Rhinoplasty (nose surgery)

Rhinoplasty, sometimes called a “nose job”, is surgery to repair or reshape the nose. It may be performed for cosmetic reasons, to change the appearance and proportion of the nose, or to correct breathing problems caused by structural abnormalities. Most operations are carried out through the nostrils, which means there are no visible cuts or scars on the face. Some require a small cut to the tissue between the nostrils.

Rhinoplasty can change the size of the nose, as well as its width and profile. The shape of the tip, the nostrils and the overall balance of the nose can also be altered. Surgery can reduce or build up structures of the nose using cartilage grafted from elsewhere in the body, occasionally from the ear and, rarely, from a section of rib cartilage.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, talking to a counsellor or psychologist may help you work through your concerns about your appearance.

Conditions rhinoplasty can correct#

Rhinoplasty may aim to:

• straighten a crooked nose
• make the nose smaller or larger
• restore the height of a flattened area
• alter the appearance of the nasal tip
• correct a hump
• open up the nasal passages to improve breathing
• correct birth defects
• repair damage caused by injury
• repair damage caused by disease, such as infection or cancer

Things to consider before having rhinoplasty#

Rhinoplasty may not be for everyone. Talk to your medical practitioner and keep the following in mind:

• Your practitioner can only work with your existing bone and cartilage, so there are limits to how far the shape of your nose can be changed.
• The surgery must not interfere with your airway and breathing. If your septum is deviated (the cartilage dividing your nostrils is uneven), your practitioner may recommend straightening it and reducing the projections inside your nose to improve breathing.
• The final results may take up to 12 months to emerge, so it is important to wait before deciding whether any further surgery is needed.
• The bones of the face and nose need to be fully mature before nose surgery is done.
• Cosmetic surgery is not usually covered by health insurance rebates. Ask your practitioner about any out-of-pocket costs you can expect.
• Smokers are at increased risk of complications. To reduce this risk, and for your general health, try to quit smoking before surgery.

It is important to have as much information as possible before deciding to have rhinoplasty. Consider asking another medical practitioner for a second opinion.

Choosing a qualified practitioner#

This procedure should be carried out by a reputable practitioner who is specially trained and experienced in rhinoplasty, working in a licensed and accredited facility. To help you choose:

• Ask your doctor to recommend a suitable specialist or hospital.
• At your first consultation, ask the practitioner about their training and experience.
• Ask to see the certificates that show they are qualified to perform this specialised surgery.
• Check that the practitioner, and the anaesthetist who will care for you during surgery, are appropriately registered with the relevant medical authority where you live.

Your current medical status#

If you are considering rhinoplasty, discuss your current health with your practitioner. This includes:

• your physical health and past medical history, including illnesses, surgeries, immunisations, diet and exercise
• a check of measurements such as blood pressure, temperature, heart rate and rhythm, oxygen saturation and respiratory rate
• your mental health, including any mental illness and its treatment
• any medications you take, including vitamins and supplements
• any allergies, and past reactions to medications

From this discussion, your practitioner can assess the risks and possible complications for you, and explain how to prepare so your recovery is as smooth as possible.

What happens during surgery#

You will be given a general or local anaesthetic. The nature of the surgery depends on the reason for it:

• Repairing an injury (trauma). To realign a broken nose, slender instruments are usually inserted into each nostril to gently push the bones back into place. A bad break may require a small incision so the practitioner can arrange the bone fragments correctly.
• “Open” technique. The nasal bones are accessed through incisions inside the nostrils and across the columella (the narrow strip of tissue separating the nostrils at the base of the nose).
• “Closed” technique. The nasal bones are accessed through incisions hidden inside the nostrils.

Once the incisions are made, the skin is lifted away from the underlying bone and cartilage. Incisions are usually closed with dissolving stitches.

Immediately after rhinoplasty#

After the operation you can expect:

• swelling and bruising, mainly around the eyes; swelling usually settles within a few days and bruising within a week or two
• mild to moderate pain and the sensation of a “stuffy” or blocked nose
• some numbness
• the inside of the nose to be packed with special gauze, and the bridge supported by a splint (often plaster of Paris) to minimise swelling and hold the new shape; a small piece of tape may also be placed over the nose
• to be able to get up and move around

You may need to wait four or five hours before eating and drinking, after which you can usually eat as normal. If you need pain relief, ask the nursing staff.

Potential complications#

All surgery carries some degree of risk. Possible complications of rhinoplasty include:

• a large blood clot (haematoma) beneath an incision site, which may need draining
• heavy bleeding from the surgical site
• infection that may need antibiotics or, in some cases, further surgery
• allergic reaction to sutures, dressings or antiseptic solutions
• slow healing, often related to smoking or diabetes
• separation of the wound edges
• short-term nausea from the general anaesthetic
• pain that may be severe and ongoing
• keloid or hypertrophic (raised) scars over the healed incisions, which may be itchy and unsightly but are not a threat to health
• numbness or altered sensation in the nose after bruising and swelling subside
• temporary numbness of the upper front teeth
• narrowed airways causing difficulty breathing through the nose
• an unsatisfactory appearance that may require revision surgery
• impaired sense of smell and, rarely, loss or distortion of smell
• darkened skin under the eyes for more than six months
• weakening of the nose’s support structure, which may cause flattening
• if an implant was inserted, it may extrude (poke out) into the nose or through the skin

This is not a complete list. Your medical history or lifestyle may put you at increased risk of certain complications, so speak to your practitioner for more information.

Self-care after surgery#

Your practitioner will give you post-operative instructions, which may include:

• reporting any bleeding, severe pain, sudden nosebleeds or unusual symptoms
• pain management and wound care
• when to have a follow-up appointment
• taking any medications sent home with you; ask what each is for, how often and how long to take it, and if antibiotics are prescribed, finish the whole course

General self-care suggestions include:

• avoiding heavy lifting, strenuous exercise, swimming and sports until your practitioner advises
• holding your head upright as much as you can
• not blowing or rubbing your nose for at least eight weeks
• avoiding aspirin, which can increase the risk of nosebleeds

Bandages and packing gauze may stay in place for up to a week, after which your practitioner removes them. You may need around two weeks off work, and broken nasal bones may ache for up to eight weeks. Ask your practitioner for advice on suitable pain relief.

Short- and long-term outlook#

You will see the difference in your nose’s shape as soon as the dressings and nasal packs are removed, about seven days after the operation. However, your “new” nose takes time to refine. Although initial swelling settles within a few weeks, it may take up to a year to reach its final profile, with gradual changes along the way. Swelling may come and go and can be worse in the mornings during the first year.

The results of rhinoplasty are usually permanent. A broken nose, once healed, is not as strong as one that has never been broken, so it is at greater risk of fracturing again from a blow to the face. Take precautions such as wearing protective headgear when playing sports.

Alternatives#

There are no other medical alternatives to rhinoplasty that can repair or reshape the nose. If your concern is about your appearance, talking to a counsellor or psychologist may help you work through it.

Key points#

• Rhinoplasty is also used to correct breathing problems caused by structural abnormalities in the nose.
• It is essential that the surgery does not interfere with your airway and breathing.
• Smokers are at increased risk of complications.
• It is important to have as much information as possible before deciding to have rhinoplasty.
• Your nose bridge will be covered with a splint, commonly made of plaster of Paris.

Where to get help#