Rhinoplasty surgery - operation to reshape the nose

Nose re-shaping (rhinoplasty)

This factsheet is for people who are considering having a nose re-shaping operation.

Nose re-shaping operations can increase or decrease the size of your nose, or change its shape. The medical terms are:

• reduction rhinoplasty, which makes the nose smaller
• augmentation rhinoplasty, which makes the nose larger or gives it more bulk

Why have a rhinoplasty?

The shape and size of your nose is genetic. Your nose is generally fully developed by the age of 16.¹

Rhinoplasty may be performed if you are unhappy with the natural shape and size of your nose. It may also be done to restore the shape of your nose after an injury.

It is very important that you are clear in your mind what it is that you dislike about the appearance of your nose and that you are able to explain this to your surgeon. He or she will then be able to tell you what is possible with rhinoplasty surgery and what is not.

Most people who have rhinoplasty report that they are happy with the results of their operation.²

What happens before a rhinoplasty?

Your surgeon will discuss how to prepare for your operation. You will be asked about your medical history and you will have a full examination, including checks on your heart and lungs.

You should ensure you are free from a cough, cold or sore throat at the time of your operation because this can increase the risk of an infection afterwards.² If you have any concerns, contact your surgeon or anaesthetist for advice.

What should I expect in hospital?

When you arrive at the hospital you will be asked to sign a consent form. This confirms that you understand the procedure and have given your permission for it to go ahead.

Your nose will be examined and its shape and size will be measured. You will usually have a photograph taken of your face before the operation, so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

The operation

Rhinoplasty can be performed as a day case, which means that you can have the operation and go home the same day. However, you may need to stay between one and two nights in hospital. It depends on the extent and time of the procedure.^1,3

The operation is usually done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Alternatively, you can have a sedative and a local anaesthetic that numbs the area around the nose.⁴

For more information on anaesthesia please see the separate BUPA factsheet Anaesthesia.

Reduction rhinoplasty

Your surgeon will make cuts inside your nostrils to reach the bone and cartilage. The shape of your nose will then be created by partially removing and re-shaping the bone and cartilage. The skin over your nose is left untouched and due to its elasticity, can shrink down to the new shape.^3,4

Making the nose smaller and narrower may mean it is also necessary to make your nostrils smaller. This is done by making further cuts in the skin of the nostrils, which leave fine scars on each side.⁴ Your surgeon will advise you whether you may need this procedure.

Augmentation rhinoplasty

Your surgeon will make a cut inside or between your nostrils and re-shape the bone. Additional bone or cartilage may be needed to build up the nose. Bone may be taken from:

• your hip
• a rib
• the back of your elbow
• the surface of your skull

This is called a bone graft.

If cartilage is used it may be taken from:

• your ears
• spare cartilage inside your nose

Sometimes artificial implants are used.^1,3

The skin over your nose will probably not need to be cut as it stretches over the new shape.

After reduction or augmentation rhinoplasty, the cuts inside or between your nostrils will be closed up with dissolvable stitches.^1,3 Your nose may be filled with surgical packing to help control any bleeding. You may also have small pieces of soft plastic inside your nose to prevent scar tissue from forming.²

What to expect after the operation

Painkillers will be given to help relieve any discomfort as the anaesthetic wears off.

If you have had an augmentation rhinoplasty, you may have to spend up to a week in hospital to recover but it's usually shorter than this.¹

If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Before you go home, your nurse will give you advice about caring for your nose.

Recovering from rhinoplasty

You will have dressings in each nostril for about a day, which prevent you from breathing through your nose. You will also have a splint over your nose to hold the bones in position. The splint can be made with various materials ranging from thin metal to plaster of Paris.^5,6 This will be removed after a week or two.^1,3,4,5

You can expect some minor bleeding for a day or two. You will be advised by your doctor or nurse to:

• keep your head up as much as possible
• avoid hot baths
• avoid alcohol
• avoid blowing your nose
• try your best not to sneeze through your nose and cough it out instead
• wear strong sunscreen and a hat for at least six months as the skin of your nose will be very sensitive to the sun

You will experience some bruising and swelling, particularly around your eyes, which will usually take up to three weeks to disappear completely.^1,3

If you find it difficult to breathe through your nose, this should ease as the swelling settles. It will take about three months for the swelling to disappear completely.^1,3,4

Your nose will also feel numb and stiff, particularly around the tip if you have had a reduction rhinoplasty.^1,3 The numbness will disappear slowly during the next few months but the stiffness is likely to be permanent.^1,3

Whilst there is no medical reason why you should stay away from work, you will probably feel more comfortable taking some time off and returning when the bruising has disappeared.

Deciding on treatment

It's important not to rush into the decision to have any cosmetic operation. And it's sensible to discuss the options with your GP, who may be able to recommend reputable surgeons or give advice about how to choose which hospitals to be treated in.

Rhinoplasty is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to give informed consent, if you are deciding whether or not to have this procedure you need to be aware of the possible side effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. There are also a number of specific side effects to expect after a rhinoplasty.

• If you have had augmentation rhinoplasty and it has been necessary to take a bone graft from another part of the body, you will be left with a scar.¹
• If you have had an augmentation rhinoplasty and a bone graft taken from your hip, you can expect this to be quite painful for about 10 days, particularly when you walk.¹
• It is quite common for there to be some difficulty with breathing through the nose during the first week after the operation, particularly in a reduction rhinoplasty, which disappears as the swelling settles. Occasionally though, the difficulty persists and can be permanent.³

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. A rhinoplasty carries risks of developing complications listed below.

• Chest infection (particularly if you smoke).^1,3
• Heavy nose bleeding either shortly after the operation, or after a week to 10 days which may require treatment in hospital.^1,3
• Infection of the nose.^1,3
• Temporary loss or reduction in sensitivity to smell after the operation, which can become permanent, although this is rare.⁷
• Changes in the shape of the nose as scar tissue matures which may require going back to hospital for minor adjustments at a later date.²
• A manufactured implant can occasionally push through the skin of the nose or its lining and need to be removed (after an augmentation rhinoplasty). This can happen months or years later, and is more likely if a large implant has been used or if the nose is accidentally injured.

Overall, about one in ten people need further surgery after having a rhinoplasty. This is either due to complications happening or if the nose does not look right after the operation. Most surgeons will wait for a year before operating again.^1,3

References

• British Association of Aesthetic Plastic Surgeons (BAAPS), Augmentation Rhinoplasty.
  www.baaps.org.uk
  viewed on 31 January 2005
• The British Association of Otorhinolaryngology ENT-UK, About Rhinoplasty.
  www.entuk.org
  viewed on 31 January 2005
• The British Association of Otorhinolaryngology ENT-UK, About Rhinoplasty.
  www.entuk.org
  viewed on 31 January 2005
• British Association of Aesthetic Plastic Surgeons (BAAPS), Reduction Rhinoplasty.
  www.baaps.org.uk
  viewed on 31 January 2005
• American Society of Plastic Surgeons, Rhinoplasty.
  www.plasticsurgery.org
  viewed on 31 January 2005
• Facial Surgery website, Rhinoplasty tutorial.
  www.facialsurgery.com
  viewed on 15 February 2005
• Better Health Channel, Rhinoplasty.
  www.betterhealth.vic.gov.au
  viewed on 15 February 2005
• Briner HR, Simmen D, Jones N, Impaired sense of smell in patients with nasal surgery, Clinical Otolaryngology & Allied Sciences, 2003, 28:5:417-419.

Published by BUPA's health information team, healthinfo@bupa.com, April 2005