Rhinoplasty surgery (commonly referred to as a nose job) is a cosmetic surgery procedure in which the nose is reshaped to improve appearance. There are many complex aspects to rhinoplasty surgery. It is probably the single most individualized procedure that we do. Every nose is different and requires a unique surgical plan to achieve the best results. Some noses are too wide, others too narrow, still others too large and some too small. Each patient clearly needs a different plan to have a successful outcome. The consultation visit is of great importance in establishing our goals and determining the optimum way to proceed. The best outcome is a natural appearance that doesn’t look like surgery was ever done.
I do all of my rhinoplasty operations under a general anesthetic as day surgery in my private clinic. Some surgeons prefer using local freezing, but I have always felt that having my patients asleep is a less stressful and a more comfortable experience for them.
Depending on the nature of the correction required during rhinoplasty surgery, the procedure is performed using different surgical approaches. Most rhinoplasty surgery is done through small incisions hidden within the nose. This is referred to as a “closed approach”. Special instruments allow significant nasal reshaping to be done through these tiny incisions. A variety of techniques may be used including the trimming of cartilage, smoothing down of bone, using internal sutures to change projection and so on. The exact changes to be made depend upon patient goals and also their ethnic background. The appearance of a nose must be in harmony with who the person is.
If certain problems such as a very wide or asymmetrical tip are present, a different surgical approach may be needed. For these cases an “open approach” is used. In this technique, a short incision is made across the columella (the vertical strip of tissue separating the nostrils) as well as the using the internal incisions already described. This additional incision allows greater exposure of the internal structures and different methods to reshape the nose can be used. The end result is almost the same as the closed approach with the difference being a few tiny sutures across the base of the columella.
All internal sutures dissolve; the only stitches that need to be removed are the ones in the columella after an open rhinoplasty. After rhinoplasty surgery, a plaster splint is applied to maintain the shape and position of the nasal correction, to protect the nose from trauma as it heals and to minimize swelling. Pain after rhinoplasty surgery is very minimal and can be alleviated with mild pain medication such as Advil.
The plaster splint is removed at the first post-op visit, which is booked one week after the procedure. It’s always exciting when patients see their new nose for the first time. There is still moderate swelling after a week and often some lingering bruising. It takes a few more weeks to really see the way it will be after healing is complete.
I advise my patients to avoid any contact sports or activities that might lead to facial trauma (boxing? volleyball?) for 6 months. It actually takes most patients a year to fully resolve all swelling and regain normal softness and flexibility. During this long healing period, the appearance changes are very subtle but typically we see greater definition as time passes.