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.