NOSE RESHAPE - RHINOPLASTY
Introduction
Corrective nasal surgery is one of the commonest cosmetic procedures performed today. The operation is performed for repair of injuries, which have caused a noticeable deformity, and also when the nose has become an unacceptable shape during growth and development.
Essentially the nasal contour is changed by removing, shifting or altering the underlying bony and cartilaginous structures. Except in special circumstances (see 'scars' below) the operation is performed from inside the nose leaving no external scars.
The skin covering the nose will redrape around its new underlying framework. At the preoperative consultation the shape of the new nose is carefully discussed with the patient.
Nature of operation
The patient is admitted on the morning of the operation. A general or twilight anaesthetic is given. The shape of the nose is changed along the lines agreed with the patient. This will very often involve fracturing the nasal bones.
At the completion of the operation a splint is placed on the nose and secured in position with sticky tape to the forehead and cheeks. The splint is removed after a week to ten days. The purpose of the splint is to immobilise the fractured nasal bones and reconstructed cartilaginous framework in order to allow optimum healing conditions.
In addition, soft packs are placed inside each nostril for twenty-four hours. The duration of stay in the clinic is usually no longer than one day.
Postoperative events
Bruising and swelling of the nose as well as around the eyes is the commonest postoperative feature. Most of the bruising and swelling around the eyes subsides within a week in most patients.
Infection and bleeding may occur as with any operation. Fortunately these complications are uncommon and do not generally give any cause for concern.
Nasal blockage As the tissues inside the nose are swollen afterwards it is not uncommon to experience a variable amount of blockage to breathing. This symptom however resolves itself in a short time following operation. It is extremely rare to experience permanent nasal obstruction if this was not already present before surgery.
Numbness of the tip sometimes occurs temporarily. It usually resolves completely.
Pain and discomfort Despite the nature of the operation, pain and discomfort are surprisingly rare. Painkillers are given as required.
Skin type The thickness and elasticity of the covering skin will be a major factor in determining the final shape of the nose.
Scars In the vast majority of cases all work is done on the inside of the nose leaving no external scars. If it is necessary to make the nostrils smaller, an incision is made where the outer side of the nostril adjoins the upper lip. Because this is located in a natural body fold, the scar is practically unnoticeable to the average onlooker.
Final shape In a few cases, especially where the skin is excessively thick, an excessive amount of scar tissue is formed under the skin or due to technical reasons, the result may be unfavourable requiring further surgery.
More surgeons are now performing an open rhinoplasty where the nose is opened up to give the surgeon direct access to the anatomical components of the nose. This is usually performed using an inverted V incision in the columella (the part that joins the middle of the tip of the nose to the lip). The scar is usually unnoticeable.
Postoperative management
After discharge from the clinic and until the splint is removed, patients are advised to rest as much as possible, sleep upright, sneeze through the mouth and avoid blowing the nose.
Ice packs applied to the eyes help to reduce bruising and swelling. The hair should not be washed until the plaster is removed as this may dislodge the plaster. Glasses may be worn on top of the splint if this is possible but once the splint is removed it is advised that glasses should not be allowed to rest on the nose for 6 weeks. Contact lenses can be inserted after a few days.
Should a significant haemorrhage occur from the nose after discharge home it is advised that ice packs are applied to the side of the bleeding. After the first forty-eight hours, bleeding from the nose is very uncommon.
Strenuous exercise should be avoided for four weeks. After that time non body-contact sports are permitted. Body-contact sports are prohibited for six months.
Result
Most patients are delighted with the result of the operation, which is generally very successful in experienced hands.
It should be stressed that there is a limit to the corrective procedures possible or recommended. The surgical goal is improvement and not to match the ideal which might be present in the mind of the patient.
Some of the limiting factors in rhinoplasty are the contour and shape of the face, the texture and thickness of the skin, the inclination of the chin, lip and forehead, the depth of the angle between the forehead and the nose, the height of the patient and the healing powers of the tissues. The amount of scar tissue formed under the skin after the operation will also have a major influence on the final shape.
Noses that have been severely injured or those, which are markedly crooked, are technically difficult to correct and a second procedure may be necessary.
