Rhinoplasty (nose job) is an operation that changes the shape and size of the nose. Rhinoplasty could be considered in the following situations:
- There is general dissatisfaction with the shape or size of the nose. The nose seems to be too large or too small, or out of proportion with the face
- The dorsum of the nose is either too wide, too high (nasal hump) or too low (saddle nose deformity)
- The tip of the nose is too droopy, too upturned, too protruding (long), or too wide
- There is discomfort regarding the shape or size of the nostrils. Nostrils could be too big, too visible, or flared
- The nose is deviated or deformed due to previous trauma or due to congenital problems
There are two basic techniques for performing nose correction: closed (endonasal) and open (external) rhinoplasty.
In the closed approach rhinoplasty, all incisions are placed inside the nasal passages.
As a result, there are no external scars, unless the size of the nostrils is also reduced (alar wedge and/or nostril sill excision). Although working through nostrils limits visualization, an experienced surgeon can still perform all required reshaping of the tip and dorsum. The advantage of the closed technique is that it enables the surgeon to see changes in the shape of the nose during surgery in a gradual fashion, it is less aggressive, and therefore allows much faster recovery. This approach is a preferred surgical technique in our practice.
In the open approach rhinoplasty, in addition to the incisions inside the nostrils, there is a small incision placed on the columella (the small bridge of skin between the nostrils). If the columellar incision and its suturing are done properly, the scar is almost invisible. The advantage of the open technique is better access to all bony and cartilaginous structures of the nose. However, the open method also has several drawbacks: greater surgical trauma, a longer healing period, and a somewhat less predictable final outcome. In our practice, we use the open approach mainly for two reasons: revision nasal surgery or cases of severe nasal deformity.
Preoperative consultation and preparation
For patients coming from abroad, a VIRTUAL CONSULTATION is the most suitable option for consultation.
More detailed information about preoperative preparation can be found here.
Rhinoplasty procedure steps
Rhinoplasty consists of three main steps:
- Correction of the nasal dorsum
- Correction of the nasal tip
- Correction of the shape and size of nostrils and alars
All those steps can also be done as a separate independent operation. Many patients, for instance, only require hump removal to achieve the desired aesthetic result. Some patients, especially males, are looking only for correction of the deviation or deformity, which usually involves only the dorsum area. On the other hand, some other patients only want to change the shape and size of the tip without touching the dorsum. Infrequently, some patients only wish to improve the shape and size of the nostrils and alars. In some cases, rhinoplasty is performed in combination with septoplasty and the procedure is then called septorhinoplasty.
If rhinoplasty includes all of the above stages, they are performed in the following order:
Correction of the nasal bridge, the aim of which is usually to lower or raise the bridge, make it narrower or wider, and/or correct deviation. In aesthetic rhinoplasty, by far the most common request is lowering the nasal bridge (removal of a hump) and narrowing it. The nasal bridge can be lowered using several different techniques. In most cases, after hump removal, a splint must be worn and is removed after one week. The image below shows the immediate result after hump removal. Much less commonly, augmentation of the nasal bridge is required to increase its height. In mild cases, cartilage taken from the nasal septum or the ear is used; in more severe cases, rib cartilage is required.
Correction of the nasal tip. In aesthetic rhinoplasty, the most common wish is to make the nasal tip shorter and narrower and to elevate it to a greater or lesser extent. There are many techniques used to change the shape of the nasal tip, and most surgeons have their own approach to achieving the desired result. The photograph below shows the immediate result before and after surgery aimed at removing a hump and improving the aesthetics of the nasal tip.
Correction of the shape and size of the nostrils. The main methods include reduction of the nasal wing volume (alar wedge excision) and/or reduction of nostril size (nostril sill excision), or a combination of both. These procedures are performed in the final stage of the operation. It should be taken into account that these procedures leave external scars. When incisions are made within normal anatomical boundaries, the scars are barely noticeable in most cases.
Early postoperative period
If silicone plates are placed in both nasal cavities after rhinoplasty to support the nasal septum, they are removed after 1–7 days. The external nasal splint is also removed after 7 days. Most sutures used are absorbable and do not need to be removed. In many cases, silicone tubes supporting the shape of the nostrils, known as nostril retainers, are used. After surgery, nasal breathing may be impaired due to swelling, which usually resolves within 3–4 weeks. Bruising may occur around the eyes. External nasal swelling and bruising are most pronounced 3–4 days after surgery. Bruising and most of the swelling subside within the first 2–3 weeks. Postoperative pain is usually mild to moderate. Over-the-counter painkillers (paracetamol, ibuprofen) are used for pain relief. In most cases, a course of oral antibiotics is prescribed after surgery. The nostrils and external wounds should be treated with an antibiotic ointment for 1–2 weeks.
More detailed postoperative care is described here.
Recovery
After removal of the splint, the nose has not yet reached its final shape. Final healing and resolution of swelling are highly individual and depend on the extent of the surgery, skin type, and the patient’s tissue response. Initial assessments of the success of rhinoplasty can be made after 1 month. Most of the healing process has taken place by 6 months. Final healing takes 12 months, and in patients with thicker skin, up to 24 months. Until the end of the healing period, disturbances in nasal sensation may occur. These are due to surgical trauma and resolve as nerve supply to the skin recovers. In addition to numbness, the nasal tip may initially feel firm and stiff to the touch. This is caused by postoperative swelling, which keeps the tissues under tension. As the swelling subsides, the nose gradually becomes softer and more freely movable.
You can see before-and-after pictures of some our patients here. More recent results can be found in Instagram.
Revision rhinoplasty
Most revision surgeries are performed to correct minor irregularities. These occur in approximately 15–20% of cases after primary rhinoplasty. Such minor corrections are performed under general anaesthesia and last about 30 minutes. Much less frequently, in approximately 3–5% of cases, a more extensive revision rhinoplasty is required. This is undertaken when significant postoperative changes in nasal shape develop, such as collapse or deformity of the nasal tip, marked external nasal deviation, or asymmetry. In most cases, more extensive revision rhinoplasty also requires the use of rib cartilage to reconstruct the internal nasal structures, as the reasons for unsuccessful rhinoplasty often lie in the patient’s naturally weak cartilage structure of the nasal septum or tip. Among other causes, postoperative nasal infection is one of the leading factors and may also result in nasal deformity.
Please note: If the revision surgery is needed, our patients do not need to pay full price. You need to pay for the anaesthesia, materials, medicines and for the accommodation. You can read about our revision policy in more detail here.
The report card of rhinoplasty
- Preoperative preparation: Do not eat or drink 6 hours before the operation. Blood tests must be done a week before surgery
- The type of anaesthesia: General anaesthesia
- Duration of the surgery: 2 to 4 hours
- Duration of hospital stay: Overnight
- Pain after surgery: Light to moderate. Common painkillers are enough to control the pain
- Haematomas around the eyes: up to 14 days; absent in some patients
- Cast: Removed after 7 days
- Stiches: Usually resorbable stiches are used which do not require removal
- Physical activity: Slight physical activity 2 weeks after surgery, full training after 4 weeks
- Last shape: Early estimation after 1 month, approximate result after 6 months and final result after 1 year
