Rhinoplasty (Nose Job)
Colloquially referred to as a ‘nose job’, rhinoplasty is a procedure that seeks to remedy any structural, shape, size and functional shortcomings of the nose. As a central aesthetic subunit of the face, the nose is one of the most important facial features and in some respects reshaping it is one of the most challenging facial aesthetic procedures. Unlike other aesthetic or reconstructive procedures, in rhinoplasty the shape and appearance of the nose continues to evolve long after the original surgery is complete. This is mainly because it involves manipulation of nasal cartilages, which are inherently relatively elastic, and also because of the surrounding forces transmitted from the skin envelope and facial muscles.
In simplistic terms, the nose can be thought of as an organ divided into three anatomical topographical sites: the skin, the skeletal support (bone and cartilage) and the mucosa (inside lining). Topographical division is into upper, middle and lower thirds, based on the underlying skeletal support. The ideal nose is determined as much by personal preferences and aesthetic standards as by cultural norms. There is no standard appearance and each procedure has to be tailored to the individual patient’s needs. Any facial cosmetic surgery should ideally seek to preserve essence and character, while enhancing aesthetic form and the nature of the subject. It is vital that both surgeon and patient understand and agree with each other on what needs to be addressed.
Some patients seek advice to address previous nasal trauma, others are concerned about the width, profile appearance or asymmetric central location of the nose in their face. A drooping, thickened tip or excessive flaring of nostrils may be other reasons for seeking advice.
During the initial consultation, your previous medical history, including high blood pressure, blood-clotting disorders, thyroid disease, all previous surgery, smoking history, allergies, hay fever, current medications (blood pressure medications, nasal sprays and blood thinners) and alternative dietary supplements will be reviewed. Dr Farhadieh will discuss your aesthetic concerns as well as any functional issues that may worry you. After examination of your nose and facial features, a set of medical photographs will be taken and all options will be discussed with you.
Major complications are not common in rhinoplasty and all possible risks will be discussed with you at length during your consultation. Smokers are advised to cease smoking for at least 3–6 weeks prior to surgery and for at least 3–6 weeks postoperatively. You will need to stop taking any blood-thinning medications or alternative dietary supplements 2 weeks prior to surgery.
Rhinoplasty is performed either as an outpatient surgery or in the hospital with overnight admission. You will need someone to drive you home afterwards. Prior to surgery, Dr Farhadieh will mark your nose and face and address any remaining questions with you. The surgery involves internal incisions and often a small external incision (open rhinoplasty), which heals well and is not noticeable. The surgery usually takes between 1 and 2 hours, but can sometimes be longer, especially in revision cases. Depending on the aim, your nose may be built up in areas using your own nasal cartilage, the bridge may be narrowed, the septum straightened and nostrils adjusted if needs be.
When you wake up in recovery, there will be a thermoplastic plaster on your nose. You will need to wear this for up to 2 weeks. Pain relief will be provided to make you comfortable. Your nose will feel blocked and breathing may seem arduous, but most patients adapt to mouth breathing quickly. If you have been admitted overnight, you will be discharged in the morning after removal of nasal packs. You will be seen again in our clinic within a week and will have your external sutures removed. The skin of your nose will be partially numb owing to the open technique, but this should recover in time. During the first week to 10 days postoperatively you should avoid physical activities, especially bending or straining. This decreases likelihood of bleeding and helps reduce swelling. The majority of swelling and any bruising from surgery will settle within the first 3 weeks, and the remainder in the ensuing 3 weeks. Careful management of the skin envelope to reduce the residual swelling helps, especially in those with thick skin. Postoperative photographs will be taken as part of your confidential medical records.
Although you can start walking immediately after discharge, reduced activity and no exertion during the first week to 10 days is advised. Social activities can start 10–14 days after surgery, depending on the level of swelling and bruising. Normal sports activities can be recommenced at 6 weeks and contact sports at 3 months.
Dr Farhadieh is a strong believer that a good patient–surgeon relationship is the building block of any successful outcome. Commitment to patient care and good communication is the philosophy of our clinic. We will follow you up again in our clinic routinely and will always be available for any issues that may require addressing.
‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’
Frequently Asked Questions
Will I need general anaesthesia and overnight admission?
Yes, rhinoplasty is intricate surgery, which deals with the nasal structures inside and out. General anaesthesia is the safest way to undertake this surgery.
Will the scars be visible?
Hardly, except for a small step external incision, which heals without a trace. The rest of the incisions are inside the nose.
How long will the recovery take?
This can vary from patient to patient. The majority of bruising and swelling resolves within the first 7–10 days. Some of the nasal tip skin remains sensitive and often numb for a few months postoperatively.
Is asymmetry following surgery common?
All humans have some intrinsic asymmetry to their face and body, but in adequately trained hands noticeable persistent asymmetry following rhinoplasty is rare. This is important in treating the nose because it is the central aesthetic unit of the face.
Can any surgeon perform a rhinoplasty?
The face is amongst the most intricate parts of the body and its importance in projecting our sense of ‘self’ is clear. Performing a rhinoplasty is often thought of as a subspecialty amongst plastic surgeons and those who are interested seek further training beyond basic plastic surgical qualifications. Dr Farhadieh has an interest in facial surgery and has undertaken two separate clinical fellowships in London, England, focusing on the face from both cosmetic and reconstructive perspectives. You are in the safest and best trained hands with us.
What will my follow up include?
Dr Farhadieh believes that the relationship between doctor and patient is sacred and privileged. Our practice is based on compassion, honesty, transparency and, above all, patient welfare. We pride ourselves on making sure that you feel supported at all times. We will be available during all stages of your journey and will schedule short-, medium- and long-term follow-up appointments as part of our overall practice.