Nose reshaping (rhinoplasty)

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Nose reshaping (rhinoplasty)

Nose reshaping (rhinoplasty), often called a nose job, is an operation to change the size or shape of your nose. You might have surgery because you’re unhappy with the way your nose looks or you may want to restore its shape after an injury.

Nose shaping for cosmetic reasons isn’t available on the NHS; it’s a procedure that’s done in private healthcare.

About nose reshaping

By the time you’re around 16 (for girls) or 18 (for boys), your nose will have stopped growing and be fully developed, although there are exceptions. So, if you want an operation for cosmetic reasons, it’s best to hold off until at least then.

Your surgeon can make your nose smaller in an operation called a reduction rhinoplasty, or larger in an augmentation rhinoplasty. They can change the size and shape of your nose, from the tip to the bridge, including your nostrils. Your surgeon can also change the angle between your nose and top lip.

This information explains nose reshaping in general. Speak to your surgeon for specific advice and information about any procedure you’re considering. 

Getting advice about nose reshaping

It’s important not to rush into the decision to have any cosmetic surgery. Make sure you choose a surgeon who’s registered as a specialist with the General Medical Council. They should have specific training in rhinoplasty techniques. They may be an ENT (ear, nose and throat) surgeon, a plastic surgeon or a maxillofacial (jaw and face) surgeon. Check if they’re registered with the British Association of Aesthetic Plastic Surgeons, The British Society of Rhinoplasty Surgeons or the Facial Plastic Surgery division of ENTUK. Most but not all rhinoplasty surgeons are involved in one or more of these societies.

Do your research and take time to find out about your surgeon’s experience – ask how many operations they’ve done and how often they perform the surgery. They may also have photo examples to show you and you may be able to talk to people who have been treated by them.

Before your operation, it’s vital to discuss what you’re hoping to gain from it and the result you can realistically expect. Meet the surgeon who will be doing your operation, rather than a clinic manager or nurse, so you can discuss all of the pros and cons involved. Before you go to your appointment, write down what you want from your operation and any concerns you have.

Your surgeon will check that a nose reshaping operation is right for you. They’ll take your age, medical history, and current physical and emotional health into account. A good surgeon will ask you to book at least two consultation appointments before you commit to having the operation. And the appointments will be at least a week or two apart.

At your first appointment, explain to your surgeon what you think is wrong with your nose as well as any points you like. Tell them how you want it to look after the operation – photos are very helpful for being really clear about this.

Take as much time as you need after your first appointment – you may find it helpful to discuss everything with family or friends. Then, using the information and advice from your surgeon, you can decide if an operation will help. Only go ahead with the operation if you’re happy that your surgeon fully understands what you want and you understand how your nose is likely to look afterwards. Your surgeon may suggest you speak to a clinical psychologist to discuss how the operation may affect you emotionally and socially.

In your next appointment or appointments, your surgeon will confirm the details of exactly what you want from the operation.

Preparing for nose reshaping

Your surgeon will examine your nose and measure its shape and size at one of your appointments before your operation. They’ll take photographs of your nose and may create images of how your nose might change after surgery. Some surgeons have computer imaging technology that can help to give you an idea of what your nose will look like after the operation. But you should be aware that your results will almost always look at least a bit different from the computer-generated image. This is because the results of plastic surgery aren’t always easy to simulate. For this reason, not all surgeons offer such images.

Your surgeon will explain how to prepare for your operation. For example, if you smoke, it’s important to try to stop at least six weeks before your surgery. Smoking increases your risk of getting infections, which can slow your recovery and wounds can take longer to heal. It’s best to delay your operation if you have a cough, cold or sore throat. These may also increase your risk of getting an infection and will slow your recovery. Reschedule your operation for after you’ve recovered. If you’re not sure, get in touch with your surgeon for advice.

It’s important to be fully informed so you feel happy to go ahead with your operation. You’ll be asked to sign a consent form.

A nose reshaping operation is usually done under general anaesthesia so you’ll be asleep during the surgery. Your hospital will give you instructions on when to stop eating and drinking. You’ll usually need to stop eating about six hours before your operation and only have clear fluids up to two hours before. But follow your anaesthetist’s advice.

You may be asked to wear compression stockings as these will help prevent blood clots forming in the veins in your leg (DVT). You may need to have an injection of an anti-clotting medicine as well as or instead of wearing compression stockings.

What happens during nose reshaping?

A rhinoplasty operation may take anything from an hour and a half to three hours.

Reduction rhinoplasty

Closed rhinoplasty

If you’re having your nose made smaller, your surgeon will usually make cuts inside your nostrils to reach the bone and cartilage. This is called closed rhinoplasty and you shouldn’t have any visible scars after your surgery. This operation takes less time and generally leads to less swelling than an open rhinoplasty, so you should recover more quickly. Not everyone can have a closed rhinoplasty – your surgeon will explain if it’s an option for you.

