Rhinoplasty

Introduction
Surgery to reshape the nose is a common plastic surgery procedure with a long history of refinement and study. It can be done to increase or decrease the size of the nose, and reshape, straighten, or rebuild any aspect of the nose. The shape of the tip, the bridge and also the nostrils can be changed as can the angle between the nose and the upper lip. Breathing difficulties may be corrected at the same time. Rhinoplasty surgery can be technically demanding, and a good result will deliver some of the most rewarding patient satisfaction in plastic surgical practice.

The Operation
Rhinoplasty is generally carried out under general anaesthetic and usually requires an overnight stay in hospital. Mild painkillers are required after surgery, but the more common sensation is one of discomfort from the nostril dressing and nasal splint. Nasal airway obstruction from swelling and blood clots is common for a few days, and can be uncomfortable. Rhinoplasty may be done by an intranasal approach (‘closed rhinoplasty’) or via a small scar across the central base (columellar) of the nose (‘open rhinoplasty’) which is designed to be hidden in shadow. The approach chosen depends upon the desired aims. Rhinoplasty surgery changes the subtle balance between the skin, muscle, cartilages and bones of the nose, and each technique is chosen to meet individual aims. Patients awake, in a semi upright position, with a nasal splint (plastic or plaster) from the forehead to the nasal tip, beneath which are steristrip tapes used to control the swelling. Indwelling nasal packs of jelonet may be used for a day or two, requiring the patient to breath by mouth. The nose, cheek and upper lip are swollen and often temporarily numb. Symmetrical ‘black eyes’ are not uncommon! Head turning and bending are restricted for the first week to reduce bleeding and swelling risk. Minor bleeding and clots from the nose after removal of the packs is common.

Recovery Period
The external splint is worn for 10 days to two weeks. Minor post – operative bleeding and crusting are common and may make nasal breathing difficult for the first few days. Nose blowing during this time is to be avoided. Itchiness and irritation from crusting is common for a few days. Patients should keep a straight head and back as much as possible for the first week, avoiding bending and lifting, which cause a bleeding risk. Bruising and swelling around the eyes settles within 2-3 weeks. The nose feels stiff and numb for a period of time, with normality returning finally to the tip at 6 weeks to 6 months. Although there is no medical reason to stay away from work for more than a few days, two weeks off is usually advised. Sporting activity is restricted for two weeks, and contact sports for six weeks, until healing has matured. Return to driving depends upon comfort and the reduction of facial and eyelid swelling. There is no restriction on showering or bathing, but towelling off should be gentle. Patient satisfaction from rhinoplasty procedures is excellent. Relative risks and benefits are discussed by the surgeon at the time of consultation.