Information about the procedure
Reshaping of the nose — and, where indicated, improvement of nasal breathing — in keeping with the proportions of the face.
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What it involves
Rhinoplasty changes the shape of the nose by reshaping its bony and cartilaginous framework. It is one of the most demanding operations in plastic surgery, because it involves working to the millimetre in the centre of the face and because the result is seen from every angle.
In some patients, the aesthetic correction is combined with a functional one — correction of a deviated nasal septum or narrowed nasal valves that obstruct breathing.
A nose is not designed from a photograph of someone else. The aim is a nose that suits the individual face — the height of the forehead, the chin and the distance between the eyes.
Types and approaches
Closed rhinoplasty
All incisions are made inside the nose, leaving no external scar. Suitable for more limited corrections. Access is more restricted.
Open rhinoplasty
A small incision is added across the columella — the strip of skin between the nostrils. This gives full visibility of the underlying structure and more precise control, especially of the nasal tip. Once mature, the scar is practically invisible.
Functional rhinoplasty
Corrects a deviated nasal septum and narrowed nasal valves. It can be performed on its own or together with aesthetic correction.
Revision rhinoplasty
Correction after a previous operation. Considerably more complex because of the altered anatomy and scarring; cartilage grafting is often needed.
Who it is suitable for
Suitable for
- A dorsal hump or irregular profile
- A wide, drooping or poorly defined nasal tip
- A crooked nose
- Disproportion in relation to the other facial features
- Difficulty breathing through the nose
- Completed growth of the facial skeleton — usually after the age of 17–18
Not suitable, or postponed, in cases of
- Incomplete growth in adolescents
- Unrealistic expectations, or a request for a nose copied from a photograph of someone else
- Body dysmorphic disorder — a condition in which surgery does not help
- Current smoking
- Active inflammation of the nose or sinuses whose cause has not been established
- Cocaine use with damage to the nasal septum
Preparation
- A detailed consultation with analysis of the profile, the frontal view and the internal structures of the nose
- Photographic analysis and discussion of the result that can realistically be achieved
- Assessment of nasal breathing
- Stopping smoking at least three to four weeks before surgery
- Stopping blood thinners, as agreed with your doctor
- Pre-operative tests and a consultation with a cardiologist or an anaesthetist
How it is performed
The operation is performed under general anaesthesia and usually takes three to five hours — longer for revision rhinoplasty.
The bones and cartilage are reshaped; where needed, cartilage grafts are taken from the nose itself, the ear or a rib.
An external nasal splint is applied for about a week. Nasal packing is used less often than in the past, and usually only briefly.
The hospital stay is one night.
Recovery
- The first 48 hoursSwelling and bruising around the eyes — most marked on the second to third day. Breathing through the nose is difficult. Sleep with your head raised on a high pillow.
- The first weekThe splint is usually removed on day 6–8. The bruising begins to fade. At this stage the nose looks swollen, which worries many patients — this is normal.
- 2–4 weeksMost patients return to work after 10–14 days. The swelling has gone down enough not to attract attention, but the nose has not yet reached its final shape.
- 1–3 monthsMost of the swelling has resolved. Nasal breathing returns to normal. The tip is still fuller than it will be in the final result.
- 6–12 monthsSwelling of the nasal tip, which is the last to settle, continues to go down. The final result is assessed no earlier than 12 months, and up to 18 months in patients with thick skin.
Pain and discomfort
Rhinoplasty is less painful than most patients expect. The main discomfort is not pain but being unable to breathe through the nose for the first few days, a dry mouth and a feeling of pressure. Standard painkillers are usually sufficient.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Prolonged swelling, especially of the tip in thick-skinned patients
- Asymmetry or irregularities that become visible once the swelling has settled
- An unsatisfactory aesthetic result requiring correction
- Difficulty breathing through the nose if it is narrowed too much
- Perforation of the nasal septum — rare
- Bleeding
- Altered sensation of the nasal tip — usually temporary
- Infection — rare
- Need for revision surgery — required in a proportion of cases according to international data
Results and longevity
Rhinoplasty has the longest maturation period of any operation. The final result is seen after a year, and up to a year and a half in patients with thick skin.
The result is long-lasting. The nose continues to change slightly with age, as it does in everyone.
The realistic expectation is improvement and harmony with the face, not perfection. Every nose has minor asymmetries, including before surgery.