What is a Rhinoplasty?
Rhinoplasty is the medical term for reshaping of the nose. It is one of the most common cosmetic surgery procedures performed.
Does Rhinoplasty give a natural appearance?
Modern Rhinoplasty is a surgical art form. A natural looking nose that is in harmony with its face, is the aim of the surgery.
Who are the best candidates for Rhinoplasty?
Anyone who is concerned with the shape or size of their nose can consider a Rhinoplasty procedure. Also, anyone who has had trauma to the nose or has airway problems.
Dr Oates performs Rhinoplasty procedures either in hospital under general anaesthetic (fully asleep) or under twilight sedation in our government licensed Academy Day Hospital (on site at Academy Facial Plastics). In the majority of cases all incisions are hidden within the nose. The skin is elevated and the underlying bone and cartilage sculpted as necessary. This will allow the removal of a hump, narrowing a broad nose, straightening a deviated nose, refinement of the tip and changing the angle of the nose to the lip. Immediately after the procedure a splint is applied to the external nose for protection and reduction of swelling, and will remain on the nose for 7 days.
You should expect some bruising and swelling around the eyes, which subsides in 5 to 10 days. Swelling on the inside of the nose tends to make it feel blocked (similar to having a cold). This may last for 1 to 2 weeks. Academy Facial Plastics will provide you with a saline spray to wash your nose out and a decongestant to reduce blockage.
After the operation you should keep your head elevated and use ice packs (frozen peas) to help reduce swelling. Exertion, sun exposure and activities that risk injury to your new nose must be avoided. If you need to wear glasses it may be necessary to use tape to prevent pressure on the bridge of the nose. Significant improvement can be seen in the nose after two weeks however subtle refinement continues for a further 12 months.
How long will I need off work?
Most Rhinoplasty patients will take between 1 and 2 weeks off work, depending on the amount of physical activity involved in their line of work
Is there Discomfort?
Most patients report Rhinoplasty as being relatively pain free though you can expect minimal to moderate discomfort due to having a blocked nose. The nasal decongestant spray will help relieve this discomfort.
Pre and Post-Operative Care
Post-operatively you will need to keep the inside of the nose clean with the saline solution. The more times per day the saline wash is used the better.
Post-operative Care Nasal Reshaping
Complications only occur in a minority of cases. If a procedure or particular patient was likely to have a high risk of complications Dr. Oates will advise you of this or decide not to perform the procedure. These complications may range from very minor ailments to death. The list below is not a complete catalogue of everything that may happen - it is unrealistic to produce such a list. If you have any other specific concerns please raise these prior to signing a consent form or having any procedure.
Dr. Oates does not use the old painful packs in the nose but may use a comfortable cotton wool type dressing in the nose, which is often removed after just a few hours. The splint is generally removed in 5-7 days.
In most cases a plastic splint is placed over the nose. Usually tapes are applied to the skin first. This combination helps reduce swelling of the nose post operatively.
Black Swollen Eyes
It is usual to get some swelling and bruising of the eyelids. This tends to be a very personal reaction with some people having almost none. Ice packs to the eyes and keeping your head elevated for 72 hours helps minimise this. Aspirin, Ibuprofen, Vitamin E will make the bruising worse. Most patients are almost back to normal in one week.
Swelling of tissues is a natural response to trauma. Swelling within your nose will reduce the airway for about 2 weeks. If you had a major septal deviation then the airway may continue to improve, no guarantee can be made as to how much improvement will be achieved. Breathing may appear worse with a cosmetic rhinoplasty because of the reduction of the nose.
For 10-14 days post op it is normal to have a very runny nose often blood stained. Very gentle blowing is OK. After one week a crust often starts forming in the nostrils and using a saline solution (i.e. Narium, FESS from chemist) regularly will help prevent and wash these away. A clean nose will heal more quickly and has less risk of infection.
Bleeding is not common after a simple Rhinoplasty. The risk increases when surgery is performed to improve the airway. Bleeding should settle quickly, but you will need to consult Dr Oates if bleeding persists.
Infection is rare in a simple rhinoplasty. Risk increases if cartilage or artificial grafts were used. Dr.Oates will often place post rhinoplasty patients on an antibiotic (i.e. Keflex) for 5 days.
Dissolving sutures are always used within the nose. At 1-3 weeks post operatively do not be alarmed if small pieces of suture expel from the nose while blowing. Some Rhinoplasties are best approached with a small incision in the columella (the section between the nostrils). These stitches are usually removed 5 - 7 days post operatively.
Usually there are no external incisions for a Rhinoplasty. If an incision is made in the columella it usually heals very well. Rarely it may be necessary to convert from no planned scar to having a scar, this would only be done if absolutely necessary to achieve the result.
Tape Adhesive Allergy
A reaction to the skin taping, used to help control the swelling, is the most common complication. It may just be excessive redness or milia (white heads) to blisters and discharge. If you have ever had a reaction to adhesive tape please let Dr. Oates know.
Straightening a crooked nose is a common request in the Rhinoplasty patient. Sometimes complete straightening may not be possible.
Revision of another surgeons operation, especially if there are significant concerns is more difficult than a initial operation and unlikely to give a perfect result. With a good understanding of specific goals and limitation it can be helpful.
The Final Results
When the splint is removed at one week, the nose will be swollen. At 2-4 weeks post op the improvements will be more noticeable. The final result continues to improve for up to one year (which is why Dr. Oates will want to see you again then). Although the changes required in the nose will be discussed at great length pre-operatively, it is not possible to guarantee the final result. Occasionally Dr Oates will use injections to help settle the nose more rapidly. Rhinoplasty is best considered to be able to achieve a single step improvement from bad to acceptable, acceptable to good, good to great.
Following any anaesthetic procedure there are common risks such as nausea, vomiting and sore throat. Rare effects as a reaction to the anaesthetic may include damage to teeth, vocal cords, drug reaction, blood clots, aspiration of gastric fluid, respiratory or heart problem and in extreme cases death.