Nose reshaping (rhinoplasty, or a 'nose job') is an operation to change the shape or size of the nose. The nose is the central feature of the face and how it looks can determine how we feel about our overall appearance, making a rhinoplasty one of the most popular and common procedures in the country. The nose develops its final shape only after puberty and this development is complete by the age of 16. This determines the earliest age at which one can reasonably carry out a rhinoplasty.

Rhinoplasty can correct the change the size, shape and position of the nose to those who are unhappy with the aesthetic appearance of their nose. It can also be performed as procedure to improve function by correcting breathing issues and help alleviate the symptoms of sleep apnoea and snoring. In these cases, one is likely to also be operating on the septum or turbinate which are blocking the airway. These procedures are named septoplasty or submucosal resection (SM resection)

There is also the large group of patients who have suffered injuries to the nose, very often a nasal fracture, playing sport or as a result of assault. These are the few patients that medical insurance companies may accept for reimbursement.

Our surgical approach is to work with a patient's natural features, sculpting the nose to harmonise the face and give a natural looking result. This requires a delicate balance between the size, shape, contours and definition of the nasal bridge and tip. Nose reshaping requires skill and surgical finesse as millimetres make the difference between a natural looking result and one that has obvious trademarks of surgery.

The Principals of Rhinoplasty Surgery

The nose is supported by a skeleton. In the upper third, it is a bony skeleton and the lower two thirds are nostrils, flexible cartilage of the same type as we have in the ear. Dividing the two airways running back from the nostrils, we have another sheet of cartilage, covered with mucosa, called the septum. This is a strut which stops the cartilaginous part of the nose from collapsing. Most operations on a Caucasian nose involves a reduction in size and therefore the bony and cartilaginous skeleton is reduced appropriately, allowing the skin to retract, and there are thus often no scars of the skin.

There are two ways that the surgeon can reduce this support;

+ Open 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. 

+ Closed rhinoplasty – 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. 

What does it involve?

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.

The Oriental and African -Nose augmentation:

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.

Non-surgical or medical rhinoplasty

The founder of the Cadogan Clinic, Bryan Mayou, introduced the medical rhinoplasty 30 years ago. In this non-surgical procedure, fillers are injected to alter and shape a person's nose. Bryan Mayou used this technique for treating the disastrous results of injury or bad rhinoplasties. He thus avoided very complicated corrective surgery, which gave unpredictable results. This was done to give permanent improvements.

Today medical rhinoplasty is a medium term solution as the fillers used commonly, Hyaluronic acid, will last perhaps a year. It does however, give patients an opportunity to have a reversible procedure. The patient can then see the likely result, if a long term surgical rhinoplasty was indicated at a later stage. There were others who will simply have top-ups every year. It is a good solution for those who are not yet comfortable with the long-term commitment of surgery and are curious about changing the shape.

We are proud to work with some of the industry's best rhinoplasty surgeons in London.
Our team of Cosmetic and Aesthetic Facial surgeons is led by Mr Bryan Mayou, one of the world's most esteemed plastic surgeons, practising at the very top edge of the discipline.

 

Frequently Asked Questions

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.

More commonly known as a 'nose job', rhinoplasty is one of the most common cosmetic surgery procedures worldwide. Your nose is one of the first things a stranger will notice about your face, so if you are unhappy with the size or shape of it, or feel as though it is crooked then you could benefit from nose surgery. Some individuals choose to undergo rhinoplasty, rhino-tip surgery or septo-rhinoplasty (correction of a deviated septum) for medical reasons to improve breathing difficulties.

Rhinoplasty Results

Click here to view our gallery of before and after and Rhinoplasty

What to expect

Free Consultation with a Patient Advisor

We offer a free, no-obligation 30 minute consultation with one of our Surgical AdvisorsThey will work with you to understand your objectives and the results you want to achieve, talk you through the procedure and answer any questions you may have. At this point your Surgical Advisor will reccommend a surgeon best suited to achieving the outcome you desire.

Surgical Consultation

If you decide that the surgical option is for you, a full consultation with your chosen surgeon will need to be booked and payment will be taken. In this consultation, a full comprehensive medical assessment will be done. Your surgeon will try to understand what areas of your nose you are unhappy with. They may take photos of your profile and ask questions about your expected outcomes. While each case is unique. your surgeon will be able to show you before and after photos of other cases they have worked on that may be similar to yours. This will give you a good idea of the outcome you can expect. You will then be given a confidential quote based on your recommended surgery and an information pack to take home with you. If you are happy to go ahead with the surgery, your surgical advisor will arrange payment options with you and a surgery date will be booked. 

The Procedure

On the day of your rhinoplasty you will be welcomed at the Cadogan Clinic reception by your Surgical Advisor and dedicated nursing staff. Following a brief medical and documentation check, your surgeon and anaesthetist will meet with you to run through the details of your procedure one last time. Your surgeon may wish to take pre-surgery photos and may mark up the areas while you are awake. You will have the opportunity to answer any last questions before being taken into theatre. A typical rhinoplasty procedure can take anywhere between 90 minutes and 2.5 hours depending on the complexity of the case. Once the surgery is done, you will be taken into recovery while you wake up. We use a variant of the general anaesthesia technique called TIVA (Total Intravenous Anaesthesia) so you will wake up quickly and with less side effects than other anasthesia. Our patients are usually sipping tea within 30 minutes.  

Recovery

After the procedure, you will recover in the capable hands of our aftercare team. As you will have had a TIVA anaesthesia you will be awake and aware in no time at all. You will be offered some food and something to drink while you wait to see your surgeon who will visit you within the hour. He will update you on the surgery and once he is happy with your recovery he will discharge you from the clinic the same day. In total, expect your time in recovery to last 2 - 3 hours. You will not be able to leave the clinic without a chaperone, but all details will be given to beforehand so that you can make arrangements accordingly. We are a day case only practice, so if you live outside of London and want to stay locally in order to be close to your surgeon, we recommend our exclusive partner hotel just minutes from the clinic, No 11 Cadogan Gardens.

Aftercare & Support

Our care and support continues in the days and weeks following your procedure with our complimentary aftercare programme. This comprised of a series of appointments made with your surgeon and nursing team to monitor your progress and recovery. You will be able to make contact with your surgeon and our nursing team at any time should you have any questions or concerns. You will be given a full aftercare plan and spoken through what you can expect in the days that follow. You will usually be required to attend a 6 week follow up consultation where your surgeon will check on your healing and take post-operative photographs. While it may take a few months for the swelling to subside, you should see be able to see visible results that you are happy with by this point. 

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