Rhinoplasty (nose surgery)

Rhinoplasty

Rhinoplasty (sometimes called a ‘nose job’) is surgery to repair or reshape the nose. This may be performed for cosmetic reasons to change the appearance and proportion of the nose and improve a person’s self-confidence. Plastic surgery of the nose is also used to correct breathing problems caused by structural abnormalities in the nose.

Almost all of these operations are performed through the nostrils, which means there are no visible cuts (or subsequent scars) to the face. Some operations require a cut to the tissue between the nostrils to perform the rhinoplasty.

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. Talking to a counsellor or psychologist may help you overcome your concerns about your appearance.

Changes to laws that affect cosmetic surgery

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal in Victoria for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health's Private hospitals page
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding cosmetic surgery or anaesthesia in Victoria.

Conditions that rhinoplasty can correct

Rhinoplasty can aim to achieve any of the following results:

• straighten a crooked nose
• make the nose smaller or larger
• restore the height of a flattened area
• alter the appearance of the nasal tip
• correct a hump
• correct birth defects
• repair damage caused by injury
• repair damage caused by disease such as infection or cancer
• open up nasal passages to improve breathing.

Things to consider before having rhinoplasty

Rhinoplasty may not be for everyone. Talk to your medical practitioner and consider the following:

• Your medical practitioner 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.
• It is essential that the surgery doesn’t interfere with your airway and breathing. If your septum is deviated (that is, if the cartilage in your nose that separates your nostrils is uneven), your medical practitioner may recommend that it be straightened, and the projections inside your nose be reduced to improve your 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.
• The bones of the face and nose need to fully mature before nose surgery can be done.
• Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies. For more information:
  • Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
  • Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible before deciding to have rhinoplasty.

Finding a qualified medical practitioner

Ask your GP for advice on a suitable and reputable specialist medical practitioner or hospital where rhinoplasty is performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a reputable medical practitioner who is specially trained to perform rhinoplasty and has a lot of experience in carrying out this type of procedure. Ask to see the medical professional’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and rhinoplasty

If you are considering having rhinoplasty, you need to discuss your current medical status with your medical practitioner.

This includes discussing:

• Your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• Your mental health – any mental illnesses or issues and their treatments
• Medications you are currently on, including vitamins and supplements
• Past reactions to medications
• Any allergies you have.

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Rhinoplasty – what happens during surgery

All surgery, including rhinoplasty, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

The nature of the surgery depends on the reasons for it, 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 medical practitioner 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 at the base of the nose)
  • ‘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 cartilage
• Stitches – incisions are closed with dissolving stitches.

Immediately after rhinoplasty

After the operation, you can expect:

• Mild to moderate pain
• Swelling and bruising, mainly around your eyes – the swelling should go down in a few days and the bruising may go away within the first week or two
• The sensation of a ‘stuffy’ or blocked nose
• Numbness
• Dressings and splints being used 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 piece of tape may be placed over the nose to keep the dressings in place.

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.

Potential complications of rhinoplasty

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

• heavy bleeding from the surgical site
• infection that may require treatment with antibiotics, or further surgery in some cases
• allergic reaction to sutures, dressing or antiseptic solutions
• the formation of a large blood clot (haematoma) beneath an incision site, which may require drainage
• keloids and hypertrophic scars – scars that are raised and thickened. These may form over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health
• slow healing, often related to smoking or diabetes
• separation of wound edges
• short-term nausea from the general anaesthetic
• pain that may be severe and ongoing
• the nose may feel numb or have altered sensation after the bruising and swelling subside
• the upper front teeth may feel numb temporarily
• the nose’s appearance may be unsatisfactory and require revisional surgery
• sense of smell may be impaired and, in rare cases, lost or distorted
• skin under the eyes may be darkened for over six months
• underlying support structure of the nose may be weak and cause the nose to flatten
• if an implant was inserted, it may extrude (poke out) into the nose or out through the skin
• airways may become narrowed, causing difficulty breathing through the nose.

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

Self-care after rhinoplasty

Your medical practitioner will provide you with post-operative care instructions, such as:

• reporting any bleeding, severe pain or unusual symptoms to your medical practitioner, including sudden nosebleeds
• pain management
• wound care
• when to have a follow-up appointment with your medical practitioner
• medications to take home from hospital (be sure to ask what they are for, how frequently they should be taken and for how long you have to take them. If you are prescribed antibiotics, make sure you take the whole course).

General self-care suggestions may include:

• not blowing or rubbing your nose for a minimum of eight weeks
• avoiding heavy lifting, strenuous exercise, swimming and sports until advised by your medical practitioner
• holding your head upright as much as you can.

Short-term outlook following rhinoplasty

Your bandages and packing gauze may be left in place for up to a week or so. Your medical practitioner will then remove the dressing and take out the nasal packs.

You may need to be off work for around two weeks.

Broken nasal bones may hurt or ache for up to eight weeks. See your medical practitioner for advice on appropriate pain relief. Avoid taking aspirin as it can increase the risk of nosebleeds.

Long-term outlook following rhinoplasty

Swelling may come and go and may be worse in the mornings in 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 medical practitioner removes the dressing and nasal packs (approximately seven days 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.

Alternatives to rhinoplasty

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.

Where to get help

• Your GP (doctor)
• A psychologist, psychiatrist or counsellor
• A medical practitioner specially trained and experienced in performing rhinoplasty
• A second opinion from another medical practitioner specially trained and experienced in performing rhinoplasty
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Information Hotline Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495