Open rhinoplasty

In open rhinoplasty, your surgeon will make a cut across the skin between your nostrils (columella) as well as inside your nostrils. You might be able to see a small scar on the columella but this is usually barely noticeable. Your surgeon will remove or rearrange some of the bone and cartilage to change the shape of your nose.

Whether you have an open or closed operation, your skin will need to be lifted off your nasal bones and cartilages and will take time to redrape over the new shape.

Augmentation rhinoplasty

If you’re having your nose made larger, your surgeon may use an open or closed rhinoplasty technique. They may need to use extra bone or cartilage to build up your nose; this is called a graft. The bone and cartilage may be taken from your nose, rib or ear.

Your surgeon will usually close the cuts inside your nose with dissolving stitches so you won’t need to have them removed. If you have stitches outside your nose, your surgeon or a nurse will take them out about a week after your operation.

What to expect afterwards

You’ll need to rest until the effects of the general anaesthetic have worn off. You may have some discomfort as the anaesthetic wears off. Your nose will feel blocked (as if you have a cold) and you’ll have to breathe through your mouth for the first week or two. You'll be offered pain relief if you need it.

You may have dressings (packs) in each nostril for a day. You may also have splints inside your nostrils as well as over your nose for around a week to keep the bones in place.

You may be able to go home on the same day or you might need to stay in hospital for a night or two. When you’re ready to go home, ask a friend or family to drive you home and ask them to stay with you for a day or so.

Your nurse will give you some advice about caring for your nose when you go home and may also give you a date for a follow-up appointment.

Recovering from nose reshaping

Your nose may feel a bit tight and sore after your operation and you may have some bruising (particularly around your eyes). If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

Having a general anaesthetic may really take it out of you. You may find you’re not as coordinated as usual or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s and anaesthetist’s advice.

There are some things you can do to help speed up your recovery.

  • Keep your head up as much as possible. For a few days after your operation, use an extra pillow or two when you sleep.
  • Try not to do anything that will increase the blood flow in your face, this includes not having a hot bath or lifting heavy things.
  • Don’t have sex for at least two weeks.
  • Don’t blow your nose in the first week after your operation, only wipe it gently. Try as best you can not to sneeze through your mouth – try to cough it out instead.
  • Don’t remove any crusts in your nostrils until you see your surgeon to have the splints removed.
  • Stay away from dusty or smoky places until you’ve recovered.
  • Don’t do any strenuous exercise or contact sports such as rugby or football, for four to six weeks. You’ll probably be able to go for a good walk after three to five days, and go swimming after around three weeks. Get advice from your surgeon before your operation about returning to any activities you do.
  • If you wear glasses, you may find it more comfortable to tape them to your forehead for a while, rather than resting them on the bridge of your nose.

Contact your GP or surgeon if any swelling, redness or pain in your nose gets worse or if you develop a high temperature.

Your splint can usually come off about a week after your operation.

Everyone recovers from surgery differently. You may find that you need to take a couple of weeks off work, but it depends on your job. Some people go back to work sooner than this. You’ll probably feel more comfortable waiting until the swelling and bruising have gone down, which can take a couple of weeks.

Ask your surgeon about when you can get back to other activities. It’s best to wait at least two weeks before you fly, for example, but check with your surgeon and your airline. And wait a day or two before you drive – check your car insurance first and wait for any swelling around your eyes to go down.

Be prepared for it to take several months before your nose completely settles into its new shape. It may take up to three months for your breathing to be clear again.

Side-effects of nose reshaping

Side-effects are the unwanted but mostly temporary effects many people get after having the procedure. Side-effects of nose reshaping surgery include:

  • soreness, swelling and bruising (particularly around your eyes) for a week or two
  • difficulty breathing through your nose – this should get better as the swelling goes down
  • light nose bleeds for a day or two
  • sensitivity to the sun – wear strong sunscreen, especially on your nose, and a hat for at least six months after your operation

Complications of nose reshaping

Complications are problems that occur during or after the operation. Every procedure has risks. We haven’t included the chance of these happening to you because this is different for every person. Your surgeon will give you specific advice and information. Possible complications of nose reshaping surgery include:

  • difficulty breathing – it’s normal to have some difficulty breathing through your nose straight after your operation but it’s possible that it could be permanent
  • stiffness and numbness – this can last a few months but can sometimes be permanent
  • infection
  • nose bleeds – these may happen shortly after your operation or later, after a week or so
  • damage to the cartilage wall between your nostrils (the septum)
  • a change in your sense of smell or taste
  • scars – the scars will be red, then purple and then gradually fade, but sometimes your surgeon may recommend an operation to make them less noticeable

It’s possible that you may not be completely happy with your appearance after the operation. If this happens to you, talk to your surgeon about your options. 

Reference: Bupa Healthcare: Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant

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