Rhinoplasty

An incision is made across the columella (the skin of the central strut of the nose separating the two nostrils. The incision is carried up and around the rim of the nostrils, allowing the skin on the nose to be peeled back. The surgeon then has a direct view of the cartilage, which they can then refashion. This technique is used for the very complicated, difficult and injured nose but is also used exclusively by some surgeons.

The closed rhinoplasty does not have an incision across the skin of the columella between the nostrils, but is carried out through the mucosa of the inside of the nose. The surgeon does not have the direct view of the nasal skeleton and therefore it is a technique for the more experienced surgeon.

A septo-rhinoplasty is commonly done to improve the way you breathe through your nose. This is often done for patients who suffer from a deviated septum. The septum is the cartilage and bone inside your nose that divides the nostrils.

Your surgeon will make an incision in the mucosa (the lining inside your nose), and lift it off the bone and cartilage in order to remove any parts that are bent, putting them into a straight position allowing for clear breathing. This procedure will improve the way you breathe, and the appearance of your nose can be adjusted as well.

Rhino-tip surgery is done to change the shape of the nose by modifying the structure of the underlying cartilage. Most alterations are done from inside the nose so as to minimize any scarring. Your surgeon can create the perfect tip for your nose structure.

Some common cases that patients come in for are:

- Big Tip: This is a rounded appearance at the tip of the nose, possibly due to thick skin.

- Crooked Tip: One nostril may appear larger than the other or the nose might be slanted to one side causing an asymmetrical look.

- Flared Nostrils: When the nostrils are larger and spread farther apart creating an upturned of flat-nose appearance.

- Hooked Tip: This is when the nose juts out and is overly-long, particularly noticeable on the profile of the patient.

Many patients have noses which are flatter with wider nostrils. In these cases, it is not a question of reducing the skeletal support, but adding to it. The bridge line can be raised by adding a manmade substance or the patient's own bone and cartilage taken from the ear, skull or rib. In each case, the extra tissue is carved to the required shape. Nostrils and nostril floor can be reduced in width by removing a wedge of tissue. The oriental may on occasions need surgery of the upper eyelid, and particularly the inner end where there is often web.

Rhinoplasty, the nose job, is the oldest plastic surgery operation. It is well recorded in ancient Egypt, India and Renaissance Italy. Evolution and refinement have continued through to the present day.

Surgically, one can reconstruct part of or the whole nose after trauma or tumour excision. More commonly we aesthetically refine the size and shape.

There is no limit to what one can do surgically – reduce the size, change the shape, improve breathing, lift or raise the bridge line or reduce the nostril size. First, you'll need to discuss carefully with your surgeon exactly what you are hoping for. They will help you with diagrams, photographs and computer morphing of images.

Once you have decided what you need to achieve the desired result, your surgeon will explain the required procedure. There are some basic options. The augmentation rhinoplasty is where tissue, perhaps your own cartilage, bone or fat, or artificial material from a package is used to raise the bridge line and tip.

More frequently we are reducing the size and shape and access is through the nostrils without a skin incision. This is the Closed Rhinoplasty.

The Open Rhinoplasty requires a small incision across the central strut of the nose (the columella) and is used for certain, more complicated operations.

Whichever surgical procedure you have, it is virtually painless and carried out as a day case, mostly under TIVA (Total IntraVenous Anaesthesia), the Cadogan Clinic form of user-friendly general anaesthesia.

The Medical or Non-Surgical Rhinoplasty is another option which has become popular recently. In fact, surgeons at the Cadogan Clinic have been using this technique for 30 years. It is a quick way of adding injectable material to disguise shape. So, for example, one can add filler either side of a hump, raising the bridge line to level it. The surgical option might be the remove the hump, making the nose slightly smaller.

It is popular because it is quick and avoids even a small operation. It is actually really useful for disguising really terrible deformities, which would involve several complicated procedures.  At the Cadogan Clinic, we have used many different fillers, including some that are permanent. Nowadays we use either your own fat or hyaluronic acid filler. Hyaluronic acid dissolves slowly and will need top-ups every 6-12 months.

