What is it?
Rhinoplasty is the surgical treatment for reshaping of the nose. Depending on the exact problem it can involve the removal of bone cartilage, a reshaping of the bridge of the nose, and reshaping and altering the tip of the nose.
The surgery is usually performed under general anaesthetic but can be performed under local anaesthesia and heavy sedation. The surgical scars may be either inside the roof of the nose or at the central strut of the base of the nose. The surgical scar, if it is placed externally, is occasionally visible and is particularly useful in noses where there has been trauma or where previous surgery has been performed.
In noses where there are minor irregularities these may occasionally be corrected by subcutaneous injections. However these may not be permanent and surgical correction is often the only way of obtaining a lasting result.
Before the Operation
The patient should be in good general medical health and avoid smoking, Aspirin or Aspirin containing medication. Surgery should be postponed if there is any evidence of infection in the nose, throat or sinuses. In your pre-operative consultation your doctor will discuss your general medical health, what medications you may be taking and if these have any bearing on the surgery. It is also likely that one would wish your blood pressure to be normal.
After in Hospital
You are likely to have a plaster over your nose to protect the surgery that has been performed. Depending on the necessity of surgery inside the nose itself, there may be packs up each nostril. This initially may cause difficulty with breathing and a sense of being gagged.
If there are no packs up the nose, there still may be residual swelling and this may also cause some difficulty breathing through the nose. In normal breathing, most people breath through their nose by preference and this inability to breathe through the nose may be initially upsetting. If packs are in place, some minor bleeding may occur when they are removed, usually twenty-four hours after surgery. There is often minor bleeding following the surgery anyway. While in hospital your blood pressure, pulse and temperature will be checked and pain killing tablets or injections given. The surgery itself does not tend to produce bad pain. It is important after the surgery not to blow your nose as this can cause significant bleeding. Occasionally if one needs to clear the nose, it is necessary to gently sniff. It is also likely that there will be significant bruising and swelling around the face and the patient may end up with black eyes. On return to the ward you will also be nursed in an upright position.
After at Home
Bruising following the surgery can last for two to three weeks. You may also find that your nose is blocked off and on, particularly in the first few weeks following surgery. This can take some time to settle down. It is important to avoid bending, stooping and straining in order not to start the nose bleeding. Paracetamol is usually adequate for pain relief. You should avoid taking Aspirin or tablets containing Aspirin as these can promote bleeding. It is probably best to avoid people with coughs and colds for the first few weeks following surgery. The protective plaster dressing is usually taken off between one and two weeks following surgery. It is likely that your nose will continue to remain swollen although it should have achieved a satisfactory shape and size. You will also probably notice that there is some numbness over the skin of the nose and this can persist for some time. You can return to work after a few days but it may be too obvious with the plaster dressing and many people tend to wait until the plaster has been removed and the bruising has settled before returning to non-strenuous work. It is advisable to avoid any heavy activity such as gym work, strenuous lifting, or straining for one month following surgery.
Surgery for Rhinoplasty correction should be avoided in people who have a cough, colds or have evidence of infection in and around the nose at the time of the surgery. Bleeding does occur during surgery but this is usually stopped on return to the ward. Occasionally it can occur again while the patient is in hospital and this may necessitate a return to theatre. Infection at any time following surgery is another cause of bleeding and tends to occur between seven and ten days post-operatively. It may necessitate packing of the nose and very occasionally a return to theatre. Due to the narrowness of the nasal passageways swelling after surgery causes them to become even narrower. This can cause some difficulty with breathing which can take a few months to settle. Removal of some of the cartilage in the centre of the nose may be performed at the time of Rhinoplasty in order to improve nasal airways. This however would be discussed with your surgeon prior to the operation. Examination of the nose prior to surgery would indicate whether this was necessary. Minor irregularities over the tip of the nose can occur following Rhinoplasty type procedures. These may be apparent and in a small number of cases and need surgical correction at a later date. This can be performed when the swelling following surgery has returned to normal. These minor irregularities may be less noticeable in those who have thick-skinned noses. Some patients also find that they may have an altered smell after the surgery.
It is important for the surgeon to understand what problems the patient is having. It may not be possible to achieve the exact results that the patient expects. It may also be very important to point out to the patient the relationship of the nose to the rest of the face and that to surgically alter a nose in some situations can leave the face significantly out of balance. It is also important that the patient would be aware that scars on the external part of the nose are occasionally necessary, particularly if there are large nostrils or if secondary surgery needs to be performed.