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, or a nose job, is nose surgery designed to address aesthetic and functional issues relating to the variety of different nose shapes.

Nose shapes vary between individuals. Different nose shapes addressed by nose surgery include:

- Large noses, nose tips or nostrils
- Long noses, nose tips or nostrils
- Asymmetrical noses, nose tips or nostrils
- Bridged noses or bumpy noses
- Deviated septums

The nose is the central feature of the face and can define the overall balance of the appearance. Nose surgery is able to address a variety of concerns via the technique’s nose contouring and nose reduction properties.

There are five types of nose operation that we offer at the Cadogan Clinic.

Closed Rhinoplasty - the most common type of nose operation. 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. Closed rhinoplasty involves reduced nasal tissue irritation, less detectable scarring, shorter operating times and faster recovery.

Open Rhinoplasty - a more invasive nose operation widely used for patients who need more extensive nose contouring or nose reduction 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. Typical conditions include a big or crooked nose tip, flared nostrils or a hooked tip

Non-Surgical Rhinoplasty - 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.

There is the pain of one or several very small needle pricks and that is about it. It is, after all, simply just another filler injection, using the same filler type and needle. There is no need for anaesthesia and there is no pain afterwards.

It is of interest to point out that a surgical Rhinoplasty is also virtually pain-free after surgery.

Do not be put off by pain. If you are uncertain about whether you will like the outcome, then the medical or non-surgical procedure could be a good choice for you.

It is important, nevertheless, that your surgeon is experienced and knows the anatomy, as there are risks particularly of skin loss or embolism with the apparently simpler non-surgical procedure.

Non-surgical Rhinoplasty is a temporary procedure. You will need to schedule maintenance appointments to maintain your new look. The benefit of this is that you can make adjustments over time. Perhaps your desired look changes or it takes several sessions to dial in on exactly what you want to see.

To see if a non-surgical rhinoplasty is best for you, book a consultation with our team at the Cadogan Clinic so we can help determine your goals and recommend the best treatment.

Rhinoplasty 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.

Contrary to popular expectation, Rhinoplasty involves virtually no pain following surgery. Whilst there may be some level of discomfort immediately following your procedure (and likely some symptoms such as a blocked nose etc.), pain levels will be modest.

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.

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.

You can view before and after nose job images in our Before and After Nose Job Gallery on this page.

At your consultation, your consultant will also share more extensive examples of rhinoplasty before and after results they have achieved.

We feel strongly that you can best understand what might be possible for you and your nose by reviewing the results of previous nose contouring and nose reduction operations.

It is very rare to be able to get your nose job on the NHS as it is considered a cosmetic surgery. It may occasionally be possible to get your rhinoplasty on the NHS if it is ascertained that the surgery is for medical reasons, but this is very rare.