We believe that you should know all the options before making your choice of procedure.

Nose reshaping is carried out with the patient only just asleep under total intravenous anaesthesia (TIVA), and depending on your requirements, the surgeon may do any of the following:

Nose reduction - make the nose smaller by removing some cartilage and bone. This often involves rasping down the bridge of the nose and fracturing the nasal bones, where they join the face. The skin of the nostrils does not shrink to the same extent as the rest of the nose and there may be a necessity for reducing the base of the nostrils or the floor of the nose, by removing a wedge of tissue.

Nose reshaping - changing the shape of the nose by rearranging or adding to the cartilaginous and bony skeleton.

Nose proportions - changing the angle between the nose and top lip.

At your initial rhinoplasty consultation, your surgeon will go through any pre-operative advice with you which will include eating well, quitting smoking, avoiding alcohol and avoiding aspirin and blood-thinning medication.
You will not be allowed food for 6 hours and water for 2 hours prior to your operation. You may choose to take Arnica tablets to reduce any bruising following your nose surgery. If you have any other questions or concerns then you will be able to address them during your consultation.

No, there is virtually no pain following surgery. There may be some level of uncomfortableness following the procedure, but there won’t be any pain. Many patients do not require analgesia.

Once you arrive at the clinic for your nose reshaping surgery, you will be taken downstairs by our friendly nurses to be prepped for surgery and meet the anaesthetist. You will also have another chat with the surgeon, as this is the final point when the surgeon needs to know exactly what you require. Once you have had your operation, you will recuperate in our recovery room and when you have eaten a few hours later and you are ready, your surgeon will discharge you with some post-operative advice. A friend or relative is able to collect you and take you home. Before leaving the clinic our nursing staff will ensure you have everything you need including a post-operative appointment time and they are likely to give you some spare gauze to keep under the nostrils to catch any drips.

Rhinoplasty is one of our most popular treatments at Cadogan Clinic, and any risks associated with nose reshaping are the same as with any other surgical procedure that involves a general anaesthetic. Any specific risks will be discussed by your surgeon who will explain the nose surgery process in detail and answer your specific concerns.

Some possible risks can include:

+ Anesthesia risks, as with any surgery there are risks with using anesthesia.
+ Infection
+ Poor wound healing or scarring
+ Change in skin sensation; possible numbness or pain
+ Nasal septal perforation (a hole in the nasal septum). However keep in mind that this is very rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication
+ Difficulty breathing
+ Unsatisfactory nasal appearance
+ Skin discoloration and swelling
+ Possibility of revisional surgery

The best way to avoid risks with surgery is to follow the proper aftercare instructions given to you by your surgeon. Many of these risks are rare.

As always with cosmetic surgery, it is essential that the surgeon, not only understands exactly what you are looking for, and can deliver it, but psychologically it is necessary to be as certain as one can be that this desired result actually satisfies the patient.

We usually recommend our rhinoplasty patients to take at least one week off work, as you will be wearing a splint for up to ten days. There is no reason however, why you should not be working from home. There may be some bleeding from the nostrils overnight or for longer if the septum or turbinate's have required treatment. You are likely to have some swelling and bruising below the eyes, if the nasal bones have been fractured. This is completely normal and will subside within the ten days. We also tell patients to avoid strenuous exercise for at least two weeks following the operation.

There are two parts to this answer. How long does it take to resume full normal activities and how long does it take for the nose to reach its final state? There is a huge time difference between the two. There is also individual variation.

Patients are usually surprised that the operation is virtually painless. We use Total IntraVenous Anaesthesia (TIVA) and therefore you wake up quickly from the operation and will not feel sick. You will be ready to go home within an hour or two. Expect some bleeding from the nostrils and you will find a gauze dressing strapped under the nose. This will be changed as necessary by the nurse whilst you are in the hospital and by yourself at home.

The bleeding usually stops by the next morning and be replaced by a clear ooze which tends to coagulate around the nostrils and internal sutures. Just keep this clear on the outside with tap water. The inside is unimportant. The nurse will deal with this when you come back at a week. The internal sutures dissolve on their own, but she will remove any skin sutures at the same time.

