Nose surgery (rhinoplasty)

Rhinoplasty is surgery to repair or reshape the nose. This may be performed for cosmetic reasons to improve the appearance and proportion of the nose, and improve a person’s self-confidence. Plastic surgery of the nose can also correct breathing problems caused by structural abnormalities in the nose due to injury or birth defect.

Almost all of these operations are performed through the nostrils, which means there are no visible cuts (or subsequent scars) to the face.

Rhinoplasty can change the size of the nose as well as its width and profile. The nose tip, shape of the nostrils and balance of the nose (nasal symmetry) can also be altered. Surgery of the nose can reduce or augment structures of the nose using cartilage grafted from other areas of the body. Occasionally, a piece of cartilage from the ear and (rarely) a section of rib cartilage may be used.

If you are concerned about the way you look, or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These may include lifestyle changes or accepting yourself the way you are.

Conditions of the nose

Some of the conditions that can be corrected by rhinoplasty include:

• Broken nose
• Birth defects of the nose
• Nasal obstruction
• Self-consciousness about the size or shape of the nose.

Things to consider

Before you opt for rhinoplasty, there are some important issues to keep in mind:

• Your surgeon can only work with the existing bone and cartilage structure, so there are limits to how far you can alter the shape of your nose. Make sure your surgeon understands why you want the operation so they can decide the best method of reconstructing your nose to your satisfaction.
• If you need surgery to repair a broken nose, it is best to seek medical attention straight away. Otherwise, the swelling of the tissues can delay surgery for around five days.
• Nose surgery to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. It is essential that the surgery doesn’t interfere with your breathing, so this may prevent you from having certain procedures. If the septum is deviated, your surgeon may recommend that it be straightened and the projections inside the nose reduced to improve breathing.
• The final results may take up to 12 months to emerge, so it is important to wait before making any decisions about the necessity for further surgery.
• Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies.
• Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should try to quit smoking.

Finding a surgeon

You may want to ask your doctor (GP) for advice on a suitable and reputable specialist surgeon or hospital where rhinoplasty is performed. At your first consultation, you should ask the surgeon about their training and experience. It is preferable to have this procedure done by a reputable professional who is specially trained to perform rhinoplasty and has a lot of experience in carrying out this type of surgery.

Medical issues

Before the operation, you need to discuss a range of medical issues with your doctor or surgeon. They will talk to you about your:

• Physical health – an examination will help your doctor or surgeon to decide if the treatment is appropriate.
• Medical history – some pre-existing medical conditions and surgery you’ve had in the past may influence decisions about this operation, including the type of anaesthetic that is used. Rhinoplasty can be performed using general or local anaesthetic, depending on the extent of the surgery required, your health and the preference of your surgeon.
• Risks and possible complications – it is important that you understand the risks and complications so that you can weigh up whether rhinoplasty is right for you.
• Medications – tell your doctor and surgeon about any medications that you take on a regular basis or have recently taken, including over-the-counter preparations like fish oils and vitamin supplements.
• Past reactions to drugs – tell your doctor and surgeon if you have ever had a bad reaction or a side effect from any drugs including anaesthesia.
• Preparation for surgery – your surgeon will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular drug or alter the dose of an existing medication. Follow all instructions carefully. If swelling of the tissues is present due to injury or trauma to the nose, your doctor may give you a course of antibiotics to take before surgery to reduce the risk of infection.

The rhinoplasty operation

The operation depends on factors such as the reasons for the surgery, but can include:

• Anaesthesia – you will be given a general or local anaesthetic.
• Surgery to repair injury (trauma) – to repair a broken nose, slender instruments are usually inserted into each nostril to gently push the bones back into their proper alignment. A bad break may require a small cut (incision), so that the surgeon can see to arrange the bone fragments correctly.
• Cosmetic surgery – rhinoplasty for cosmetic reasons can include ‘open’ or ‘closed’ techniques.
• ‘Open’ technique – this involves accessing the nasal bones through incisions inside the nostrils and through the columella, the narrow strip of tissue that separates the nostrils.
• ‘Closed’ technique – this involves accessing the nasal bones through incisions that are hidden inside the nostrils. Once the incisions are made, the skin is lifted away from the underlying bones and cartilages.
• Surgical procedures – this depends on the reshaping required. For example, the nasal bones may be chiselled or broken and realigned or the cartilage may be trimmed back.
• Stitches – incisions are closed with dissolving stitches.

