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Rhinoplasty … The Nose Job

Introduction

A rhinoplasty is a surgical procedure by which the appearance of the nose is altered and the function is improved. The beautification of the nose may be done in multiple ways. The functional improve is best achieved in conjunction with an ENT (ear nose and throat) surgeon. Plastic surgeons are trained in facial dimensions and nasal aesthetic thus honouring facial proportions achieving he best cosmetic result.

The nose may be straightened, narrowed, lengthened, shortened, made bigger or smaller, less pointy or more refined. The idea is to create greater harmony to the face. Often times some form of chin augmentations will be needed either by fat fills, filler or a chin implant. Keep in mind that there is no such thing as a perfect nose. Surgery, though, can enhance facial features and emphasize your unique and natural beauty.

I cannot make a new nose nor make a replica of another person’s nose. I can merely adjust your nose so that it better fits your facial proportions. The attractiveness of a nose is the ability to blend with the rest of the face in a harmonious fashion. For instance: wide splayed nostrils can be narrowed, broad tips made finer and an eye catching nasal hump removed and straightened.

A rhinoplasty involves a combination of the following procedure done as need with great variations between individuals.

best address your concerns.

A Rhinoplasty is done in theatre under general aesthetic. The procedure may take anything from 60 min to 5 hrs. The reason for the great variability in theatre times is based on the fact that noses are very different amongst people. Many patients have functional and anatomical abnormalities which may only be found at the time of operation. It is thus of value to the surgeon to take this time to correct the anatomical deformity as much as possible. The procedure may be done as a day case but it is vital for you to arrange a lift home as driving yourself is not recommended.

The anatomical abnormalities of your nose and surgical corrections needed, will be determined in your pre-operative consultation. It is important to discuss you expectations with your surgeon so that together you can formulate a realistic achievable goal. It is important to inform your surgeon about previous nasal surgery, trauma, allergic conditions, bleeding tendencies, smoking and any other surgical risks which you or your family may carry.

In my practice I most commonly do primary rhinoplasty, which means a rhinoplasty in a patient whom have not had previous nasal surgery and no significant history of trauma to the nose. A secondary or re-do rhinoplasty requires a team effort and is best done as a multidisciplinary approach involving more than one surgeon including an ear nose and throat surgeon. We have such a team and a consultation will be arranged accordingly.

Patients requiring nasal septal surgery will be seen, and operated on, in conjunction with a ENT Surgeon (Ear, nose and throat surgeon)

The rhinoplasty addresses not only the different anatomical subunits of the nose but also the skin, subcutaneous tissue, cartilaginous and bony framework. These aesthetic subunit have certain measurements which need to be honoured in order to achieve an aesthetically pleasing nose. The measurements are different in males and females.

Skin have various qualities mostly determined by the patient’s gender and ethnic origin. The skin may be thin or thick, smooth or rough. Thick skin does not show modifications as easily as thin skin.

If the abnormality is found to be severe you may even require a cartilage graft either from the area behind the ear or even rib cartilage. Cartilage graft are able to augment the nasal framework similar to Lego blocks and sometime you just need that extra bit to give a better shape.

The vast majority of rhinoplasty procedures require bony work. The bony-work is done by specialised fracture techniques in order to get the desired result. None the less, the element of a” broken nose “applies as per the prolonged swelling and bony tenderness.

The operation may be done through an open or closed technique. An open technique means a small little cut on the inferior aspect of the nose. This scar completely disappears in time. The open technique has the advantage of greater exposure thus allowing complete correction of the deformity under direct vision. However the open technique is associated with a longer down time i.e. prolonged swelling.  In patients requiring minor alterations in nasal shape a closed technique is a very good option, with reduced downtime compared to the open technique. In the closed technique the incisions are on the inside of the nose and not visible.  I will discuss the surgical approach and modifications needed in our pre-operative consultations.

After a nose job, people usually wear a nasal splint for the first week. You can expect swelling and some bruising around the eyes after surgery that will begin to improve after the third day. It can, though, last up to two weeks. The procedure is not particularly painful but is does have a degree of discomfort due to the swelling.

You will have to see your surgeon once a week until you are given the “all clear”. In patients having the open technique you will require suture removal five to seven days after the procedure. You are not to rub or blow your nose. You may however use damp cotton swops carefully in areas of irritation including the inside of the nose. You will be given an antibiotic ointment to apply to dry crusting areas

Expect your nose to have a little swelling, which probably only you and your surgeon will notice. This will go away over the next six months. The final shape of your nose will be apparent after it has completely healed and the final result is only truly appreciated one year after the procedure.

You should avoid strenuous activity for three to six weeks after surgery. You should be careful not to bump your nose in the first six months, which for some unknown reason seem to be more common after this procedure. I would also recommend being careful with biting especially apples and ask you beautician to go easing during facials. You may return to your social activities as soon as within two to three weeks without any recognizable signs that you had a procedure done.

Below follows a list of the most frequent complications encountered after the procedure:

Immediately: Pain, bruising for up to 3 weeks, easily covered with makeup after a week. Nausea and vomiting (as some blood my trickle down your throat before and after the procedure. Swelling, your nose and face will be swollen for a long time not however noticed by others. Infection of nose or infection of cartilage grafts. Bony tenderness around the nose where were fractures were done.

Later: A numb feeling over the tip of nose and upper lip which will be permanent in some cases. Stiffness or harness of nose mostly seen in secondary cases or in cases were bony grafts were done. Obvious scarring including keloid scar (scar growth), hypertrophic scars (widened scar).

Much-much later: Facial structures are dynamic and change and grow over time. Cartilage grafts may resorb, change shape and position over time. Unfortunately this change is not predicable and may require surgery later. Mild asymmetries between the left and right side are not uncommon as very few if any individuals have a perfectly symmetrical face.

A great master once told me that life is too short to live with an ugly nose. Wide nostrils, flat or wide noses, significant humps or a large hooked nose are easily correctable. I am here to help you to be the best you can be.

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011 482 2196
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