What is Rhinoplasty?
Rhinoplasty is a surgical procedure to remodel the nose. The extent of the surgery can range from changing the size of the nose to completely changing its shape. The aim of surgery is to make your nose look more natural and ensure that it is in true harmony with the rest of your face.
What does the surgery involve?
Rhinoplasty is performed either as an open or closed procedure. A closed procedure is where the surgeon makes any small incisions hidden inside the nostrils. An open rhinoplasty requires an additional incision to be made across the narrow piece of tissue that separates the nostrils (columella). The approach taken depends on the structural changes to be made to your nose.
The operation takes between one to two hours to perform. At the end of the procedure, a splint is put on the outside of the nose and this is left in place for about a week, whilst healing takes place. Sometimes, small dressings are put inside each nostril (packs). These packs are usually removed the next day.
Rhinoplasty is usually performed under a general anaesthetic (you will be asleep during the procedure).
Operations on the nose are not particularly painful which surprises most people. However, expect to be swollen, bruised around the eyes and cheek region and to feel “bunged up” for the first few days to weeks. Simple painkillers may be required.
Providing all is well, you can expect to go home the morning after surgery. Occasionally, you can go home on the same day.
What are the risks and side effects of surgery?
Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are given a clear picture as everyone varies in the risks they are willing to take.
Bruising and swelling will occur and you are likely to have black eyes. Your nose can start bleeding after the operation although this is uncommon.
Infection in the nose can occur. This can be treated with antibiotics. However, it is important to let your surgeon know if your nose is becoming more blocked, swollen or sore or if you develop a headache and fever two to six days after the operation.
Unpredictable results are possible. Bones can move and cartilage may alter its shape over time. Occasionally, a second operation may be required to refine your results. This is often performed under a local anaesthetic. However, any scarring on the nose from the original surgery must be allowed to settle down first. Any adjustment required will be done approximately one year after the original procedure.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). Developing a chest infection is uncommon but more likely to happen to people who smoke.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon. Decisions about cosmetic surgery should never be rushed.
How do I prepare for surgery?
Following your consultation, if you decide to proceed with an operation, a range of dates will be offered to you. You may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests and a heart tracing (ECG) may be taken. You will be given the opportunity to ask any questions you may have or raise any concerns.
You will be admitted to the hospital on the day of your operation. If you are having a general anaesthetic, you will be asked not to eat anything six hours before surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation.
It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
If you smoke, you should consider giving up several weeks before your operation. The longer you give up beforehand, the better. Smoking reduces the amount of oxygen in the blood and can increase the risk of breathing and healing problems after your operation. If you can’t stop completely, cutting down will help.
Arrange for someone to take you home after surgery if possible as you will not be able to drive yourself home afterwards.
What happens after the operation?
Once you have recovered from the anaesthetic, you will be encouraged to sit up in bed resting on extra pillows. The nasal splint will be in place and you will have a small pad applied to the end of your nose to catch any leakage or drips. You will feel a little drowsy following surgery. Expect to wake up and doze on and off for a little time.
You will notice more bruising the morning after surgery. Swelling is usually at its worst two days after treatment and then it begins to subside. Sitting up as much as possible will help it settle. The bruising will begin to disappear from about the tenth day.
Before you leave the hospital, you will be given a follow up appointment for 4 – 14 days following surgery, depending on whether there are stitches to be removed.
What is the estimated recovery time, absence from work and return to usual activities?
Recovery times vary from one person to another so use the times given as a guide only. If you have any concerns during this period, do contact the hospital team for advice.
Rhinoplasty post surgery timeline
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Day 1 to 3
Might be some watery red fluid coming from your nose. You might feel a bit down and will feel like you have a heavy cold. Important that you do not blow your nose. May have slight nose bleeds.
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Day 4 to 7
Bruising and swelling beginning to go down now. Should be able to wear your contact lenses but continue to sleep sitting up. Make sure that you keep the nasal splint dry. Any external stitches will be removed.
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Day 7 to 10
You can now blow your nose (gently) and sleep lying down. Check your outpatient appointment time – you can soon have that splint removed. Eyes may still be black but the bruising is beginning to fade.
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2 weeks
Much of the bruising and swelling is gone. Most patients are ready to go back to work or at least feel they can go out and about. Any remaining bruising can usually be covered up with make up.
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3 weeks
Most of the swelling has gone now. At the end of this week, you can return to more vigorous exercise If you like.
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2 months
You will still feel some numbness and stiffness at the end of your nose – this will continue to improve with time. It will be fine to return to any form of contact sport. Apply high factor sunscreen until at least the six month stage.
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6 months
Swelling continues to reduce. The shape of your nose will continue to refine.
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12 months
Nearly all healing complete. Any refinement needed will be done at this time.