Rhinoplasty Surgery
(Nose Surgery / Nose Job)

Rhinoplasty, more commonly known as a nose job or nose surgery, comprises a group of operations designed to improve nasal aesthetics while preserving (or improving) nasal airflow and breathing. “Noses are my passion, which, like clefts, truly combine surgical skills with a degree of artistry.”

RHINOPLASTY TECHNIQUES

Noses come in an endless variety of shapes and sizes. Hence there is no one standard rhinoplasty operation that can be applied to every patient. Broadly, there are 2 operative approaches that can be used for rhinoplasty – a so- called “open or open tip” or a “closed” rhinoplasty. For the better part of the past 15 years, I have most often employed the “open rhinoplasty approach” which allows the surgeon binocular visualisation of the entire nasal skeleton. This changed in 2018. I now offer “most primary patients” a closed, scarless, preservation rhinoplasty in Cape Town.

The open approach leaves one with a small scar across the columella, which usually fades to be come barely visible over time. Still today, I make use of this approach in complex secondary nose-jobs (where patients have had prior rhinoplasty) Over the past 6 years I have been very fortunate to begin the journey of moving away from traditional open approach, reduction rhinoplasty to a new movement in rhinoplasty surgery – that of Preservation Rhinoplasty. Where possible nowadays, I will try, in all suitable primary patients, to use part or all of the preservation rhinoplasty philosophy.

Preservation rhinoplasty is a “new” philosophy in rhinoplasty, based on tissue preservation rather than resection / reconstruction which is currently the standard. It is conceptually the opposite of the septal L strut concept, in that most of the septum is preserved and manipulated, rather than being resected. The skin and soft tissue envelope is largely preserved as the plane of elevation is done at a true sub-perichondrial / sub-periostial level, using (ideally) a closed approach; although many proponents do it open too. Ligamentous structures are also preserved or if breached, are formally repaired. The dorsum / bridge is preserved where possible, with or without some manipulation, and a let- down or push- down procedure is done, hence preserving the integrity of the midvault and the keystone area, and so avoiding the need for midvault reconstruction. Osteotomies are done very accurately with either ostetomes, piezo, specifically designed micro-saws or micro-power tools. Lastly, the alars are largely preserved and manipulated using sutures. In short, there is minimal resection in the true sense of the term. Like in all of rhinoplasty, patient selection is important – this is not a procedure for all patients, but rather for a select group of primary rhinoplasty patients. Whilst the term preservation rhinoplasty is a new one, it is really a constellation of older techniques that have been refined as more of the anatomy is defined. I have been been fortunate to learn this evolving technique from colleagues abroad and am pleased to be able to offer it to selectd primary patients. See my Instagram for some examples.

ABOUT THE rhinoplasty operation

The Rhinoplasty operation is performed under general anaesthetic. Once asleep, local anaesthetic is injected in to the nose to limit bleeding and enable better visualisation. I do most primary surgeries “closed” using preservation techniques. All elements are addressed to varying degrees to include tip manipulation, bridge adjustment and narrowing of the nasal bones when indicated.

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 structures, notably the adjusted tip . 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. Secondary surgery is more complex and takes longer.

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. Internal silicone splints are also used for the first 7 days.

Recovery & Aftercare

External sutures (across the columella) are removed at a week post op, if an open approach was used. 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.

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. That said, with modern preservation techniques, the swelling and brusing is remarkably less than what was the case with the open structured approach.

Rhinoplasty Cost: What to expect

Rhinoplasty is a highly individualized procedure, and as such, the cost reflects the unique nature of each patient’s needs and goals. Several key factors contribute to the overall investment in your rhinoplasty procedure. The complexity of the surgery is a primary consideration. A revision rhinoplasty, for example, often requires more intricate work and therefore may incur a higher cost than a primary rhinoplasty. Similarly, the extent of reshaping required, whether focusing on the bridge, tip, nostrils, or a combination thereof, will influence the final price.

Anesthesia fees, facility fees, and pre- and post-operative care costs are additional components to consider. If functional issues, such as a deviated septum, are addressed concurrently, this may also impact the overall investment. While these factors contribute to the overall cost, they are also essential to achieving the best possible outcome. We believe in transparency and are happy to discuss these factors in detail during your consultation. Contact us today to schedule a consultation and explore your options.

Nose Surgery Before And After

Nose Surgery Before And After - Patient 2

Rediscover Your Confidence with Rhinoplasty Surgery

Schedule a consultation with Dr. Paul Skoll, an expert scarless rhinoplasty surgeon in Cape Town. We’ll discuss your goals and create a personalized treatment plan to achieve the nose you’ve always desired.

A few commonly asked questions

What are common rhinoplasty side effects?

Patients can expect some swelling and bruising after their rhinoplasty operation; this is normal. Nasal congestion, similar to having a cold, is also common. Patients might also experience some temporary numbness in the area. These effects usually peak in the first few days and then gradually improve over the following weeks.

Is Rhinoplasty Painful?

While some discomfort is normal after any surgical procedure, rhinoplasty recovery is often surprisingly manageable. Many patients find their pain levels to be quite low, typically between 0 and 4 out of 10, just one day after surgery.

Will I have visible scars after rhinoplasty?

I specialize in scarless preservation rhinoplasty, minimizing or eliminating visible external scars. Any tiny internal scars that may occur typically fade significantly over time.