Nose reshaping (rhinoplasty)

Rhinoplasty (also known as nose reshaping or a ‘nose job’) is a surgical procedure to increase or decrease the size of the nose, or to change its shape, whilst maintaining normal breathing and nasal functions. It is often performed for cosmetic reasons, but there are some medical reasons for having the procedure. There are various techniques that surgeons use to perform this operation. Your surgeon will advise which is the most appropriate in your case, and will explain how your nose will appear afterwards.

There are any number of reasons why you might feel dissatisfied with the shape and size of your nose, and you may have spent your whole life feeling self-conscious about it. Do you feel it is too big and bulbous? Are your nostrils too wide? Is it noticeably crooked? Does the tip of your nose point up too much? These kinds of considerations can sometimes have a significant impact on your mental well-being, confidence and self-esteem, and are unlikely to change over time. As such, you may be considering a rhinoplasty as a surgical solution.

Aside from cosmetic reasons, you might consider getting a rhinoplasty:

  • To repair your nose after an injury,
  • To correct a birth defect,
  • To help with certain breathing difficulties.

Some of the common issues patients often want to correct include:

  • Altering the length of the nose,
  • Altering the width of the nose,
  • Altering the angle from the tip of the nose to the top lip,
  • Reshaping the tip of the nose,
  • Altering the bridge of the nose,
  • Altering the shape and size of the nostrils,
  • Fixing a broken, crooked, or bent nose due to an injury,
  • Addressing a tight nasal passageway, causing breathing difficulties.

Rhinoplasty is carried out under a general anaesthetic and either requires a one night stay in hospital, or in some cases, can be performed on a day case basis.

There are various techniques that surgeons use to perform this operation, and you will be advised which is the most appropriate in your case.

Rhinoplasty is either performed from inside the nostrils (referred to as a ‘closed rhinoplasty’) which allows your surgeon to reach the nasal bones and cartilage, or by making a small cut on your nose across the skin between your nostrils, elevating the skin for better access (an ‘open rhinoplasty’). The nasal bones and cartilage are rearranged or removed to achieve the shape you have agreed with your surgeon. The skin of the nose is left untouched and will shrink to the new nose shape in time.

A closed rhinoplasty results in less swelling, and as the cuts are made inside the nostrils, there should be no visible scarring, which helps to reduce your recovery time. This isn’t always appropriate for every patient, particularly if you are having significant reshaping, as it gives the surgeon a lot less visibility during the operation, but your surgeon will let you know if it is an option for you. Scarring after open rhinoplasty can be straight, shaped like a zig-zag, or in a ‘V’ shape.

In order to keep your facial features in proportion, sometimes your surgeon will need to make your nostrils smaller. If this is the case, the surgeon will make small incisions in the skin at the crease on the side of each nostril, which will leave scars on each side. Once surgery is complete, these incisions are closed with sutures (stitches). Any internal suture is usually dissolvable, so you won’t have to come back into hospital to have them removed, but external stitching, such as in this case, will have to be taken out by your surgeon, most likely at your follow-up appointment.

If the aim of your rhinoplasty is to make your nose larger (referred to as ‘nose augmentation’) your surgeon will use either a closed or open rhinoplasty to build up the nose with extra cartilage, known as a ‘graft.’ The cartilage tends to be taken from your ears, but bone can also be used from your elbow, hips, ribs, or skull. If this is not an option, your surgeon may use artificial implants, which are often silicone-based. This type of rhinoplasty can help to build up a flat or concave bridge of the nose, as well as enlarging the tip. It may also be used for reconstruction of the nose if you have had severe nose damage.

The bridge of the nose can also be addressed in a rhinoplasty if you have a ‘hump’ (called a dorsum). The nasal bone can be shaved down with a special file to remove the hump, and your nose will then be broken to allow the pieces to be brought together to form the new nasal bridge.

Rhinoplasty can be used to change the angle between your nose and your top lip too. Your surgeon can remove parts of the cartilage and bone separating your nostrils, referred to as the ‘septum’, which helps to reshape the angle of the tip and can also shrink the tip. The septum is similarly adjusted in order to reduce the length of the nose, if desired.

In order to alter the width of your nose, your surgeon can break and reposition the side nasal bone, giving your nose a thinner, narrower appearance.

Sometimes, you may require a number of these procedures, depending on your desired outcomes of surgery. These can all be done in the same operation, but it will take longer and most likely will increase the length of your recovery time.

