A rhinoplasty procedure reshapes, corrects or reconstructs the nose to achieve more aesthetically pleasing proportions and to enhance ones' physical appearance.
The nose develops its final shape only after puberty and this development is complete by the age of 16. This determines the earliest age at which one can reasonably carry out a rhinoplasty.
Whilst this is most commonly carried out for aesthetic reasons, a nose job can also be performed as a procedure to improve function by correcting breathing issues and help alleviate the symptoms of sleep apnoea and snoring. In these cases, one is likely to also be operating on the septum or turbinate which are blocking the airway, otherwise known as a septoplasty or submucosal resection.
There is also the large group of patients who have suffered injuries to the nose, very often a nasal fracture, playing sport or as a result of physical assault. These are the few patients that medical insurance companies may accept for reimbursement.
Whatever the motivation, our surgical approach is designed to work with a patient's natural features, sculpting the nose to harmonise the face and give a natural-looking result. This requires a delicate balance between the size, shape, contours and definition of the nasal bridge and tip. Nose reshaping requires skill and surgical finesse as millimetres make the difference between a natural-looking result and one that has obvious trademarks of surgery.
A Rhinoplasty, or a 'nose job', is one of the five most common cosmetic surgery procedures in the UK, accounting for roughly 10% of all cosmetic procedures in 2020 alone.
As the central feature of the face, the size and shape of the nose is a key determining factor in how we feel about our overall appearance and attractiveness. If, for whatever reason, you are unhappy with it, a rhinoplasty procedure is the most effective solution to change it.
The nose is supported by a skeleton. In the upper third, it is a bony skeleton and the lower two-thirds are nostrils, flexible cartilage of the same type as we have in the ear. Dividing the two airways running back from the nostrils, we have another sheet of cartilage, covered with mucosa, called the septum. This is a strut which stops the cartilaginous part of the nose from collapsing.
Most operations on a Caucasian nose involve a reduction in size and therefore both the bony and cartilaginous skeleton are reduced, allowing the skin to retract, often without trace of a scar.
An incision is made across the columella (the skin of the central strut of the nose separating the two nostrils. The incision is carried up and around the rim of the nostrils, allowing the skin on the nose to be peeled back. The surgeon then has a direct view of the cartilage, which they can then refashion. This technique is used for the very complicated, difficult and injured nose but is also used exclusively by some surgeons.
The closed rhinoplasty does not have an incision across the skin of the columella between the nostrils, but is carried out through the mucosa of the inside of the nose. The surgeon does not have the direct view of the nasal skeleton and therefore it is a technique for the more experienced surgeon.
A septo-rhinoplasty is commonly done to improve the way you breathe through your nose. This is often done for patients who suffer from a deviated septum. The septum is the cartilage and bone inside your nose that divides the nostrils.
Your surgeon will make an incision in the mucosa (the lining inside your nose), and lift it off the bone and cartilage in order to remove any parts that are bent, putting them into a straight position allowing for clear breathing. This procedure will improve the way you breathe, and the appearance of your nose can be adjusted as well.
Rhino-tip surgery is done to change the shape of the nose by modifying the structure of the underlying cartilage. Most alterations are done from inside the nose so as to minimize any scarring. Your surgeon can create the perfect tip for your nose structure.
Some common cases that patients come in for are:
Big Tip: This is a rounded appearance at the tip of the nose, possibly due to thick skin.
Crooked Tip: One nostril may appear larger than the other or the nose might be slanted to one side causing an asymmetrical look.
Flared Nostrils: When the nostrils are larger and spread farther apart creating an upturned of flat-nose appearance.
Hooked Tip: This is when the nose juts out and is overly-long, particularly noticeable on the profile of the patient.
The nose is central to the face. Therefore, a nose that is out of balance with the rest of the face (forehead and chin) stands out and becomes the dominant feature (Look at family photos!). Rhinoplasty surgery aims to correct this imbalance in the nose and therefore make the nose less obvious, i.e. aesthetically balanced with the facial proportions.It is important to realise that each nose is unique and must be in balance with the rest of the face – or it will stand out. A good rhinoplasty should be almost undetectable, since it should put the nose in better balance with the face.
Just like with all surgical procedures there are always risks associated with nose job surgery. However, complications are uncommon. The most frequent is irregularity following surgery in about 5%. This may require revision surgery or non-surgical treatment.Bruising is common and may take two weeks to resolve, while major bleeding is rare. Infection is infrequent (less than 0.5%) and will require a course of appropriate antibiotics. Hypertrophic or keloid scarring is also rare but will require specific treatments to reduce the scarring. Altered sense of smell is common after a nose job and resolves after six to eight weeks.
If you would like to remove a bump, straighten your nose, or improve your nose in another way to achieve an aesthetically balanced nose that is in proportion to your face, rhinoplasty surgery is right for you.Nasal surgery can correct deformities that are congenital, result from an injury, or developed in adulthood. You should be realistic as to what can be achieved by rhinoplasty surgery and understand the risks and side effects of this surgery.
Most cases of primary rhinoplasty surgery do not create any external or visible scar. However, in some cases (commonly following injuries or developmental abnormalities of the nose), an external scar in the columella is necessary, since an open rhinoplasty is being performed.Open rhinoplasty should be reserved for complex tip surgery and revision surgery to the tip of the nose – it should not be used in every rhinoplasty. Occasionally, some noses are too wide, and this requires a resection of tissue around the nostrils (alar base resection), resulting in a scar in the groove between the nostril and the cheek.
The results are first and foremost natural. The goals of rhinoplasty surgery are to restore an aesthetically pleasing nose that is in balance with your facial features – i.e. looks natural and does not appear abnormal.Each nose is individual., and so what is suitable for you will not necessarily be good on another face and vice versa. Remember that it can take up to 12 to 18 months before the final appearance of the nose is achieved.
The results of nasal surgery are permanent, but note that as you age, your nose will change over the years. For example, the tissues around the tip of the nose may become thinner and allow the tip to droop.
Rhinoplasty surgery is performed under general anaesthetic, commonly as a day-case or overnight procedure.
Rhinoplasty surgery normally takes approximately one hour to one and a half hours to perform depending on the complexity of the surgery.
Mild pain/discomfort is expected for three to five days. Patients can go back to their normal daily activities after one week, but avoid strenuous exercise/activity for six weeks, including any contact sports, to allow full healing of the nose.
In the majority of rhinoplasty surgeries, nasal packs (like small tampons) will be inserted into the nostrils at the end of the operation. Packs are utilised to absorb any bleeding after the operation and splint or support the internal part of the nose in the early post-operative period.
In complex nose surgery, e.g. septo-rhinoplasty, the nasal packs may be required for seven days post-operatively. The packs are normally removed before you leave the hospital or at your one-week post-op visit.