should wear items of clothing that fasten easily from the front or the back. Avoiding clothing that needs to be pulled over your head will help you to avoid the treatment area. This will help you to feel more comfortable.
You may find it more comfortable to sleep propped up after surgery, so make sure you have plenty of extra pillows. We advise that you rest and sleep in an inclined position on your back for the first few days. This will help to avoid contact with the treatment area and will also help reduce swelling.
Your surgeon will give you specific advice on your rhinoplasty preparation. Following your surgeon’s advice will help to achieve the results you desire.
What can I expect after a rhinoplasty?
Your consultant will speak to you about your rhinoplasty aftercare during your consultation for the surgery. They will give you specific time frames for when you can begin to start activities like driving, exercising and when you can go back to work.
We like to stress the importance of following the advice of your surgeons. We know it can be hard to slow down the pace of your life and refrain from certain activities. Despite this, you must remember that your surgeon’s advice is in the best interests of your recovery. Your surgeon will also explain about any medications you may have to take or apply after the procedure.
Below are some general rhinoplasty aftercare tips:
Directly after the surgery
If your surgeon decides to use a general anesthetic, you will awaken slowly after the surgery. Your memory and concentration may be affected, however, this will only last for 1 to 2 days. If your surgeon chooses to use a local anaesthetic, you may experience altered sensation on your nose but this will eventually wear off. You will not be able to breathe through your nose for a while after your surgery.
You should expect to experience some pain, swelling and bruising around your nose and eyes after your surgery. This can take 3 to 6 weeks to settle. In the meantime, you can manage it by using a cold compress and over-the-counter pain relief such as paracetamol. You should also sleep with your head propped up by pillows for a couple of days. This will help to reduce swelling and in turn, pain.
It is likely that your surgeon will “pack” both your nostrils with dressings and apply a splint to your nose to maintain its new shape. Because of this, it is important that you remember to breathe through your mouth following your rhinoplasty. If you need to sneeze, you will need to try and remember to do this with your mouth open. You should avoid blowing your nose or removing any crust until your surgeon removes your splint. They usually remove the splint around 7 to 10 days after your operation during your follow-up appointment.
Returning to work
After your procedure, we recommend that you take around 2 weeks off before you return to work. In addition, it is essential that you avoid dusty or smoky areas and heavy lifting for at least 4 to 6 weeks.
Returning to exercise
You should avoid strenuous activity, heavy lifting and contact sports for at least 4 to 6 weeks.
You should try to avoid blowing your nose and sneezing after your surgery. If you usually struggle with allergies, you may like to avoid any known triggers. We also advise that you avoid hot baths and getting your splint wet after your procedure until you no longer need to wear it.
You may see an instant difference to your nose in the first few weeks following surgery. Despite this, it can take around 6 to 12 months to appreciate the full cosmetic results so it is important to be patient.
Usually, your scars tend to be pink and raised in the first few weeks after surgery but they will eventually fade to faint white lines over the following months. As the incisions used for this procedure are either inside the nostril or on the area of skin between the nostrils of the of the nose, scarring will be well hidden.
Your nose will feel stiff following an augmentation rhinoplasty and this is likely to be a permanent change. This is because it no longer has the flexibility of the natural frame of the nose. Most rhinoplasty patients say that you get used to this change with time.
Following your surgeon’s specific rhinoplasty aftercare advice will reduce the risk of complications and help achieve the best results from the procedure.
What are some common rhinoplasty FAQs?
We have listed some of the most common rhinoplasty FAQs below. These may answer any questions you have or may help you to think of more to ask at your consultation.
Will the NHS pay for my rhinoplasty?
This procedure is not usually available on the NHS for cosmetic reasons. However, it may be provided by the NHS if you require the surgery to help with breathing difficulties.
What are the limitations of a rhinoplasty?
There is a limitation to the amount of reduction that can be achieved if you have mature skin or a very large nose. This is due to the elasticity of the skin and its reduced ability to shrink down to a smaller frame. Equally, it may not be possible to make the nose as large as you may desire.
In addition, if you have had a change in the contour of your nose from an injury, it may not be possible to completely correct this.
When can I wear glasses again?
Your surgeon will advise that you wait for at least 6 weeks after surgery before wearing glasses. This will prevent the application of pressure to the nasal bone. You should ensure that if you must wear glasses that they are loosely fitted and padded in order to protect the results of your rhinoplasty. You could also use a nose guard or tape to lift your glasses off your nose.
What effect do smoking, alcohol, and drugs have on a rhinoplasty?
There can be an increase in the risk of complications from surgery if you are a smoker. We strongly recommend that you stop smoking and using all nicotine products at least six weeks before surgery. Furthermore, if you can reduce your alcohol consumption before your surgery, this can also benefit you.
Taking recreational drugs will also increase the risk of complications occurring during and after your procedure.