Rhinoplasty (nose surgery, nose reshaping or nose job) is a surgical procedure for correcting and reconstructing the form, restoring the functions or aesthetically enhancing the appearance and proportion of the nose. Rhinoplasty may also correct impaired breathing caused by structural abnormalities in the nose.
Indications for rhinoplasty can be divided into
- Reconstructive reasons: deformities arising from birth, hereditary or trauma
- Cosmetic reasons: to enhance facial harmony and proportion.
Rhinoplasty can change
- Nose size, in relationship to the other facial structures
- Nose width, at the bridge
- Nose profile, with visible humps or depressions on the bridge
- Nasal tip that is large or bulbous, drooping, or too upturned
- Nostrils that are large, wide or upturned
- Nasal asymmetry and deviation (deviated nasal septum)
Preoperative evaluation before rhinoplasty
Communication is vital to achieving the patient’s goals. During the initial consultation, patients should discuss their goals and expectations with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the desirable results from the surgical procedures involved and their long term benefits. Every patient is different. Therefore a specific treatment regimen is planned to suit an individual’s need.
- Discussion about expectation and desired outcome
- Medical conditions, drug allergies and previous medical or surgical treatment
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs should be revealed
- Discussion of type of anaesthesia
- Examination and measurement of the face and nose
- Photography for preoperative and postoperative evaluation
The risks and safety information on rhinoplasty
The practice of medicine and surgery is not a perfect science. Therefore, some risks may occur even in the hand of an expert. Although good results are usually achievable, some potential risks may arise such as
- Poor wound healing
- Numbness (temporary)
- Skin discolouration
- Skin contour irregularities
- Post rhinoplasty swelling
- Nasal asymmetry
- Alteration in the nasal airway
- Possibility of revision surgery
- Anaesthesia risks
Types of rhinoplasty
- Augmentation rhinoplasty
- Reduction rhinoplasty
- Alarplasty or nasal base surgery
A. Augmentation Rhinoplasty
Augmentation rhinoplasty is a surgical procedure that can be performed for both aesthetic and functional reasons. Functional reasons for augmentation include providing structural support for deficient areas of the nose such as the upper or lower lateral cartilages. Augmentation can also be performed to enhance the appearance and proportion of nose to the face to restore facial harmony.
There are varieties of materials that can be used for augmentation rhinoplasty. An autologous graft is made from materials harvested from your own body. For example, cartilage grafts may come from your ear, ribs or nasal septum. Bone grafts may derive from your leg or hip. When tissues from your own body are used, there is a reduced risk of complications. Non-autologous or artificial materials used for implants or grafts include medical-grade silicone, medpore or Gore-Tex.
The ideal candidate for augmentation rhinoplasty:
- Completion of facial growth (preferably 13 years of age or older)
- Healthy individuals who do not have life-threatening illnesses or medical conditions
- Preferably non-smokers
- Individuals with realistic goals in mind for the improvement of the appearance
Postoperative expectations of augmentation rhinoplasty
A splint or bandage is usually placed on the surface of the nose to support and protect the new structures during the initial healing phase. After the surgery there may be swelling, bruises or discomfort, irritation for several days that can be controlled with oral medications, cold compression and ointment. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively. Any external sutures on the nose will be removed about 7-10 days after the surgery. It may take several months for swelling to resolve and up to a year for the shape of the new nose to be fully refined.
B. Reduction Rhinoplasty
Reduction rhinoplasty corrects the structural framework of the nose itself by removing or re-arranging the nasal cartilage and/or bone to achieve the desired nose shape and size. This procedure can be performed via incisions placed inside the nostrils without leaving behind any visible stitches or scars (closed rhinoplasty). In a condition where the nasal tip or the lower third structure of the nose need to be re-shaped, a tiny incision is made on the underside of the nose just between the nostrils (open rhinoplasty). This technique will leave a small scar, and its location makes scar inconspicuous.
Indications for reduction rhinoplasty include:
- To alter the hump at the bridge of the nose
- To reshape the tip of the nose
- To change the length or width of the nose
- To change the width of the nostrils
- To remove excess fibrofatty tissue or skin on the nose.
Occasionally chin augmentation can be performed to complement a rhinoplasty. These procedures are popular with both men and women to create facial harmony. For men, creating a stronger or shorter nose, along with a stronger jawline, is often the objective. Women sometimes wish to have a more petite nose and less pointy chin.
