Definition & Overview

A nose surgery, also known as rhinoplasty, is a surgical procedure that aims to reshape the nose. It can alter the shape of a nose in many ways; for example, it can make the nose larger or smaller, or change the angle of the nose in relation to the upper lip. It can also adjust the tip of the nose, or correct unwanted indentations, bumps, and other defects. A rhinoplasty can be conducted for both medical and cosmetic reasons.

A rhinoplasty is performed under local or general anesthesia, and can be done on an outpatient basis, although in many cases, the patients are asked to stay overnight for monitoring. The procedure is performed by a surgeon who has training in either plastic surgery or otolaryngology, or both.

Who should undergo and expected results

A nose surgery or rhinoplasty is most helpful for those who:

  • Are not satisfied with the physical appearance of their nose
  • Are having problems with breathing or chronic congestion due to a problem with their nasal structure
  • Have large bulbous nasal tips
  • Have drooping, hooked, or upturned nasal tips
  • Have excessively large, wide, or upturned nostrils
  • Have experienced traumatic injury affecting the nose
  • Have asymmetrical noses
  • Have a deviated septum


Depending on the reason behind the surgery, its results can either be significant and highly visible or very minor and almost unnoticeable. The results, however, are permanent as long as the nose is kept free from any injury or trauma after the procedure. It is important though that the surgery is done after a patient has passed complete nasal development, which occurs at age 15 or 16 among female patients and age 17 or 18 among male patients.

However, it is important to note that there is always a challenge in achieving exactly the goal that the patient sets, so results may differ a bit from patient's expectations.

How the procedure works

A rhinoplasty, regardless of the goal, starts with thorough planning and consultation. If the nose has to be adjusted for medical reasons (i.e. correcting a deviated septum), its structure will be studied closely first so the surgeon can properly plan the surgery in a way that the desired alignment is achieved. The same is done for a rhinoplasty that is cosmetic in nature. Prior to the procedure, the doctor and the patient discuss not just the details of the surgery but also the expected results in relation to the final appearance of the nose. Once the plans are finalized, the patient will be given a schedule for the procedure.

During the procedure, the patient will be given an anesthetic in the form of intravenous sedation or general anaesthesia. The final decision will be based on the doctor's recommendation. Once the patient is comfortably sedated or anesthetized, rhinoplasty will be performed. There are two techniques used when surgically altering or improving the nose's appearance; open and closed techniques. The open technique involves creating a small, external bridging incision, allowing the surgeon to fold the nasal skin upward and access the lower nasal skeleton. Meanwhile, the closed technique means that all surgical incisions are created inside the nostrils. Thus, patients do not have to worry about visible scarring following the procedure. Through these techniques, cartilage and tissue may be removed or adjusted, or an implant is inserted to achieve the desired results.

After the procedure, the nose will be covered with a splint and a bandage, both of which have to stay in place for about a week. It is normal to feel puffy and experience some swelling around the nose and near the eyes for several days following the procedure. Using a cold compress will help minimize the pain and swelling, but if the pain is unbearable, the attending physician or surgeon may prescribe pain medication. The pain and swelling, however, will eventually subside over the course of 14 days following the surgery, as long as the patient follows all the post-surgical care instructions the doctor provides. Patients are also asked to avoid any strenuous activity for several weeks following the rhinoplasty procedure, and will benefit from keeping the head still and elevated during the first few days.

Possible risks and complications

Aside from swelling and bruising that affect the eye and nose region after the surgery, a nose surgery also comes with other risks, such as:

  • Bleeding
  • Adverse reaction to anaesthesia
  • Scarring
  • Poor healing of wounds in the nasal area
  • Changes in the sensation of the skin, i.e. pain or numbness
  • Injury to the septum (the wall dividing the two nostrils)
  • Irritation due to the tape and bandaging that has to be worn after the surgery
  • Infection
  • Severe swelling inside the nose that may cause serious nasal congestion and blockage
  • Skin discolouration
  • Results that differ from what was expected


By choosing the right surgeon and taking the necessary preparation and precautionary measures, these risks can be easily avoided.

References:

  • Bagheri SC. Primary cosmetic rhinoplasty. Oral Maxillofac Surg Clin North Am. 2012;24:39-48.
  • Tardy ME Jr, Thomas JR. Rhinoplasty. In: Flint PW, Haughey BH, Lund VL, et al., eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 45.
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