Rhinoplasty (Nose job)
The nose forms the centrepiece of the face and requests for rhinoplasty are on the rise, particularly in the age of social media and ‘selfie trends’.
Often, in addition to parts of the nose that may require correction for cosmetic reasons, there may also be functional issues such as difficulty breathing that may be improved upon at the time of surgery. The areas of the face surrounding the nose, such as the midface and the lips and chin, also need to be considered when attempting to achieve a harmonious look.
I always strive to explain to patients that the end result needs to be consistent with the shape of their face. A small petite nose may not suit a round, full face. Similarly, a broad nose on a thin long face will need to be narrowed at the base. The end result should always be a natural looking nose that suits that particular face.
The anatomy of the nose is complex. The different components of the nose may need to be adjusted including the skin, bone, cartilage, nostril and septum. In brief, the nose can be divided into 3. The upper 1/3rd is mainly bone. This may be wide and may need to be narrowed to give the nose a better profile when viewed from the front. This is done by ‘breaking’ the nasal bones. A dorsal hump (the common bump found on many noses) is partly composed of bone, so a hump reduction may be required to improve the side profile.
The middle 1/3rd is composed of the upper and top half of the lower lateral cartilages. These may also be reduced in height as part of the hump reduction. Some of the lower lateral cartilage is frequently removed to narrow the middle and lower 1/3rd of the nose. Finally, the lower 1/3rd of the nose generally comprises the tip and alar rims. The tip of the nose almost always requires modification to improve definition, rotate upwards or set backwards.
Additional procedures such as a septoplasty to straighten a deviated nose, alar base reduction to narrow the base, or spreader grafts to improve the breathing and widen the mid-nose.
You will require an assessment with the nursing team a few weeks before surgery. Ideally this is done face to face, but may on occasion be done telephonically. During this period you will have an opportunity to discuss any aspect of your surgery at that time.
You may take ARNICA tablets (unless contraindicated) prior to your surgery to reduce bruising. These can be purchased from health food stores and leading chemists. Commence taking the tablet if you wish 24 hours after surgery for a further 1 week.
We are all born with some minor asymmetry of the face. This is entirely normal. I will try to adjust this as best as I can during the procedure, but if minor differences still remain after the operation we accept that it is within normal limits.
The operation is usually performed under a general anaesthetic, usually with one night in-hospital stay.
Day of the operation
On arrival you will have routine observations performed and a check of all the relevant paperwork carried out by the nursing staff. Then you will be asked to change into a gown.
All your jewellery must be removed, including ALL metal body piercings. It is recommended that you do not bring anything of value into hospital. All makeup must be removed as it can damage your eyes if left on while you are asleep. You must also remove all nail varnish and acrylic nails.
What will happen when I wake up?
You will wake up in recovery sitting upright with a bolster across the nose to catch any oozing and hold the nasal packs in. It is important that you remain in this position to help reduce the swelling unless indicated otherwise.
You will be allowed out of bed to pass urine (water) with the assistance of the nursing staff the first time, in case you feel lightheaded. Because you are lying / sitting more upright than normal for the first few day after the operation, it is quite common for the small of your back to be uncomfortable. It helps if you move slightly from one buttock to the other to relieve the pressure.
You will not be allowed home until you are comfortable and pain free. We send you home with a range of different painkillers (mild, moderate and strong) and a course of oral antibiotics and some tablets to minimise the risk of bleeding.