“Hello, my name is Mr Alwyn D’Souza. I am a board-certified, internationally renowned consultant otolaryngology (ENT) / head and neck / facial plastic and reconstructive surgeon. I have a wealth of experience in the medical and surgical management of general ENT (otorhinolaryngology) conditions alongside reconstructive and aesthetic facial plastic surgery”.
“The nose has important functions related to breathing and is critical aesthetically. It is made up of bones and cartilages that form the shape of a roof. The roof is supported by the midline wall called “the nasal septum” which separates the nose into right and left nostrils. The shape of the nose depends on all these structures and the skin covering it”.
“The nasal shape, whether large, small, flat, pointed, crooked or simply a mismatch on the face, can be improved with surgery while maintaining its function, when carried out by an experienced surgeon. The operation is called Rhinoplasty, also known as “The Nose Job” . When Rhinoplasty is combined with an operation on the septum, it is called a Septorhinoplasty”.
Introduction to Rhinoplasty
Expectations and Rhinoplasty
Goals of rhinoplasty surgery are improving the nasal aesthetics and function. Perfection in rhinoplasty surgery is not realistic. The thickness and texture of your skin, the strength, shape and symmetry of the nasal bones and cartilages, healing power of your body following surgery and, of course, the skill of the surgeon, all have an impact on the outcome.
The results refine over 9 to 12 months following surgery and continued changes in the shape of the nose occur with time. A successful rhinoplasty equals a happy patient after surgery. Therefore, if you are considering rhinoplasty, you should clearly determine the areas you find unsatisfactory and tell your surgeon what you would like to change. If you need your nose to be perfect and if you are expecting surgery to correct all imperfections instead of merely making them better DO NOT have the surgery, as your expectations of the final outcome may exceed what the surgery can deliver.
Some requested changes are more accomplishable than others. In general, however, the majority of the patients are happy with the end result. Also, be aware that, on rare occasions, more than one surgery may be required to achieve a satisfactory result, adding to the cost of the procedure.
A full assessment of your nose and facial features is carried out with the aid of photographs during the consultation. A computer programme is often used to assist this process and an operative plan is outlined. The surgery is usually performed under general anaesthetic, i.e. you are asleep throughout the procedure. Cuts are made only inside (in endonasal rhinoplasty) or inside and outside (open rhinoplasty).
The nose and the skin are lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the change in the shape of the nose. Small pieces of bone and cartilage may be removed from or even added to the nose to smooth out any bumps or dips. At the end of the procedure all cuts are stitched in place. If extra cartilage is required to obtain the desired shape and support, then either the ear or rib cartilage is used as donor graft. A small dressing is inserted inside the nose, which is removed the next day, and a temporary splint on the outside of the nose is used for 10 days.
Reasons for a Rhinoplasty
Minor discomfort, blocked nose, discharge of blood stained mucous, nasal crusting, bruising and swelling around the nose and eyes for 1 to 2 weeks is common. Nose blowing should be gentle and opening the mouth to sneeze is advised to minimise the chance of bleeding.
It may take up to 3 months for breathing to be clear again. Sun exposure in the first 6 months after surgery can result in skin redness and should, therefore, be avoided. Numbness and rigidity of the nasal tip are common after surgery but this settles within 6 to12 months.
Most people need 1 to 2 weeks off work, especially if the work involves heavy lifting or strenuous activity. You should also not play any sports for at least 6 weeks, where there is a risk of your nose being knocked.
Cosmetic dissatisfaction is the most common issue after surgery and is related to unrealistic expectations. Infection, bleeding, septal perforation, sensitive teeth, tip numbness, and loss of sense of smell can all occur but are rare. Very occasionally, revision procedure may be required.