There is often bruising around the eyes. It is not painful. It appears quickly after surgery but settles equally quickly. The last remnants under the eyes go by 10 days.

Most patients, where the bones are fractured, will have a plastic or plaster of Paris splint over the nose, which is removed in 7 to 10 days. This is the moment of revelation. However, the nose is not how it will finally end up. It will be swollen and without definition. The tip, in particular, may at this stage appear unchanged. The actual final shape will take 6 to 12 months to settle. You will get some idea when this is, when the skin feels normal and all stiffness has gone. You need to be patient.

You are not ill after surgery, just a little bruised with a splint. You should not exercise for a couple of weeks, but you can do most other things if you don’t mind people seeing you. It is the same splint for a broken nose, and this would be the obvious white lie to explain it.

A rhinoplasty, also known as nose surgery or a ‘nose job’, is a procedure that addresses many concerns related to your nose. As the nose is the central feature on your face, it can define your overall look. With a nose job, we address various concerns, including:

- Size reduction

- Length reduction

- Correcting asymmetry

- Removing a bridge or bump on the nose

- Reshaping the tip or shape of the nose

- Alleviating a deviated septum or improving breathing difficulties

- Making changes to the nostril shape and size

Not all rhinoplasty procedures are created equally. Depending on your needs, we offer different procedures to achieve your desired results. During your initial consultation with your surgeon, they will evaluate what type of rhinoplasty surgery is right for you.

There are five types of rhinoplasty procedures that we offer at the Cadogan Clinic.

Closed Rhinoplasty

This is the most common type of rhinoplasty. There are no external scars, as all incisions are done inside the nose. The soft tissues are lifted slightly upward, allowing access to the bone and cartilage. There are several advantages of closed rhinoplasty, including reduced nasal tissue irritation, less detectable scarring, shorter operating times and faster recovery.

Open Rhinoplasty

This is a more invasive surgery and it is widely used for patients who need more extensive work. Your surgeon will make incisions in the columella, which is the skin between your nostrils beneath your nose. Following the incisions, the skin is lifted up allowing access inside the nasal cavity for your surgeon to perform reshaping. After the surgery is complete, the columella is sutured and the nose will be secured in place with tape and a splint to keep the nose in place. The splint will keep the nose in place during the healing process and normally will be removed after one week.

Open rhinoplasty is excellent for patients with issues such as genetic or structural deformities, trauma to the nose requiring grafting and unsatisfactory results from a previous nose job.

Septo-Rhinoplasty

A septo-rhinoplasty is commonly done to improve the way you breathe through your nose. This is often done for patients who suffer from a deviated septum. The septum is the cartilage and bone inside your nose that divides the nostrils. Your surgeon will make an incision in the mucosa (the lining inside your nose), and lift it off the bone and cartilage in order to remove any parts that are bent, putting them into a straight position allowing for clear breathing. This procedure will improve the way you breathe, and the appearance of your nose can be adjusted as well.

Rhino-tip Surgery

Rhino-tip surgery is done to change the shape of the nose by modifying the structure of the underlying cartilage. Most alterations are done from inside the nose so as to minimize any scarring. Your surgeon can create the perfect tip for your nose structure.

Some common cases that patients come in for are:

• Big tip - this is a rounded appearance at the tip of the nose, possibly due to thick skin.
• Crooked tip - one nostril may appear larger than the other, or the nose might be slanted to one side causing an asymmetrical look.
• Flared nostrils - when the nostrils are larger and spread farther apart creating an upturned or flat nose appearance.
• Hooked tip - this is when the nose juts out and is overly long, particularly noticeable on the profile of the patient.

Non-Surgical Rhinoplasty

This is another very common form of rhinoplasty. It is non-surgical and non-invasive and involves an injectable filler being used to correct very minor imperfections. This is a popular choice for clients who need minimal changes to the shape of their nose. Keep in mind that over time the filler will begin to dissolve and you may need further treatments.