RHINOPLASTY

What can be done to improve the shape of the nose?
Nose refinement is one of the most common cosmetic operations of all. The shape of the nose can be altered by removing, changing or adding to the underlying structure of bone and cartilage and then redraping the skin over it - like a tent covering over a frame.

How much improvement can corrective surgery make?
Although improvement is nearly always possible, perfection is not. There is no such thing as the ideal nose, and a drastic change is not usually advisable. A bulbous nose simply can't be refined down into a small chiselled one although humps, tips and nostrils can all be adjusted. With the insertion of extra cartilage, bone or an implant, noses can be increased in size or built up. The most important consideration is that your adjusted nose harmonises with the rest of your face and looks normal causing no comment and functions properly. Sometimes the chin needs to be altered as well, to balance the profile.

How will I be prepared for rhinoplasty?
After specifying to the surgeon exactly what it is you wish to alter about your nose, the surgeon will advise on what he believes to be the right technical and aesthetic solution. He will then tell you about how the operation will be done, the recovery time and possible complications. Photographs will then be taken ready for the second consultation. These photos should be used throughout the pre-surgery discussions. Computerised images may be used to give you an idea of the end result, although how a nose reshaping operation will turn out depends partly on the thickness of the skin of your nose (thicker skin is harder to redrape) and how the scares under your skin soften and mature. There is absolutely no guarantee that the computer image can be surgically produced, this is merely a guide.

What happens if I want my nose built up?
Noses can be enlarged by using cartilage taken from the septum of the nose, ear or a rib, or bone, usually taken from the skull just above the ear.

How long does the operation take?
One to two hours under a general anaesthetic. In more involved cases, a one night stay in hospital may be advised. Straightforward cases are done as a day case.

Is there much pain?
Surprisingly little. Usually oral pain medication in the first couple of days is enough to deal with any discomfort that may arise. Not being able to breathe through your nose is perhaps the biggest discomfort.

What are the after effects like?
On awaking, you will find a plastic splint taped over your nose to hold the fractured bones in place. You will be given ice packs to reduce the swelling around your eyes. Any stitches will be removed in four days and the plaster will be taken off at about ten days. The signs of surgery start to disappear quickly and after about two weeks little evidence of surgery should be evident, although numbness and minor swelling can take several months to subside.

What about the risks?
Around one in twenty people who have a rhinoplasty may require touch-up surgery. This can often be done under a local anaesthetic - it's often just a very small adjustment. However, it cannot be done for a whole year after the original operation, until scars have completely matured and softened. Other complications are unusual. The most common is swelling around the nose which eventually settles down and can be helped by massage. Nose bleeds and infection are rare, but can be helped by antibiotics. Sometimes the nose is constantly runny after surgery, but this should settle down within three to six months. Much more common is the development of tiny broken capillaries where the skin has become thinner, so that from a distance, the nose looks pinker. People with dark skins may notice that the skin below their eyes becomes darker after a rhinoplasty. This can be dealt with later with laser treatment.

How old does a person have to be to undergo rhinoplasty?
Since the nose doesn't complete its growth until after puberty, there's little point in performing surgery on it until growth has stopped around the age of 18-19 in boys, and around 16 in girls. Rhinoplasty should be strictly limited to extreme cases only at this age and undertaken warily.