Rhinoplasty Surgery
Nose Reshaping

Rhinoplasty, more commonly known as a nose job or nose reshaping surgery, comprises a group of operations designed to improve nasal aesthetics, while preserving (or improving) nasal airflow and breathing.

Techniques

As noses come in many shapes and sizes, there is no one standard operation that can be applied to every nose, making this a very "tailor made" procedure to address the multitude of possible nasal shapes and sizes. Broadly, there are 2 operative techniques that can be used for rhinoplasty - a so- called "open or open tip" or "closed" rhinoplasty. The open procedure is used to shape and re-contour 'tip' problems, whereas the closed rhinoplasty or nose surgery can be used to address a bump on the bridge of the nose, in some-one with good tip aesthetics. I now use the open technique exclusively.

The Procedure

The operation is performed under general anaesthetic using totally intravenous anaesthesia. Once asleep, a small "W" type incision is made across the columella (the fleshy bit of tissue between the nostrils) and this is extended to inside the nostrils. Using this approach provides excellent exposure of the tip cartilages which can then be manipulated to improve the tip aesthetics, usually by a combination of removal of some of the tip / alar cartilage, and using internal stitches to reshape these.

The bridge / dorsum can also be addressed using this open approach, and often some filing down of a bony / cartilaginous hump is done to get improved "dorsal aesthetic lines" to the nose. In addition, it is often necessary to fracture the nose to make it more narrow, once a hump is removed.

Over the past several years, increasing importance has been placed on the functional aspect of rhinoplasty - the idea being to have an aesthetic nose that functions (breathes) as well, or better than pre-operatively. As such, we often have to address the nasal septum (internal cartilage) by septoplasty, and use some of this septal cartilage to support certain internal structures / valves. Previously somewhat neglected, this type of functional surgery is currently commonly performed as part of a modern rhinoplasty.

The surgery may take 2-4 hours - depending on what is required. Not all patients need a "full rhinoplasty"; some patients can be adequately treated using a "tip rhinoplasty" in which only the tip cartilages are re-shaped, and no bony work is done. Only a minority of patients fall in to this category.

Either way, the surgery is often done as a day case (occasionally an overnight stay is needed). A splint is placed over the nose at the completion of the surgery, and is generally worn for the first week or so.

Post-Op

External sutures (across the columella) are removed at 5 days to a week post op. Bruising is variable and always more in men than women. I usually recommend Arnica to be taken post op to assist with the resolution of the bruising and swelling, but not pre operatively. As regards to pain, rhinoplasty patients have remarkably little pain post op - just some stuffiness, especially when nasal plugs are used for the first 24 hours.

Although some result will be seen at about a week when the cast is removed, it is important to realise and understand, that it takes about a year to 18 months before the final result can be appreciated. This time is needed for the skin envelope to contract and re-contour to the cartilage framework that was adjusted at the surgery, and the thicker one's skin, the more protracted this process.

Complications

Medical complications are relatively uncommon in rhinoplasty (infection, bleeding etc ), however, rhinoplasty allows little room for error - as little as 2mm can be the difference between a great result and a poor result. Patient satisfaction with the results of the surgery does vary, and a sobering statistic is that about 12% of rhinoplasty patients request a second, corrective surgery - this coming from the best surgeons in the world! Provided the goals of surgery are clear, and the patient expectations are realistic, a good outcome should be anticipated. It can be a life changing operation, increasing one's confidence, and often one's breathing!



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Member |  International Society of Aesthetic Plastic Surgery (ISAPS)
Fellow  |  College of Surgeons of South Africa (Plastic Surgery)
Member |  International Member of THE American Society of Plastic Surgeons
Fellow  |  Royal College of Surgeons
Member |  Association of Plastic & Reconstructive Surgeons of SA