Before undergoing any cosmetic surgery, it is important to consider all other options and ensure your decision to have surgery has been sufficiently thought out. For this reason, your consultant will generally recommend waiting a few weeks between your initial appointment and your surgery, so as to give you ample time to do all the research you need, letting you make the best decision for you.

The nasal bone continues developing and growing through childhood, typically up until the age of 16 years. It is therefore not advisable to operate before this age, unless there are medical reasons to do so, especially as the psychological implications of having rhinoplasty require a significant level of maturity. There is no upper age limit, as long as you are physically fit enough to withstand the demands of surgery.

For surgery to go ahead, you should be in good physical and mental health, ideally undertaking regular exercise and eating a balanced diet, and be at a healthy weight. Your GP will be able to assist you if you are struggling in any of these areas.

Smokers are also advised to stop smoking several weeks beforehand, as smoking can increase the risk of complications and can slow down the rate of recovery from surgery. Nicotine in cigarettes causes your blood vessels to tighten, which means the supply of blood and oxygen to the affected tissues is restricted, preventing your body from healing itself at the expected rate. If applicable, you may also be advised to stop taking the contraceptive pill four-six weeks prior to your operation, as doing so reduces your risk of developing a blood clot. If you are planning a pregnancy in the near future, your surgeon may suggest postponing any surgery until a later date, as any changes to your body may affect the outcome.

At this stage, you will want to locate your nearest Circle hospital for your convenience, as this may influence which plastic surgeon you ultimately decide upon. Whichever Circle hospital and surgeon you choose, your surgery will be carried out efficiently, safely, and competently by specialists in this field.

Your initial consultation is held in one of our comfortable, modern consultation rooms to help put you at ease, and is key in helping you and your surgeon make an informed decision on how best to proceed. They will provide you with a non-judgemental and compassionate platform to talk openly and honestly about your aims and goals for surgery, discussing what it is that troubles you about your nose, and they will help you understand what is achievable through surgery alone. It is important to be honest with your surgeon at this stage about what you hope to gain from surgery and how you want to look once the procedure is complete. It is possible that your surgeon will advise you against surgery if it is not deemed necessary or appropriate for you.

At this point, they will often take photos of your nose from different angles, which can then be referenced during surgery, and allow you to compare it with the results once surgery is completed. You may also undergo a physical examination, possibly at the same time, so your surgeon can start to plan the potential method of surgery. On occasion, they may require additional diagnostic tests, and your surgeon will advise you if any further assessments are needed.

You will be asked for your medical history, particularly in relation to your nose and respiratory function, covering areas such as:

  • Allergies,
  • Nasal trauma or injury in the past,
  • Any breathing difficulties you may have experienced,
  • Drug use,
  • Conditions such as non-allergic rhinitis (chronic sneezing with no apparent cause).

This will help determine what kind of surgery you are suitable for and will allow your surgeon to highlight any potential problem areas. Every rhinoplasty is different, so your surgeon will be looking to tailor their approach to your specific needs, taking into account the unique qualities of your facial features.

Before the procedure, your consultant will see you for a second appointment to assess your individual condition, discuss your needs, goals and intended outcomes for surgery in case anything has changed for you, and decide on the most suitable type of rhinoplasty for you. This also provides you with the opportunity to ask any questions you may have about the procedure or your recovery, and your surgeon can help ease any concerns that may have arisen along the way. Typical questions you may find yourself asking include:

  • How long will it take?
  • What happens after my operation? What aftercare do you offer?
  • How long should I expect my recovery to take?
  • What anaesthetic will you be using?
  • What happens if the surgery goes wrong?
  • What level of pain will there be after my operation?

No concern or question is too small; cosmetic surgery is a big undertaking, and all our consultants appreciate that patients may be understandably apprehensive before the operation.

As with any surgery, it is important to make sure your preferred surgeon has the necessary qualifications and is registered with the usual regulatory bodies, such as the General Medical Council Specialist Register. All our surgeons at our Circle hospitals are registered with the appropriate bodies and comply with all relevant regulations, and you can verify this on the Care Quality Commission (CQC) database.

Your surgeon may also prompt you to think about how you will get home after surgery, as you will be strongly advised against driving. You will therefore need to make other arrangements, preferably with someone available to accompany you home and stay with you throughout the first night.

Your surgeon will recap what you have covered, explaining and discussing the potential benefits and risks of a Rhinoplasty, and will advise you on the wearing of a nasal splint post-operatively. They will be happy to go over any detail again if anything remains unclear to you. As cosmetic surgery fundamentally aims to alter your appearance, it is important that you fully understand what the procedure involves and are comfortable with the plan going forward.

