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.