A rhinoplasty (or ‘nose-job’) is an operation carried out to change the external appearance of the nose. The nose is extremely important for breathing and if the inside of the nose is bent and interferes with functionit would have to be straightened as well.

The first thing to understand is that a nose-job is not a complete change of one’s nose to get someone else’s but the improvement of one’s physical defects. Nowadays the trend is for surgeons avoid giving the patient a ‘surgical’-looking nose t

ENT surgeons (or Otolaryngologists) have long been involved in facial cosmetic surgery

Why a ‘nose-job’

ENT surgeons (or Otolaryngologists) have long been involved in facial cosmetic surgery. The nose is a central feature of the face and its modification is known as rhinoplasty. A rhinoplasty (or ‘nose-job’) is an operation carried out to change the external appearance of the nose. The nose is extremely important for breathing and if the inside of the nose is bent and interferes with function it would have to be straightened as well.
Patients usually come for advice about facial cosmetic surgery after several years of soul searching. They feel uneasy with that person in the mirror. Many would have kept their feelings hidden from their family members and often feel self conscious and over-sensitive about comments directed at their appearance. They often feel guilty because they cannot be happy with themselves and at the same time feel that others consider their desire for cosmetic change as frivolous and low down in the priorities of family life. Indeed, other family members who take for granted the patient’s appearance often show surprise or lack of understanding to this individual since they have accepted that person as he/she was and expect him/her to continue being exactly the same person.

A frank discussion with the surgeon should take place where there is good communication and where the patient is as clear as possible on what is bothering him/her. The patient should feel comfortable with and feel confidence in his/her surgeon. Most individuals would be happy with removing or improving most of the features that are bothering them. The first thing to understand is that a nose-job is not a complete change of one’s nose to get someone else’s but the improvement of one’s physical defects.

A ‘natural’ look is very important in Southern Europe and people do not want to look ‘operated’.
Surgeons are very wary of those with excessive demands who can never be satisfied and sometimes they may feel that they may not be able to help an individual with deep-seated psychological conditions. In these cases a referral to a colleague may be the best option instead of surgery. Some individuals expect the cosmetic surgeon to automatically change their life with an operation and of course this is not within the surgeon’s power!

Function and appearance

Very often in Mediterranean noses there are deviations in the nasal cartilage due to injuries in childhood which have been long forgotten. The surgeon has got to be aware of sinusitis and nasal allergy which contribute to the problems that are faced by patients. It is not easy to correct breathing problems which arise as a result of previous cosmetic surgery to the nose. The best time to get things right is the first time. Function and appearance pull in opposing directions. Although a satisfactory job on both counts can usually be carried out and it is very important for the patient to realise that sometimes, ensuring a good airway may need a compromise on the cosmetic result. ENT surgeons develop a wealth of experience and techniques over the years dealing with broken and injured noses and properly understand the behaviour of airflow through the nasal valves.

The Operation

There are two main ways of carrying out a rhinoplasty- first by using a completely internal approach and second by making a small incision below the nasal tip. The second option is used especially if one of the aims of the operation is to improve the nasal tip. This small incision usually disappears within a few weeks since very thin sutures are used. The great majority of surgeons have changed to this technique as it offers excellent access to nasal structures with more predictable results. After the approach is made instruments are passed up to sculpt and modify the cartilages and bone of the nose. Once the nose has been altered to the required position, it is held in place with a rigid splint. Nasal packing is very rarely used by this author so the pain and bleeding associated with their removal are hardly ever seen. The operation itself is done under general anaesthesia ,ie with the patient fast asleep and lasts around 1-2 hours depending on the extent of the work to be done. It is generally done as a day case, ie patients are generally well enough to go home that same evening.

What are the potential risks?

The rhinoplasty itself in skilled hands has few complications, mainly infection and bleeding. Antibiotics are used to prevent infections. One should avoid going to the gym and staying in hot sun since this increases the risks of bleeding. Not every patient heals the same way. Some take more than others for eg bruising to disappear. However very rarely, soft tissue healing may be unequal and unexpected distorsion of the nose may occur, needing further corrective surgery.

What am I to expect after the operation?

It is likely that there will be bruising around the nose. Nowadays \'black eyes\' are quite rare and the bruising and swelling is usually minor. You will experience some pain, but this is not normally very severe. Your splint will stay on for one week and then will be removed together with the sutures. Your nose will feel blocked until it is cleaned at this time although there is usually no packing inside the nose itself. You will be asked to apply some cream or ointment over the sutures. You will be advised not to lift heavy objects and stay away from smoky or dusty areas. Make sure no one accidentally hits your nose!

How long will I be off work / school?

One week off is usually required although some patients need a longer period of time before going back to work.

Will there be any scars?

No. The only cut made in the skin is small and does not produce visible scars. Patients with a history of keloid scarring are advised to let the surgeon know well in advance of this problem so that the approach may be modified.

Redo surgery

This is increasingly being seen as surgeons encounter patients who are not quite satisfied with the result of previous operations. Patients who have already have had surgery and suffer some injury to their nose want to have the injury corrected. It is important to keep expectations realistic. In redo surgery the surgeon has to work in the face of several obstacles, such as very thick skin or thick nasal bones. Previous scarring increases the possibility of bleeding and tissue swelling. If the individual’s cartilages have already been reduced previously there may be a lack of cartilage, which means that the surgeon may have to harvest grafts from other places such as the ear in order to strengthen or straighten the nasal structure.

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Disclaimer: Patients are advised to discuss their medical condition and any indications for medical treatment or surgery with their general practitioner or the specialist who is delivering health care. This article is designed to help with frequently asked questions and does not take any responsibility for specific patients.

©Mr. Adrian M Agius 

Mr. Adrian M Agius MD, FRCS(Ed), M Med Sc (Bham)
ENT and Rhinoplasty surgeon