Rhinoplasty
what it can realistically change

Why the nose is designed to suit your face rather than a photograph, what is technically possible, and why the result only shows after a year.

Rhinoplasty is the operation with the widest gap between expectations and reality. Not because the results are poor, but because the nose sits in the centre of the face, is seen from every angle, and every millimetre counts.

What it can change

• Remove a hump and smooth the profile
• Narrow and refine the nasal tip
• Lift a drooping tip
• Narrow the nostrils
• Straighten a crooked nose
• Improve breathing where there is a structural problem

What it cannot change

• Give you the nose from a photograph of someone else
• Make the nose as small as you like — it has to stay functional and suit your face
• Change the quality and thickness of the skin
• Guarantee perfect symmetry
• Cure allergic rhinitis or a sinus problem

The nose is designed to suit the face

The same nose can look large on one face and balanced on another. What matters is the height of the forehead, the projection of the chin and the distance between the eyes.

That is why, when the chin is weak, mentoplasty is sometimes discussed as well. Some patients who come in about their nose actually have a problem with their profile as a whole — in that case, reducing the nose alone does not change the overall impression.

Open or closed technique

With the closed technique, all the incisions are inside the nose and there is no external scar, but access is more limited.

The open technique adds a small incision across the columella, the strip of skin between the nostrils. It gives a full view of the structures and more precise control, especially at the tip. After a few months the scar is barely noticeable.

The choice is not a matter of fashion but of what needs to be done.

Breathing

Cosmetic correction on its own does not improve breathing. If you have a deviated septum or narrowed nasal valves, this is corrected separately — functional rhinoplasty, which can be combined with the aesthetic procedure.

Conversely, if you breathe normally, a well-performed operation should not make your breathing worse. Over-narrowing the nose is a real risk and one of the reasons not to chase the smallest possible nose.

Timescales

No other operation in plastic surgery takes as long for the result to mature.

• The nasal splint is removed on day 6–8
• Bruising fades within about two weeks
• By one to two months the main change is already visible
• The nasal tip stays swollen the longest
• Final result: 12 months, or up to 18 with thick skin

A patient who is unhappy with the tip at three months is very often happy with it at twelve. That is why aesthetic revisions are not discussed until a year has passed. A functional problem — worsened breathing — or a complication, however, is assessed straight away, without waiting for the result to mature.

Revision surgery

Worldwide, a proportion of rhinoplasties need a minor touch-up. This is no secret and not a sign of poor work — every nose heals in its own way, and internal scarring cannot be fully controlled.

Secondary (revision) rhinoplasty is considerably more complex than the first operation because the anatomy has been altered, and it often requires cartilage grafting. That is why the first operation should be done carefully, not quickly.