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.

Rhinoplasty is the most requested aesthetic operation. 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 prevents 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 takes two to four hours. 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. No stitch, wound or scar shows from the outside. 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

The nose is easy to injure, so protect the operated area. A knock can change the shape the surgeon made.

• Do not wear glasses for 2 months.
• Do not sleep on your side for 20 days.
• Do not press on your nose.
• Do not do heavy sport.
• Avoid constipation.
• Eat a salt-free diet.

Rest properly for the first two or three days. Avoid tiring activity for a week. 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.