Nose job (Rhinoplasty)
Surgery to improve the shape of the nose is a popular operation as this central facial landmark defines one’s sense of individuality, character and personality. The physical and emotional importance of the nose in generating self-esteem and confidence in the mind of its owner simply cannot be overstated. It is however, truly a surgery of millimetres, as slight alterations in profile can lead to profound changes in appearance. This is one area where computer morphing during the consultation is extremely helpful to both patient and surgeon in visualising the exact desired end-result.
Changes to the bone and cartilage framework are performed by one of 2 techniques: Closed or Open Rhinoplasty. When the main work is confined to the bridge of the nose (such as in shaving down a hump), then all the cuts can be hidden inside the nose (Closed technique). Skin is separated from the bone, which is suitably reshaped and the effect is refined by sight and by feel, as skin is re-draped over the new framework.
The advantage of this method lies in scar-less surgery, dissolving internal stitches, less swelling and faster recovery. The walls of the bony pyramid almost always require controlled fractures leading to variable bruising, and necessitating the wearing of a protective splint for at least 5 days. I prefer to admit patients overnight as day-cases could bleed at home and then have to rush back.
Before and After Closed Rhinoplasty, patient desiring a straight bridge
When the tip of the nose requires additional work, or more major alterations to the cartilage framework in the lower half are needed (such as in straightening a crooked nose), then symmetry is better established by looking at the cartilages as they are worked upon as opposed to just feeling the bone through the skin. A small cut in the skin between the nostrils, joined to cuts hidden inside the nose, enables the skin to be lifted off the framework like the bonnet of a car (Open technique). This allows the surgeon to clearly see everything, and make the necessary alterations including placement of any grafts, perfectly. Skin again is re-draped over the new framework and the same recovery protocol followed- skin stitches come out on day 6 and internal stitches dissolve. There is greater swelling and numbness to contend with after open surgery, but the precision obtained is unmatched- so much so that many highly esteemed Rhinoplasty surgeons will always do their noses open.
Before and After Open Rhinoplasty
If there exists a functional obstruction to breathing in addition to the aesthetic concerns, the services of a Consultant ENT Surgeon may be required for a combined operation (eg Septorhinoplasty). Recovery from any of these types of surgery involves about 2 weeks off work and driving, and the final outcome can take up to a year to get established.