Rhinoplasty (aesthetic, correction of deviated nasal septum, cleft nose, revision rhinoplasty)
A nose can either be made bigger or smaller both from the front or the profile. In addition more subtle changes can be made to improve the projection of the tip, straighten the nose or improve the airway. The size and shape of the nostrils can also be altered. The changes made to a nose should always keep up with the patient’s cultural and ethnic origin as well as the overall balance of the face. Particular attention should be given to the size and shape of the upper and lower jawbone. The thickness of the nasal skin will also determine how much can be done. It is very difficult to make subtle changes in patients with very thick skin.
Surgery
It is done under a general anaesthesia although smaller changes, especially to the tip may be carried out under a local anaesthetic with some sedation. At least one day’s hospital stay is usually necessary.
Normally most of the scars are on the inside of the nose and not visible at all. In certain cases it may be necessary to have a small scar across the skin between the nostrils or in the fold at the side of the nostrils. Various materials may be used to augment the size and profile of the nose e.g. cartilage, bone, or synthetic materials.
At the end of the operation a small splint will be fitted over the nose to protect the nose from accidental injury and the nose will be packed with vaseline impregnated gauzes.
Complications
The undesired result is the most important potential complication. Therefore, a thorough discussion of you expectations and the limitations to your expectations is very important. Most patients considering rhinoplasty have at least two consultations and detailed discussions of possibilities with the help of photographs. Rhinoplasty is an operation often needing revision (18%).
The scars are most of the time on the inside of the nose and not visible. Spotting of blood is common in the first 10 days after the operation. The nose may feel numb but the feeling does improve within 6 months postoperatively. Swelling and bruising can be marked the first 5 days, especially under the eyes if the bones of the nose need to be altered. The swelling subsides gradually and might take up to 1 year.
After the surgery
You are normally able to go home after the first night in hospital. The splint will be removed after 10 days. Most of the bruising disappears after 2-3 weeks. The final result of the operation should only be judged after 6 months to a year when every thing has healed. Sleeping with a few pillows will help with reducing the swelling. The nose will be blocked for the first few weeks due to the swelling on the inside of the nose. Most patients easily adapt to breathing through the mouth in the early phase of the surgery.