RHINOPLASTY (NOSE)

What is a rhinoplasty?
Rhinoplasty is an operation designed to change the appearance of your nose. There are several components to your nasal shape that you may wish altered in some way, such as the profile from the side view, the length or width, or the shape of the tip.

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The changes you wish to achieve may require altering the bones and cartilages that make up the bones, the lining of the nasal passageways or even the skin covering. It is important to be clear about the changes you want and to agree with your surgeon on realistic goals before surgery.

How long does it take?
The operation is performed under general anaesthetic and generally takes about two hours.

Do I have to stay in hospital?
Usually rhinoplasty involves an overnight stay in hospital. It is possible for the surgery to be done on a day surgery basis if you wish. You may experience some discomfort over the next 2-3 days. Pain relief will be prescribed for this time.

What happens after surgery?
Following the operation you will have a small splint over the nose for protection. This should stay in place for about one week. Usually small strip bandages are placed into the nostrils to prevent bleeding. These should not cause undue discomfort and will be removed the morning following surgery.

Your nose will feel strange, somewhat tight and swollen for several days and a degree of swelling and bruising, particularly around the eyes and cheeks, will probably be encountered. Although most of the swelling subsides in 4-6 weeks, there continues to be some swelling that may take six months or longer to subside. Swelling inside the nose can persist for several weeks and cause nasal stuffiness.

When can I return to normal activities?
Generally speaking you will be confident and happy to engage in social contact by the second week following surgery. It is important for you not to over-exert during the healing period or troublesome bleeding may occasionally occur and require repacking of the nose.

Are there any risks?
As with any surgical procedure, there is a small risk of complications. Surgery and anaesthesia are very safe and it is most unlikely you will experience any difficulty. However, there are areas of potential problems you need to understand before proceeding with your surgery.

Bleeding: Bleeding is the most likely problem that may occur after rhinoplasty. It can be problematical in about 2-3% of cases. It is most likely to occur immediately following surgery or that evening. You should avoid smoking for at least three weeks before and after surgery to assist the healing process.

Minor oozing is not uncommon and the nasal packs used overnight following the procedure are intended to control this. It is possible in cases of persistent problematical bleeding that return to the operating theatre will be required. It is advisable not to blow your nose for 2-3 weeks after the operation as this may cause troublesome bleeding.

Infection: Infection following rhinoplasty is very uncommon due to the superior healing qualities of the facial areas. If infection occurs it will become evident within one week of surgery and may delay the healing process or result in the development of scar tissue. This may require treatment with antibiotics. In the unlikely event of infection, the ultimate result of the surgery may be adversely affected.

Scarring: Incisions or cuts used to perform the surgery are designed to be hidden in such a way that nobody should notice that you have had surgery. The incisions can be either completely internal or may involve a small cut through the base of the nose.

Scarring following surgery can taken up to 2 years to mature and can generally be expected to be minimal and unnoticeable. However, while great care will be taken to give the neatest incision closure possible, the healing process can be unpredictable and it is possible, although unlikely, that you may be unhappy with some aspect of your incision lines or the shape of your nose.

Nasal shape: Swelling of the nose can affect nasal contour for some months and during this period of settling, improvement in nasal shape can be expected. It is likely that close scrutiny of your new nasal shape may reveal some small irregularity in contour or symmetry. Having expectations of improvement with change of shape rather than perfection is the most likely result in post-operative satisfaction.

Breathing: The nose is part of the airway by which air enters the body during breathing. By manipulating the nose shape it is possible the nasal air passageway can be altered. You may notice nasal congestion and some restriction to airflow through the nose, particularly in the early post-operative months. This can be expected to resolve as swelling settles. You may also temporarily experience a diminished sense of smell.

Sensation: The tip of the nose often feels numb for some months but this is quite normal and usually recovers completely. In the first few weeks there may be a feeling of stiffness or numbness in the upper lip. This is because swelling in the nose can affect the movement of the lip. As with all other changes due to this swelling process, it is quite transient. The lip or a front tooth may be numb temporarily.

Anaesthetic: You will be receiving a general anaesthetic and your anaesthetist will be discussing with you possible discomforts following anaesthesia. Anaesthesia today is very safe and the chance of any problem is very low. Any questions you have regarding your anaesthetic would be best answered by your anaesthetist at the time of surgery.

How important are psychological factors in relation to this procedure?
Emotional stability is the primary factor to be considered before any aesthetic surgery is performed. A "new body" does not guarantee a new life or an end to all personal problems. It is mostly the mental attitude of the individual that determines a successful outcome. Rhinoplasty can improve your appearance and renew your self-confidence; the rest is entirely up to you.

General Information
It is important to remember that healing continues for some time following surgery as the skin shrinks and adjusts to the new framework. Rarely, the final result may not be what you and Dr Drielsma anticipated. Minor irregularities usually can be corrected with a revision procedure.

The quality of skin overlying the nasal cartilage is an important factor in the final appearance of the nose. Thick and oily skin does not conform as well and may compromise the result. Older skin does not possess the elastic properties of younger skin and may preclude an optimal result.

You should avoid smoking for at least three weeks before and after surgery to assist the healing process. You should also not take aspirin or aspirin containing medications for two weeks prior to surgery.

Should there be any questions regarding rhinoplasty, be sure they are answered in advance by Dr Drielsma. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation - a well informed patient is a happy one.

Finally, there can be no absolute guarantee with any surgery. Remember, the realistic aim of this operation is improvement, not perfection.

Please note: The above information mentions only some of the benefits and complications of a rhinoplasty. This information should not be regarded as a substitute for information and advice provided by Dr Drielsma during consultation.