Your Circle Health team will ask you to complete a pre-admission health questionnaire. This information will assist in planning your individual care, taking into account your medical history and any previous hospital treatment you have received.

You will be contacted to arrange an appointment for a Pre-operative Assessment with the Cosmetic Surgery Specialist Nurse. At this appointment, the nursing staff will carry out appropriate tests e.g. a blood test, and discuss your patient journey. Please use this opportunity to raise any concerns or questions you may have.

If you take regular medication, please continue to take it unless your surgeon or anaesthetist advises otherwise. If you are unsure about taking any medication, please contact the Cosmetic Surgery Specialist Nurse.

Before arriving for your procedure:

  • Take a bath or shower at home on the day of your admission.
  • Remove make-up, nail varnish and jewellery. Rings that you prefer not to remove can be covered.
  • Follow the fasting instructions detailed in your admission letter – generally, this advises you not to eat for 6 hours and not to drink for 2 hours prior to your admission.

The day of your surgery:

When you arrive at your Circle hospital, you will be escorted to the Surgery Unit where the nursing staff will prepare you for your surgery. You will be provided with a theatre gown, dressing gown, and slippers for your use. You may be asked to wear support stockings to help maintain the blood flow in your legs.

Your surgeon will visit you, carry out pre-operative skin marking to highlight the correct areas for incision, and will ask you to sign a consent form. By signing this form, you are giving your permission for the surgery to go ahead, and confirming that you are aware of the possible risks and complications. You will also be seen by an anaesthetist, who will administer your general anaesthetic and monitor you closely throughout the surgery, as well as the Cosmetic Surgery Specialist Nurse, who will help you with your aftercare.

The surgery typically takes between an hour and a half and three hours but depends on how much alteration is required.

Following your surgery:

You will be taken from the operating theatre into the Recovery Suite, where you will be looked after until you are fully awake following the anaesthetic. After this, you will return to your room, where the nursing staff will check your dressings and monitor your pulse and blood pressure at regular intervals.

Your face may feel puffy, you may feel drowsy from the anaesthetic, and there may be an aching sensation in your nose. The anaesthetist will prescribe painkillers and you should take these regularly for the first week or so. Pain can slow down your recovery, so it is important to discuss any discomfort you experience with the nursing staff. There may be a drip in one of your arms – this is to keep you well hydrated. This will be removed when you are able to drink a satisfactory amount. Until the effects of the anaesthetic have passed, you will need to rest.

You will usually have a nasal splint (made from either plastic or metal) over your nose to support it and help keep its new shape. In some cases, packs (gauze dressings) are placed in each nostril to support and stabilise your septum. These packs will prevent you from breathing through your nose. They will be removed prior to your discharge home. As your nose will be swollen, you will likely be unable to see under the splint. If your nose has had to be broken and reset during surgery, you will have a significant amount of bruising under the eyes, and this may increase over the next 2-3 days, becoming a deeper shade of purple.

You will be visited by your surgeon who will assess your progress and answer any questions or concerns you may have. Providing you are not feeling nauseated, you may start to drink and eat when you feel ready. Nursing staff will give you advice on getting out of bed, personal hygiene, and diet. Sitting and sleeping upright (with extra pillows) will help reduce swelling, and you should have someone with you who can help look after you and make sure you don’t exert yourself.

Recovery times can differ significantly, depending on the level of rhinoplasty, whether or not there were any complications, your general health and the health of your body’s immune system, and how much you adhere to post-operative care guidelines. Your surgeon may be able to give you a more accurate estimate once your surgery is complete.

Following rhinoplasty, you are likely to have some pain/discomfort, swelling and bruising. These are temporary and should subside after the first few weeks. You can manage your pain using over-the-counter painkillers, but if you have a low pain threshold, your consultant may be able to prescribe you stronger medication. Your surgeon may suggest using an ice pack to help with the swelling initially.

You will be visited by your consultant and/or Cosmetic Surgery Specialist Nurse before you are discharged home. They will give you advice about caring for your nasal splint (and will usually advise you to wear it for 7 days), the wearing of support stockings to help prevent blood clots, and will discuss your post-operative activity, as this can differ depending on the type of rhinoplasty you have received and whether or not there were any complications in your surgery.

Hospital contact details will be provided should you require any advice once you have returned home, and a post-operative follow-up appointment with your surgeon will be arranged.

Continue to take painkillers if you feel you need them. A general anaesthetic can affect your co-ordination and reasoning skills, so you should avoid operating machinery, drinking alcohol or signing legal documents for 48 hours. You should follow your surgeon’s advice regarding how long to avoid driving but you certainly should not begin driving again until you are confident that you can safely perform an emergency stop without experiencing any discomfort. For this reason, it is important to have worked out logistics for your journey home prior to your surgery, and ideally you will want someone accompanying you in case you have any ill effects after your anaesthetic.

