Rhinoplasty
The Aims of the Operation
The operation is aimed at making your new nose look correct for your perception. Others may not notice a difference and indeed patients are surprised by the absence of other people’s reaction to the new nose. Although noses can be changed to a certain degree and Mr Khandwala will tell you what is surgically possible and not possible. For instance, thick skin on the top of the nose cannot be thinned and therefore the nasal tip may still look slightly bulbous. There is a limit to the amount of reduction one can obtain and on a scale of 1-5, one can change a nose by about 2 degrees but not a complete 5. The skin on the nose needs to shrink to the new dimensions. Previous injury may prevent it becoming a perfectly straight nose.
The Consultation Process
The consultation process involves at least two consultations; the second and third consultations are usually free of charge. Photographs are taken at the first consultation and the procedure of rhinoplasty and its complications are discussed. You will also be shown pictures of pre and post-operative results.
At the next consultation your pictures are put onto the computer screen and changes are discussed in detail. These pictures may also be printed for the results and changes to be noted.
Points to consider
The nose is a central feature of the face, but is influenced by the size of other features, chin, cheekbones, forehead, the length of the nose and the size of the jaw are important features to be considered. All these factors will be taken into consideration during your consultation with Mr Khandwala.
Risks of the operation
Infection, nasal bleeding, difficulty with breathing and further operations are the common risks. Occasionally there is a loss of the sense of smell. 10% of patients require some degree of further surgery. This will normally be done a year after the original surgery. This operation is done under a general anaesthetic.
Instructions for the patient after the operation
Expect to have some minor bleeding from the nose for the first day or two. Simply dab this away gently with gauze squares. Keep your head up and sleep with at least two pillows. Try not to blow your nose hard and try and avoid sneezing. Leave any crusts or remnants for Mr Khandwala to clear when he sees you a week after surgery. You may usually go back to work a week after the operation after the plaster has been removed. You will, however, be more comfortable if you have taken two weeks off.
What can be achieved
A reduction rhinoplasty reduces the size of the nose leaving the skin intact. This often involves removing the hump of the nose and then fracturing the sides of the nose in order to make the resulting nose smaller and improve its line. The nostrils and the tip of the nose are addressed through incisions on the columella and or the sides of the nose.
These will usually leave a fine scar which settles down very well. If there are breathing difficulties, modification of the septum between the two nostrils can be carried out. Cartilage from the septum can be harvested to modify the tip of a nose.
Large nostrils are difficult to make smaller without actually cutting the skin at the sides of the nostril to reduce them.
The plaster and splint are removed in a week’s time and the nose is usually swollen to start off with. You will be able presentable to others in about two weeks’ time; however, the swelling continues to reduce gradually and noses are often slightly swollen for about a year following surgery. Most of the swelling takes about six to twelve weeks to settle down. There may be minor problems of shape which appear when the plaster is removed. These usually settle down with time. The nose and its tip will feel numb for several months.
After the operation
When you wake up you will normally have a plaster on your nose and will be unable to breathe through both nostrils due to the presence of packs in the nostril. Bruising and swelling around the eyes is quite common, especially if the nose has been infractured. The swelling usually settles down in about two week’s time. There may be some scabs around the nostril after the packs have been removed. The packs are usually removed at 24 hours following surgery.
The plaster and splint are removed in a week’s time and the nose is usually swollen to start off with. You will be able presentable to others in about two weeks’ time; however, the swelling continues to reduce gradually and noses are often slightly swollen for about a year following surgery. Most of the swelling takes about six to twelve weeks to settle down. There may be minor problems of shape which appear when the plaster is removed. These usually settle down with time. The nose and its tip will feel numb for several months.
MORE INFORMATION ON RHINOPLASTY FROM BAAPS