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Rhinoplasty or Nose Surgery
Rhinoplasty surgery can be used to correct the external appearance of deviation, prominence, over projection, bumps and irregularities. Internal structures that affect airflow and obstructive symptoms can also be corrected. These usually involve the septum, turbinates or internal valves. Usually these are performed together, either by the same surgeon or two surgeons working in conjunction.
There are two traditional approaches to nasal surgery. Using a closed technique the incisions are placed only within the nostrils, there is no visible external scar. An open technique joins the internal nasal incisions across the columellar. This is the skin and cartilage structure in line with the septum or nasal-dividing structure. The skin can then be reflected to expose the nasal structure and an uninterrupted view of the nose cartilage and bone skeleton. This is very useful for fine tip work and modification.
A thorough history is needed to plan the surgery and accurately address the concerns. Previous trauma may affect internal structures and result in scar tissue. Obstructive or blocked nasal symptoms, especially if consistent on one side, suggest a sided issue. There is a physiologic nasal cycle where nasal obstruction alternates between the sides throughout the day. Each nostril lining takes turns to dilate to humidify and warm the inhaled air. Simple clinical tests can show up obstruction.
Surgery is generally performed under a combination of local and general anaesthesia. The local anaesthetic takes away pain and by containing adrenaline it causes small blood vessels to vasoconstrict or shut down. This helps to reduce bruising. Because the local anaesthetic reduces pain the amount of general anaesthetic required can be reduced, helping with post-operative nausea.
Removing both cartilage and bone can reduce the bump on the top of the nose. At times this results in a wider nose, which needs to be corrected by cracking the nasal bones and bringing them closer together.
A narrow nose also gives the illusion of a small nose. A sign of aging can be dropping of the tip of the nose. Shaving a small amount of cartilage from the septum and reducing the lower lateral cartilage allows the nose tip to rotate up. A combination of stitches, cartilage trimming and cartilage grafts may be needed to refine and narrow the tip.
Wider or bulbous tips are improved. Deviation is corrected by moving the nose across and usually need cracking of the nasal bones where they meet the cheek. Long noses can be shortened and over projected noses can be reduced.
If surgery is performed on the internal structures then internal splints or packing may be needed. Usually a splint or plaster of Paris external splint is required for the first week. Internal nostril stitches are usually dissolving, but if used, the outer skin stitches may need to be removed. Swelling is fairly common but variable. Bruising is also common and may result in black eyes. The open technique may result in numbness of the nose tip that takes months to resolve.
At the time of consultation all aspects of the surgery and recovery should be fully explained. This should include adverse outcomes, risks and complications. Often an array of before and after photographs is used to show likely outcomes.
Nasal surgery performed for appropriate conditions is extremely well tolerated with very favourable outcomes. Realistic expectations are usually met. If the surgery is performed after trauma then a medicare rebate may apply.
Fast facts
Cost: $3000-7000
Hospital: Day surgery or over night
Recovery: 1-2 weeks depending on bruising.