What gives the nose its shape?
The nose is formed by bone and cartilage found under the skin. The top of the nose is formed by bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage which is softer. The skin of the nose varies in thickness from person to person and this can also affect its shape.
What are the reasons to have the operation?
The main reason for having a rhinoplasty is to change the shape of the nose. However, if there is also a problem with breathing through the nose the operation can also help correct that at the same time.
The general appearance of the human face varies. The shape of the nose depends on the shape of the facial bones, the facial dimensions, the colour and thickness of the skin and the characteristics of the different human races.
Most people get used to the way they look but some want changes. The commonest reason for that is a nasal hump, a bent or twisted nose, a narrow or broad nose, a low, over or under projected tip.
There is no such thing as a perfect nose and any changes made to it should exist in harmony with the rest of the facial characteristics. It is very important that the patient has realistic expectations of what a rhinoplasty can offer to avoid disappointment.
What is Rhinoplasty?
Rhinoplasty is an operation to change the shape of the nose. The type of rhinoplasty depends on which particular area of the nose needs correction. The nose can be straightened, made smaller or bigger or change angles.
Pieces of cartilage or bone may be removed from or added to the nose to change its shape. Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. This might need to be connected at the same time. The combined operation is called a septorhinoplasty.
How successful is the operation?
Everybody’s nose and face is different. The thickness of the skin is important in how much better the nose will look after rhinoplasty. If the skin is thin, it makes bumbs or hollows in the nose difficult to hide. If it is thick not all changes made show up on the outside.
Your surgeon will aim to produce a nose that looks natural. However, he might not always be able to say exactly how your nose will look after the operation. It is important that you discuss your expectations with the surgeon. 90-95% of the patients are happy with the results but some people request more surgery.
How is the operation done?
Photographs will be taken to allow a record to be kept in your notes and to allow the surgeon to plan the operation.
The operation is usually performed with you asleep (general anaesthetic). Cuts are made inside the nose. Occasionally a small cut on the skin between the nostrils or at the base of the nostril may be necessary. The skin of the nose is gently lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips.
After the operation, for about 6 months you need to protect the skin of your nose from the sun as it is very sensitive. It is important to wear strong sunscreen and a hat.
Also, the tip of the nose may feel a little numb for up to three months. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.
How long will I be off work?
You can expect to go home the day after your operation. Occasionally you can go home the same day.
You should rest at home for at least 1-2 weeks.
You should not play sport where there is a risk of your nose being knocked for 6 weeks.
What are the possible complications?
The commonest complication of the operation is bleeding. If that happens either during or after the operation then the surgeon might need to put some dressings in the nose to stop the bleeding.
Rarely, the operation may leave a hole in your septum. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment.
Is there any alternative treatment?
There is no pills or tablets that can be used to change the shape of the nose. Very rarely an injectable skin filler might be helpful for small refinements in the shape of the nose.
In some cases a patient’s wish for a rhinoplasty may be related to a disorder of body image (body dysmorphic disorder). These patients should not have surgery and should be offered a referral to a psychiatrist.
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