The nose is made up of bone and cartilage covered by soft linings of skin. The top of the nose is made of bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage which is softer. The middle partition of the nose is called the septum. In some people, problems with these structures can alter the way the nose looks, and may also cause problems with breathing via the nose. The most common features people are concerned with are deviations of the nose to one side, a nasal hump, a nasal depression, too wide or too a narrow nose, over or under projection of the soft nasal tip. Improving these features of the nose can also involve improving its function and help with breathing. However there is no perfect shape to the nose and any alteration has to fit and suit the rest of the face.
It is important that expectations about the effects of surgery are not unrealistic. People who believe that their lives will change if they have cosmetic surgery are often disappointed. Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation.
What is septorhinoplasty? Septorhinoplasty is an operation to straighten the septum and to change the external appearance of the nose. The type of operation depends on which particular area of the nose needs correction. The nose can be straightened, made smaller (reduction) or bigger (augmentation) and bumps may be removed. The shape of the tip of the nose can be changed (refinemnet of nasal tip). Pieces of cartilage or bone may be removed from or added to the nose to change its shape.
Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. This may be corrected also and this combined operation is called septorhinoplasty.
What is rhinoplasty? This is where there is surgery performed on the external nose only, and not on the nasal septum.
Why have septorhinoplasty?
You may be advised to have a septorhinoplasty if the shape of the septum and bones of your nose is causing you to have difficulty breathing through your nose. This may be because of the way your nose has grown or it may be due to an injury to the nose. You may also need septorhinoplasty to straighten your nose if it has become deformed after an injury.
Do I have to have septorhinoplasty? The shape of your nose will not do you any harm so it can be left alone if you want to. Only you can decide if it is causing you so much bother that you want an operation. The blocked nose could be helped with nose drops or sprays but the shape of the bones and septum can only be changed with surgery.
How is the operation done? You will be asleep. Approaches for the surgery can be either through the nostrils (intranasal) or by the use of a small incision on the under side of the nose (external). Cuts are made inside the nose and the septum is straightened. The bones of the nose are fractured and moved to a straighter position. The skin may be lifted up over the front of the nose to change the shape of the tip and middle part of the nose. Small cuts in the skin (under the nose) may be used to carry out all of these procedures. At the end of the operation the nasal bones are fixed in position. A plaster or splint is applied to the outside of the nose to keep the bones in this position.
After the operation We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We will take them out the morning after your operation. You may get a little bit of bleeding when the packs come out – this will settle quickly. The front of your nose can be a bit tender for a few weeks. Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood-coloured watery fluid from your nose for the first two weeks or so – this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this. The plaster cast is removed one week after the surgery. Stitches are also removed between 5 to 7 days post surgery.
You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps. Most of the swelling has subsided after two weeks but it may be longer before the skin and soft tissues over the bone and cartilage settle. It may take up to three months for your nose to settle down and for your breathing to be clear again. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.
Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months. The nose may feel a little stiff and numb for up to three months, particularly around the tip.
How long will I be off work? You can expect to go home on the day after your operation but you will need to rest at home for at least a week. If you do heavy lifting and carrying at work you should take two weeks off. Since the bones of the nose have been broken you will need to be careful for six weeks that you do not knock your nose, as you may push it out of shape. You should avoid contact sports.
How successful is the operation?
Everybody’s nose and face is different, so it may not be possible to make your nose look exactly like your perfect nose. The thickness of the skin is important in how much better the nose will look after rhinoplasty and in what can be done. If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside. The operation aims to produce a nose that looks natural. It is important that you discuss your expectations with your surgeon. 90-95 % of patients are happy with the results of their operation but some people request more surgery.
What can go wrong?
Sometimes your nose can bleed after the operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Very occasionally patients need to have another general anaesthetic and return to the operating theatre to stop the bleeding.Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.
The operation may rarely leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes not problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum.
Very rarely, you can have some numbness of your teeth, which usually settles with time.
Up to 10% of people may have some reservations about the end results and about 5-10% of patients need further operations in the future to further adjust the shape of the nose.