Rhinoplasty (Nose Reshaping)

Rhinoplasty is surgery that changes the shape of the nose. The surgeon also uses it to correct deformities that block breathing or weaken the sense of smell. One operation can treat the outside and the inside of the nose together.

For a short checklist of what to do before and after the operation, see the rhinoplasty guide.

Rhinoplasty is one of the most requested aesthetic operations. Before you decide, a doctor examines you and tells you whether your nose suits the operation. An experienced surgeon matters here more than in most operations. The nose sits at the centre of the face, so a change of a few millimetres changes how the whole face looks.

The first examination

The process starts with an examination by a specialist. You say what you want to change. The doctor says whether that change suits your nose and your face, and the two of you decide together. The same examination shows whether anything in your nose blocks the operation.

If the nose is suitable, the doctor checks your general health. Bleeding disorders and similar conditions can prevent surgery. Tell the doctor about every medicine you take.

Talk openly about what you expect. A clear conversation helps prevent a result you did not want, and it lowers the chance that you need a correction operation later. The doctor photographs your nose from several angles and shows the planned change on a large screen. This makes the plan easier to agree on.

How long the operation takes

A rhinoplasty usually takes one to two hours. Complex cases can take longer. The exact time depends on what the surgeon does. The surgeon chooses the open or the closed technique for your nose. You stay under observation for a few hours after the operation, then you go home.

The two techniques

Open rhinoplasty

The surgeon makes a small cut under the strip of skin between the nostrils. This gives a wide view of the working area. Large changes are safer this way, so surgeons choose it for bigger operations. The surgeon controls the area better than in the closed technique and can work to the millimetre. Healing takes longer than after a closed operation.

Closed rhinoplasty

The surgeon makes the cut inside the nose. There is no cut on the outside of the nose. Through that cut the surgeon reaches the cartilage, the bone and the tissue under the skin, makes the planned change, then closes the cut. The working area is smaller than in the open technique. For smaller changes it heals faster, because the tip of the nose is not opened, and the risk of a visible scar is lower.

In both techniques the surgeon can cut and shape the bone with a piezo device, which is an ultrasonic bone cutter. That method is called piezo rhinoplasty. Work on the tip of the nose has its own techniques and is called tip rhinoplasty. The turbinates inside the nose can be reduced at the same time with laser, radiofrequency or cautery.

An operation planned to correct a problem left by an earlier nose operation is called revision rhinoplasty.

Who it suits

• A deformity of the nose, present from birth or caused later
• A crooked nasal bone, or a hump on the bridge
• Difficulty breathing or snoring caused by the structure of the nose
• A nose that is too large or too small
• A problem with the angle of the nose
• Nostrils that are larger or smaller than normal
• A tip that droops, turns up, looks pointed, pinched or uneven

Age

If the nose works normally and you want the operation only for its appearance, wait until the cartilage has finished growing. That happens between the ages of 15 and 18, and the doctor tells you when. If the nose does not work properly, or if its shape harms the child psychologically, the surgeon can operate earlier.

Before the operation

Rhinoplasty needs care before and after surgery more than most operations do.

Patients often ask which technique is better. Open and closed suit different noses, and the right choice changes from patient to patient. The surgeon decides after the examination, because the choice depends on what has to be done and on the structure of your nose. This decision belongs to the surgeon, not to the patient.

If you take blood thinners, stop them one or two weeks before surgery, in the way the doctor tells you. Do not smoke and do not use tobacco products, because they slow wound healing. Follow the advice your doctor gives, and be at the clinic on the day of the operation.

After the operation

Follow these rules after the operation:

• Cold gel packs or ice on the skin around the eyes and on the cheeks reduce swelling and bruising.
• Sleep on two pillows with your head raised. Do not turn your head more than 45 degrees. More movement can make the nose crooked. Follow this rule for 3 weeks after the operation.
• Do not sleep on your side for 20 days after the operation.
• For 1 week, do not wear clothes with a tight neck. Wear clothes that button at the front.
• Do not strain, because straining can cause bleeding. Eat vegetables and other high-fibre food to prevent constipation. Food without salt can help the swelling go down faster.
• Very hot food and drinks increase bleeding and nasal blockage. Do not eat or drink very hot things, especially in the first week.
• For the first 2 days, tape a piece of gauze under your nose, over the upper lip. It catches any blood and keeps your clothes clean.
• Brush your teeth with care, and do not hurt your nose.
• In the first days after the operation, do not chew very hard food. Eat soft food.
• Stay in bed and rest for 1 week after the operation.
• You can start walking after the second week. Wait until day 40 for heavy sport and strenuous activity.
• For 1 week, do not laugh hard and do not make large facial movements.
• Protect your face from the sun for 6 weeks. If you do not, the swelling takes longer to go down.
• Do not swim for 1 month. Swimming can injure the nose.
• Your face can swell 3 to 4 days after the operation. Most of the swelling goes down in 2 to 3 weeks. In some patients the remaining swelling takes 12 to 18 months to go.
• Bruises can last 7 to 10 days and usually go after the 10th day. If they last longer, you can cover them with make-up.
• Take the medicines your doctor recommends.
• Do not wear glasses for 6 weeks.
• You can wear contact lenses 2 days after the operation.

Check-ups are on day 7, then at 1 month, 3 months and finally 6 months after the operation. The surgeon sees you in between if needed. At these visits you and the surgeon look at the result together.

Take the medicines the doctor prescribes, on time. Come to every follow-up appointment. If the doctor asks for dressings, have them changed regularly, by a health professional if needed.