Rhinoplasty or Nose Plastic Surgery

Rhinoplasty or nose plastic surgery -- commonly called a 'nose job' -- corrects cosmetic features or the function of your nose.  A rhinoplasty is one of the most difficult cosmetic procedures to undertake and requires an understanding of the function and anatomy of the nose.

Amongst the many features of a nose to address are the septum (middle strut), the dorsum (or top) of your nose as well as the shape of the tip of your nose.  Less commonly in the lining of your nose (mucosa) and your sinuses may require surgical attention as well.  The skeleton of the nose is composed of both cartilage and bone both of which have to be sculpted to obtain the ideal result. 

The best candidates for a rhinoplasty are those who have realistic expectations of what is achievable.  The surgery undertaken upon your nose will depend on an assessment of your nasal symptoms and anatomical features. 

This requires an accurate knowledge of the effect of the physiology and anatomy of your nose to produce a desirable outcome.  Age is also a consideration and generally speaking, the nose has not matured sufficiently before the age of 15.  Surgery undertaken on an immature nose can produce unpredictable results.  It is also important to consider a persons’ emotional maturity prior to undertaking a rhinoplasty.

Accurate photo documentation will take place preoperatively.  Almost invariably, “Alter Image” software will be utilised to demonstrate a proposed end result of surgery and will be stored to compare with the postoperative result.  This is an important step in understanding what is possible and digital manipulation of photographs provides a central point for discussion preoperatively.  Details of anaesthesia and the postoperative course will also be discussed.    An account of medications and your past medical history will be obtained during the preoperative interview.  Certain medications (most notably aspirin, other anticoagulants and herbal remedies) must be avoided preoperatively.  Smoking in particular adversely affects wound healing.  Once adequate healing has taken place, a copy of photographic images will be supplied to you.

In the majority of cases, surgery takes place under general anaesthetic.  The procedure takes an hour or two, it occasionally may take longer than this. 

There are two basic methods of undertaking surgery – the “open” or “closed” methods.  The former method includes an incision through the columella to facilitate lifting of the skin from the top of your nose.  The “closed” method utilises incisions which are placed entirely on the inside of your nose.  The “open” method may be preferred and as a better appreciation of the structure and skeleton of the nose is obtained.  At the completion of surgery, paper tape is applied to the dorsum of your nose and this may be covered by a splint.

Very little pain should be experienced and your facial swelling and bruising will be maximal within the first 48-72 hours, especially if the bony skeleton of your nose warrants surgery. 

A little bloodstained discharge from you nose is common but that should reduce over the first few days.  It is very uncommon to require the insertion of nasal packing following nasal surgery of this nature.  You will soon be able to return to your normal activities within a short period of time but strenuous exercise should be avoided for at least 10 days following surgery.  The initial postoperative as it will take place at approximately 5-7 days following surgery.  Following surgery, most people also feel weary and it is quite common for people to feel a little depressed at this stage but within a week or two following surgery, the end result will become more visible and your spirits tend to lift.  Try to keep in mind why you decided to have surgery in the first place.

• It is impossible to guarantee surgical results with this kind of a cosmetic procedure and the digital manipulation of your image undertaken preoperatively is used as a guide only.  Results cannot always be guaranteed and a small percentage of patients will require revision surgery.
• Pain is usually mild and can be controlled using simple analgesics (not aspirin as this may promote postoperative bleeding).
• Bruising around the eyes is very common and may take 7-10 days to settle.
• Avoid excessive sun exposure following surgery.
• Avoid excessive pressure over the top of your nose following surgery.
• By the end of six weeks, the result of surgery is reasonably stable.

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