Nose Re-Shaping

Background
Surgery to change the shape of the nose is performed if the patient is not happy with the natural shape or size of their nose, following injury to the nose (often as a child) or following previous surgery which has changed the shape. It may also be required where the patient complains of nasal blockage when surgery to improve the nasal airway requires a change in the shape, for example following a fractured nose when the shape is affecting the size of the internal nasal passage. Often there are features of the nose that the patient is not happy with, typically these are a prominent profile or the end of the nose being too prominent or bulky. There are also many more subtle features that can be addressed and these can be discussed fully in the clinic. Most patients want a nose that does not stand out and blends into the other features of their face. They usually want a natural ‘non-operated’ looking nose.

Septorhinoplasty
This term refers to an operation which encompasses a range of surgical procedures that change the shape of the nose (rhinoplasty) and the internal structure of the nose (septoplasty-see section on nasal blockage). Although they are often performed at the same time they can be performed separately. The structure and function of the nose are inextricably linked together. It is vital that when the shape of the nose is altered the structures that hold the nasal airway open are preserved and that the long term stability of the nose is maintained.

The consultation
Good communication between the surgeon and the patient undergoing nose re-shaping is essential. It is crucial to spend time with the surgeon discussing the specific way in which you would like your nose changed. Often a second consultation is undertaken to discuss any issues arising from the initial discussion. It is extremely important that both the surgeon and the patient are happy with the goals and limitations of surgery before undergoing a procedure particularly if the patient has had previous surgery. Your nose will be examined and if you are complaining of blockage, a very small telescope will be used to identify the cause.

The Operation
The surgery is performed under general anaesthetic either as a day-case or with an overnight stay. The steps taken during the procedure vary and are tailor-made to the patients requirements but often involve breaking the nasal bones and changing the shape of the cartilage and soft tissues that make up the framework of the nose. There are two basic approaches that are used. The first involves the incisions being made inside the nose (the endonasal or closed approach) and the second involves a small incision in the narrow area of skin between the nostrils combined with internal incisions (the external or open approach). The open approach is usually used when more extensive work needs to be carried out or work to the end of the nose (nasal tip) is required. An external incision will also be required if the nostrils need to be narrowed. Generally these incisions heal up very well.

After the Operation
A dressing and a nasal splint or small plaster are applied to the nose for a week. If there are external incisions the stitches are removed at 5 to 7 days. The surgery is not particularly painful but there is some discomfort which lasts for around a week. We will give you painkillers to take home. You will be given antibiotics to take home if a cartilage graft is used in the nose but these are not required routinely. The nose has a very good blood supply and often bleeds a little after the operation. A nasal pack is sometimes required and is removed before you leave hospital. The bleeding gradually resolves although very rarely further treatment is required to stop the bleeding. Swelling of the nose and under the eyes is variable but the majority of this usually settles in the first 1-2 weeks after the operation and then gradually subsides. If the nasal bones are broken there will be bruising under the eyes and this is mainly gone by two weeks but there may be some traces of bruising that can take a little longer to settle.

Depending on the degree of surgery performed inside the nose your nose will be blocked for a few days after the surgery- see also septoplasty. It is important to realise that the healing process goes on for several months and that refinement of the nose is a gradual process after the surgery.

We do everything to ensure that you have an excellent result and will see you in the clinic after the surgery as required. You will be given a list of instructions on what to expect and how to look after your nose following the surgery- see post-operative instruction sheet.