Rhinoplasty Surgery
Nose Surgery / Nose Job

Rhinoplasty, more often called a nose job or nose surgery, is a set of specialised procedures that improve the aesthetic appearance of the nose while maintaining or enhancing the flow of air and breathing through the nose. The nose is a complex structure made of bone, cartilage and soft tissue and the procedure is highly individualized to balance the facial proportions while maintaining the structural integrity.

"Noses are my passion, which, like clefts, truly combine surgical skills with a degree of artistry."

Dr. Paul Skoll, Rhinoplasty Surgeon

Cosmetic & Structural Modifications

Depending on a patient’s unique anatomy and aesthetic goals, rhinoplasty can alter the size, shape, and angles of the nose by precisely reshaping the underlying nasal bone and cartilage framework (such as the scroll region and dome area). Key modifications include:

Bridge Alterations:
Removing a prominent dorsal hump or building up a flat bridge to create a smoother, more balanced profile.
Tip Reshaping:
Refining a bulbous, drooping, or asymmetrical nasal tip by adjusting the lower lateral cartilage (the dome area).
Proportion Adjustments:
Increasing or reducing the overall size and scale of the nose to better fit the patient’s facial profile.
Refining the Nostrils:
Narrowing a wide nasal base or adjusting the span and symmetry of the nostrils (alar base reduction).
Altering Facial Angles:
Adjusting the nasolabial angle—the relationship between the base of the nose and the upper lip—to enhance the facial profile.

Functional Benefits

Beyond cosmetic enhancement, rhinoplasty is frequently performed for reconstructive and functional reasons.

It can correct congenital structural defects, repair deformities caused by physical trauma, and significantly relieve chronic breathing issues by correcting a deviated septum or reducing enlarged turbinates.

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” and 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 visualization 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. Dr. Skoll performs 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.

Rhinoplasty Recovery Time & 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 amount of reshaping required, whether it’s the bridge, tip, nostrils or a combination of the three will affect the final cost.

Think about other costs such as anaesthesia fees, facility fees, and pre- and post-operative care costs. If functional issues, like a deviated septum, are corrected at the same time, this can also affect the total investment. While these factors add to the overall cost they also are essential to the best possible outcome. We are happy to go into these factors in more detail during your consultation. We are all about transparency. 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

Book a consultation with Cape Town’s expert scarless rhinoplasty surgeon, Dr. Paul Skoll. We will discuss your goals and create a personalised treatment plan to achieve the nose you have always wanted.

A few commonly asked questions

Am I a suitable candidate for a rhinoplasty procedure?

If your facial growth is complete (usually after the age of 16 for women and a little later for men), you are in good physical health, and you have reasonable expectations for the procedure, you may be a good candidate for rhinoplasty.

Often candidates have functional problems such as difficulty breathing or are unhappy with the size, shape or symmetry of their nose. To find out if you are a candidate, schedule a comprehensive consultation with Dr. Paul Skoll.

How should I prepare for my rhinoplasty surgery?

Full pre-operative instructions will be provided. This will usually mean that you will be asked to avoid aspirin, blood thinners and some herbal supplements for at least two weeks before your operation.

Smoking can greatly impede healing, so it is crucial to stop smoking at least two to four weeks before and after the procedure.

You will also need to arrange for a friend or relative to drive you home and help you in the first few days of your recovery.

What are common rhinoplasty side effects?

After your rhinoplasty operation, it is normal for some bruising and swelling to occur in patients. You might also get nasal congestion, like when you have a cold.

The area may be numb for a short time. These effects are usually greatest during the first few days and tend to improve over the following weeks.

Will I have visible scars after rhinoplasty?

Dr. Paul Skoll specializes in “scarless” preservation rhinoplasty surgery without or with minimal external visible scars. Any small internal scars that may develop will generally fade significantly over time.

Can rhinoplasty also improve my breathing or a deviated septum?

Yes, no doubt about it. Rhinoplasty is performed for functional and aesthetic reasons. A deviated septum is a condition in which the wall that separates your nostrils is crooked. This can make breathing difficult.

Often referred to as septorhinoplasty, we can combine a rhinoplasty with a septoplasty (to straighten the septum) to greatly improve the airflow and breathing through your nose, as well as the appearance of your nose.

Is it painful to get nose surgery?

Some discomfort is par for the course with any surgical procedure, but rhinoplasty recovery is often surprisingly manageable. Most patients say they do not have very high pain, generally between 0 and 4 out of 10, the day after surgery.

When will I see the final results of my rhinoplasty?

After the cast is taken off, you will notice an improvement right away, but you should be patient. Over time, as the swelling goes down, your nose will continue to get better.

The final, true shape of your nose won’t be fully visible until all remaining swelling has subsided, which could take a few months or longer.

The majority of the significant changes will be noticeable between three and six months.

What types of nose surgery can help me breathe better?

Functional nose surgeries — septoplasty, turbinate reduction and nasal valve repair — are performed with the specific goal of improving breathing. These functional operations correct internal, structural blockages, and not the outside shape of the nose:

Septoplasty: This fixes a deviated or crooked septum (the wall between your nostrils) to make airflow more even.
Turbinate Reduction: Reduces swollen or enlarged nasal tissues that often cause chronic congestion.
Nasal Valve Repair: Opens the narrowest, collapsible areas of the internal airway so they do not collapse when you breathe in.

Please Note: Often these functional procedures are done at the same time as a traditional cosmetic rhinoplasty or sinus surgery for complete relief.

Can nose surgery completely remove internal nasal blockages?

Yes, functional nose surgery is very effective in removing permanent structural blockages inside the nose.

If your breathing problems are due to physical obstructions ( such as a deviated septum , enlarged bone or cartilage , nasal polyps , or narrow airways ) , surgery can be performed to physically change or remove the obstruction to create a clear path for air to flow.

Surgery can physically change or remove the obstruction to create a clear path for air to flow. However, if your blockages are mainly caused by temporary medical issues like seasonal allergies, chronic inflammation or environmental sinus infections, surgery alone might not remove the symptom.

In these cases the best results are obtained by combining structural surgery with continued medical management of allergy.