Immediately after rhinoplasty

After the operation, you can expect:

• Pain
• Swelling and bruising, mainly around your eyes – the swelling should go down in a few days and the bruising may go away in the first week or two
• The sensation of a ‘stuffy’ nose
• Numbness
• Dressings and splints to support healing – the inside of your nose will be packed with special gauze. Your nose bridge will be covered with a splint, commonly made of plaster of Paris. The splint helps to minimise swelling and keep your nose in its new profile while healing takes place. Sometimes, a small tape may be placed over the nose to keep the dressings in place
• Blocked nasal breathing – you will have to breathe through your mouth until the packing gauze is removed.

After the first few hours:

• You can get up out of bed and move around.
• You should be able to eat anything you like – you may have to wait four or five hours before you are able to eat and drink. .
• If you need pain relief, ask the nursing staff.

Complications of rhinoplasty

All surgery carries some degree of risk. Some of the possible complications of rhinoplasty include:

• Risks of anaesthesia including allergic reaction, which (rarely) may be fatal
• Surgical risks such as bleeding or infection
• Rupture of small surface vessels of the nose
• Delays in healing
• Sudden nosebleeds
• Unevenness (asymmetry) or irregularities in the shape of the nose – these may settle with time
• Alterations to nasal airways – these may occur after a rhinoplasty or septoplasty.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. You need to speak to your surgeon for more information.

Taking care of yourself at home

Be guided by your surgeon, but general self-care suggestions include:

• Follow all instructions on looking after your wounds and how to best keep your nose clean.
• If you have any medications to take home from hospital, be sure to ask what they are for and how often and for how long you have to take them. If you are prescribed antibiotics, make sure you take the whole course.
• Hold your head upright as much as you can.
• Your bandages and packing gauze may be left in place for up to a week or so. Your surgeon will then remove the dressing and take out the nasal packs.
• Avoid blowing your nose.
• Report any bleeding, severe pain or unusual symptoms to your surgeon, including sudden nosebleeds.
• You may need to be off work for around two weeks.
• Avoid contact sports (or any activities that could cause your nose to be knocked) for about six weeks.
• Broken nasal bones may hurt or ache for up to eight weeks. See your surgeon for advice on appropriate pain relief. Remember that aspirin can increase the risk of nosebleeds.
• Make an appointment for a later check-up with your surgeon after about one week.

Long-term outlook

Swelling may come and go and worsen in the morning during the first year following your nose surgery. The results of rhinoplasty are usually permanent. You will be able to see the difference in your nose shape as soon as the surgeon removes the dressing and nasal packs (some seven days or so after the operation). However, it is important to realise that your ‘new’ nose may take time to fully refine.

Even though initial swelling subsides within a few weeks, it may take up to a year to adjust to its final profile. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

A broken nose, once healed, isn’t as strong as a nose that’s never been broken, which means it is at increased risk of fracturing again if you experience a blow to the face. Take all precautions – for example, wear protective headgear while playing sports and use a seat belt when travelling in a car.

Other options

There are no other medical alternatives to rhinoplasty that can repair or reshape the nose. Talking to a counsellor or psychologist may help you overcome your concerns about your appearance and you may decide that you like yourself the way you are.

Where to get help

• Your doctor
• Plastic surgeon
• The Australian Society of Plastic Surgeons Information Hotline Tel. 1300 367 446
• Royal Australasian College of Surgeons Tel. (03) 9249 1200

Things to remember

• Rhinoplasty is surgery to repair or reshape the nose.
• Rhinoplasty may be performed for cosmetic reasons or to correct a deformity due to injury or birth defect.
• A cosmetically altered nose may take 6–12 months to achieve its final shape (profile).
• Talk with your surgeon about the risks and benefits of rhinoplasty and what results you can expect.

You might also be interested in:

• Anosmia - loss of smell.
  
• Cosmetic surgery.
  
• Nosebleeds.
  
• Sinusitis.
  

Want to know more?

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The Australian Society of Plastic Surgeons

Last reviewed: November 2011

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rhinoplasty?open">Nose surgery (rhinoplasty) - Better Health Channel</a><br/>
Rhinoplasty is surgery to repair or reshape the nose for cosmetic reasons, or to correct a structural abnormality caused by injury or birth defect. The operation is often performed through the nostrils, which means there are no visible cuts to the face. Talk with your surgeon about the risks, benefits and what you can expect.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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