Postoperative expectations of reduction rhinoplasty
Recovering from reduction rhinoplasty usually takes about 7-14 days in most cases. After the surgery, there may be swelling, bruises, numbness or discomfort for several days which can be controlled with oral medications, cold compression and ointment. Some patients may experience nose stuffiness or nose bleeding. A splint or bandage is usually placed on the surface of nose for a short time to assist the nose to retain its new shape will it heals. Oral antibiotics and analgesics are prescribed to reduce the risk of infection and postoperative pain respectively. Any external sutures on the nose will be removed about 7-10 days after the surgery.
The nose is a tripod structure consists of nasal bones that form the side walls and a central structure separating the nose into the right and left side called nasal septum. Nasal septum can be deformed through injury, trauma, disease or sometimes a previous surgery. When the nasal septum is deformed or deviated, it can have significant consequences to the overall appearance and function of the nose. A deviated septum can cause a blockage in the nose leading to breathing difficulties, chronic sinus infections, stagnating mucus, inflammation and irritation.
Septorhinoplasty is a surgical procedure performed to improve both the external appearance and internal breathing capabilities of the nose. The cosmetic benefits of septorhinoplasty are to improve the appearance of a crooked nose and shape of the nose thus creating a balance with other facial features. Some of its functional benefits may include relieving nasal blockages, snoring and sleep apnea.
Postoperative expectations of septorhinoplasty
Patients are discharged with a cast over the nasal bridge and internal splints placed along the nasal septum. Occasionally, the nose may be packed to control nose bleeding. Recovering from septorhinoplasty usually takes about 7-14 days in most cases. The cast, splints and any externally visible sutures are removed one week after surgery. Most patients return to work one week after surgery. Any bruising around the eyes that may occur typically resolves within two weeks post-operative. Swelling peaks two to three days after surgery and gradually subsides after that. A considerable reduction in swelling is evident in one month, but the nose will continue to heal for a full year after surgery. Routine post-operative follow up are periodically scheduled for the year following surgery to ensure optimal healing.
D. Alarplasty (Nasal Base Surgery)/ Nostril Reduction Surgery
Nasal base varies with one’s ethnicity. Wide flaring nostril and large nostril openings are very common among the Africans, Asians and occasionally in Caucasians. In general, the width of the eye or the area between the eyes comprises about one-fifth of the facial width. On a frontal view, a broad nasal base may distract the apparent facial balance or distract the surrounding facial features. The shape of the nose base, when viewed from below, is generally triangular. The shape of the outer nostril wall (nasal alar) ideally displays a gentle convexity between the nasal tip and nose-cheek junction (alar crease). When the shape of the nasal alar demonstrates an accentuated convexity, this may detract from nasal or facial balance.
Alarplasty or nostril reduction surgery is a cosmetic surgical procedure aim to reduce the wide flaring nostrils and nasal base width by removing a wedge of the nose at the alar base. The wound is closed together by meticulous repositioning at the natural crease of the external nose-cheek junction or hidden in the nostril to conceal the tell-tale sign of surgery. This surgery can be done alone or combined with nasal augmentation to enhance the overall appearance (size, shape, symmetry and proportion) of the nose and nostrils.
Postoperative expectations of alarplasty or nostril reduction surgery
Post-surgical swelling peaks at about two to three days after surgery and gradually subsides after that. Most patients return to work on 1-2 days after surgery. The recovering time from alarplasty usually takes about 7-14 days in most cases for the swelling and bruises to subside. Any externally visible sutures are removed one week after surgery. A significant improvement in the visible scars at the alar crease or inside the nostrils is evident at one month and will continue to become inconspicuous 6-12 months after surgery. Routine post-operative follow up are periodically scheduled for the year following surgery to ensure optimal healing.
How much will a rhinoplasty surgery cost?
Cost is always a consideration in elective surgery. Rhinoplasty prices can vary widely.
The price of rhinoplasty may include:
- Surgeon’s fee
- Hospital or surgical facility costs
- Anaesthesia fees
- Prescriptions for medication
- Medical tests
When rhinoplasty is performed for nasal trauma or to improve breathing function, this procedure is considered as reconstructive surgery and may be covered by insurance. This requires a detailed examination to verify the cause before authorisation from your insurer. Patients are advised to contact their insurance company for further verification.