Your nose may bleed a little when you return home - do not pack your nostrils to try to stop the bleeding. Simply take some gauze and hold it against your nose until the bleeding stops. If bleeding has not stopped within 15 minutes, please contact your Circle Health hospital immediately. To help prevent nosebleeds, keep your head up as much as possible and avoid taking overly hot baths/showers. You can also reduce your chances of bleeding by avoiding activities and movements that increase the blood flow to your face, like bending down or straining.

You may find that your nose is blocked - if this is the case, you must not blow your nose or use any nasal decongestants. In bed, try using two pillows to ensure your head is kept elevated while you sleep. This can help prevent nosebleeds and also ease your symptoms of feeling ‘bunged up’ or congested. Breathing through your mouth can lead to dryness of the lips and mouth - drink plenty of water and use a cream to prevent your lips cracking.

If you are going to sneeze, try to sneeze through your mouth rather than your nose, as this ensures your nose is not put under any unwanted pressure or strain. Similarly, you will want to stay away from smoky or dusty places while you are recovering, particularly in these early days, to avoid the increased chance of sneezing. It is often best to avoid hot drinks as well as spicy foods, as these can cause your blood vessels to dilate, leading to further bruising or swelling.

For the first few weeks it will be a good idea to avoid groups of people in order to help prevent catching a cold. Your surgeon will usually advise not blowing your nose for at least a week while your nasal tissue heals, and a cold in the early part of your recovery could set back your recovery time. It is best not to pick any crusts that form in your nostrils, at least until your first follow-up appointment, where your surgeon can check them and advise you accordingly.

You will receive a post-operative telephone call from the cosmetic surgery specialist nurse one to two days after your discharge home to ascertain your progress and well-being. You will also receive a follow-up appointment at which your surgeon will assess your progress and give advice on when you can resume your normal activities.

In terms of washing, take a bath rather than a shower so as to avoid your nose and splint getting wet. You can wash your face with a damp cloth, but make sure you keep the splint dry. If recovery has gone well, your splint  will be removed after a week at your follow-up appointment, along with the removal of any external stitches, if applicable.

With the splint gone, this may be the first time you see your ‘new’ nose, but bear in mind that it takes time to see the full results of a rhinoplasty, and you will likely still have heavy bruising and swelling. You should also take care not to knock or bash your nose once the splint has been removed, as this can affect the final results of your rhinoplasty. For similar reasons, those that wear glasses are often advised to tape them to their forehead, rather than resting them on the bridge of their nose. Early on, you may also want to wear clothes that you don’t have to pull over your head, so as to avoid tugging or catching your nose. As such, rather than t-shirts, buttoned shirts are a good idea as they can be worn without any ill effects to your nose.  

The length of time you will need to take off work will depend on your type of employment, but is usually a minimum of one week; longer if your work is physically strenuous. Even if you are able to go back after one week, you may not feel at your best right away. Due to the highly visible nature of any facial swelling or bruising, you may feel more comfortable waiting for the bruising around your eyes and nose to heal, which can take up to 20 days to fully subside if your nose was broken during the surgery.

After three weeks, you may find that most of the swelling has reduced, although you will likely be able to see some minimal swelling in the tip of the nose for a couple of months. The tip may also feel stiff and numb, but feeling and sensitivity should be restored after a few months.

You must avoid moderate to strenuous exercise, heavy lifting and swimming for approximately six weeks after surgery. This is especially relevant early on, as you will want to avoid any activity that raises your blood pressure during the first few weeks. In the first week post-surgery, it would be wise to just relax while the healing process gets underway. Contact sports can usually be resumed after 2 months, but this should be approved by your surgeon first. You will want to avoid too much time out in the sun, as this can discolour the skin around your nose, which in some cases can be permanent. Sunburn can cause further complications, so you will want to be wary of this for at least 8 weeks, applying lots of sun cream if you do have to be out in the sun.

Although swelling may disappear within the first month or two, it can take a lot longer for the final results of your rhinoplasty to become clear. The new shape of your nose takes some time to settle and redefine, and depending on the type of procedure, the results may not be visible for up to a year.

If at any time during your recovery you need advice or have any concerns or queries, please contact the Cosmetic Surgery Specialist Nurse.

Surgical procedures are invasive, so like all surgery, a rhinoplasty carries an element of risk. The possible complications of any surgery can include:

  • An unexpected reaction to a general anaesthetic,
  • Excessive bleeding,
  • Developing a blood clot (usually in a vein in the lower leg, known as a DVT – deep vein thrombosis),
  • Infection (requiring a course of antibiotics).

Signs of infection include uncontrolled pain, redness, swelling, oozing from wounds, and fever. Please contact your Circle Hospital immediately if you notice any of these symptoms.

Risks and complications specific to Rhinoplasty could include:

  • Heavy nosebleeds,
  • Scarring
  • Difficulty breathing,
  • Numbness in the nose,
  • Bruising or swelling,
  • A change in your sense of smell,
  • Nerve damage in the nose,
  • Extruding bone or cartilage,
  • Rejection of skin grafts,
  • Damage to cartilage between nostrils.

Nosebleeds are to be expected in the days immediately after surgery, but if it is unusually heavy, a further operation may be required, which could delay your recovery time and affect the finished results of your rhinoplasty. In the rare circumstance of severe bleeding, you could require a blood transfusion.

Any scarring after surgery will tend to change colour over the next 12-18 months, starting out red, turning purple, and then fading to a paler shade after a year. Sometimes, your scars may become painful, irritated, or grow larger. In the case of these abnormal scars, you may require surgery to address them.

After a rhinoplasty, you are likely to have some discomfort/pain, swelling, and bruising. The bruising and discomfort are temporary and should subside after the first few weeks, and you can use over-the-counter pain medication to manage this. Swelling may take several months to settle. Swelling may cause some difficulty breathing through the nose during the first week. Occasionally this can last longer than a week, and in some cases is permanent. Your nose will feel stiff and numb, particularly at the tip, but again this should settle after a few months.

Due to the intricate nature of surgery, in rare circumstances some other areas can be affected, such as your nerve endings, muscles, and blood vessels, and while the effects are usually temporary, it could be permanent.

If you have had an augmented rhinoplasty and have had either bone, cartilage or an implant used to enlarge your nose, pieces can end up extruding or ‘poking out’ through the skin of the nose, and can happen if the pocket created for your graft or implant is too small. Extrusion is more likely if you suffer a subsequent facial injury, and can happen months or even years after surgery. Follow-up surgery may be required to correct the extrusion, either putting it back in place or removing it entirely.

In some circumstances, you may be disappointed with the results, feeling that your nose still doesn’t look the way you wanted it to. It is also worth considering that if you are not satisfied with the results of your procedure and wish for further surgery, you would need to wait for your nose to fully heal first, which could take up to a year. Further rhinoplasty operations carry their own risks, as the fragile structure of the nose can be heavily weakened by multiple surgeries, and in some cases can collapse.

Should you need to return to surgery due to any immediate complications, you will be covered under the fixed priced surgical package for  6 months.

If you are concerned about these risks and complications, feel free to discuss them with your Circle Health consultant, who will be able to answer any of your questions and determine which of the risks you may be more susceptible to. It is vital that you are aware of all the potential risks of surgery before undergoing any procedure, and your consultant will want to help you feel at ease beforehand by clearing up any queries you may have, and helping you to weigh up the risks against all the possible benefits you face from having the surgery.

At Circle Health, rhinoplasty surgery starts from £4,825.

This comes with the reassurance that you are being treated by medical professionals with extensive experience, fully qualified and in line with all the relevant guidelines and accreditations, alongside a multi-disciplinary team at one of our modern Circle hospitals.

Having cosmetic surgery is a very personal decision. Circle offer a range of cosmetic treatments for men and women, both surgical and non-surgical. Having a consultation with a suitably qualified cosmetic surgeon will help you to really understand your motivations and expectations, in order to arrive at the best solution for you. Circle specialists may advise you against having cosmetic surgery, so it’s really important to be open and honest when discussing your options.

Understandably, everyone is different and has their own desires or opinions that are important to them as a person. Before making any decisions, it is advised that you seek independent professional medical advice, such as from your local GP.

As every patient has different needs, desires, queries, and concerns, it is always best to talk to one of our consultants face to face if you are considering rhinoplasty surgery. This gives you the perfect opportunity to discuss all the benefits a rhinoplasty can provide, addressing any worries you may have at the same time.

Although there are no specific alternatives to surgery, your consultant will be able to advise you on how appropriate rhinoplasty may be in your case, and can ultimately help you decide if surgery is your best option. Why not get in touch with our team today and book an appointment?

We have no waiting lists so can quickly arrange a consultation for you with one of our dedicated plastic surgeons. Take that first step towards a boosted self-confidence today.

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