RHINOPLASTY SURGERY
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Colloquially referred to as a ‘nose job’, a rhinoplasty is a procedure that seeks to address any structural, shape, size and functional issues of the nose. As an integral feature of the face, the central aesthetic subunit the nose plays a huge part in determining what someone looks like. Because of this, reshaping the nose is often considered 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 relatively elastic, and also because of the surrounding forces transmitted from the skin envelope and facial muscles.
GETTING RHINOPLASTY SURGERY WITH OUR CLINIC 
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.
WHAT TO EXPECT BEFORE AND AFTER RHINOPLASTY SURGERY 
Before surgery:
During the initial consultation, Dr Farhadieh will go over your previous medical history by asking for information on the following things:
- High blood pressure
- Blood clotting disorders
- Thyroid disease
- All previous surgeries
- Smoking history
- Allergies and hay fever
- Current medications
Dr Farhadieh will then 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 record 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. These include asymmetry, smell loss, loss of taste, permanent change in voice and/or breathing, infection and postoperative bleeding. Its worth remembering that the literature reflects it has one of the highest rates of revision surgery with up to 1 in 3 having revision surgeries. Smokers are advised to stop smoking for at least 3–6 weeks both before and after surgery. You will need to stop taking any blood-thinning medications or alternative dietary supplements for at least 2 weeks prior to surgery.
Rhinoplasty is performed either as an outpatient surgery or in the hospital with overnight admission. It’s important to note that 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 often not noticeable. Nose job surgery usually takes between 1.5 and 2 hours, but can sometimes be longer, especially in cases where it is a revision rhinoplasty or more extensive work is carried out. 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.
After surgery:
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 post-surgery. Pain relief will be provided to make you comfortable, as your nose will feel blocked and breathing may seem arduous at first. However, most patients adapt to mouth breathing quickly. If you have been admitted overnight, you will be discharged in the morning.
You will be seen again in our clinic within a week. The skin of your nose will be partially numb owing to the open technique, but this often recovers 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 following 3 weeks. Careful management of the skin envelope helps to reduce swelling, especially in those with thick skin. Its important to remember that individual recovery varies between individuals. Postoperative photographs will be taken as part of your confidential medical records.
Although you can start walking immediately after discharge, reduced relative 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.
GET THE BEST QUALITY CARE AVAILABLE 
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.
Get in touch with either our Sydney or Canberra clinics today to enquire about making an initial consultation with our professional team of medical experts.
Frequently Asked Questions
Yes, rhinoplasty is intricate surgery, which deals with the nasal structures inside and out. General anaesthesia is the safest way to undertake this surgery.
Hardly, except for a small step external incision, which heals well. The rest of the incisions are inside the nose.
This can vary from patient to patient. The majority of bruising and swelling resolves within the first 7–14 days. Some of the nasal tip skin remains sensitive and often numb for a few months postoperatively.
All humans have some intrinsic asymmetry to their face and body, but in adequately trained hands noticeable persistent asymmetry following rhinoplasty is not uncommon. This is important in treating the nose because it is the central aesthetic unit of the face.
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.
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.
1. There are some general risks associated with ANY operation, which include:
a) Infection in surgical wound(s) with resultant redness, pain and possible discharge. In severe cases, wound(s) could break open and need to be resewn after washout and debridement.
b) Possible bleeding in surgical wound(s) with swelling or bruising. Occasionally, this will require secondary surgery for evacuation.
c) Secretions may accumulate in the lungs and cause a chest infection.
d) Deep vein thrombosis.
e) Death is possible during or after an operation following severe complications.
f) Smoking significantly increases the risk of complications. Therefore, you should completely stop smoking at least 4 weeks prior to surgery, and refrain from smoking for at least 4 weeks.
2. The following facts, risks and complications apply specifically to THIS operation:
a) Antibiotics are given during and after the operation, to minimise the risk of infection. If infection were to occur, it would be treated with the usual techniques.
b) Black eyes, stuffy nose, numbness of the nose, and swelling are expected for 2-6 weeks and occasionally may last longer.
c) Some swelling of the nose may persist for many months, particularly at the nasal tip. Whilst most swelling subsides in the first 9 – 12 months, in certain individuals it may persist for longer. In some cases, the injection of steroid may be required to expedite the reduction in swelling.
d) Postoperative pain varies from very mild discomfort to significant pain. You will be given pain- relieving medication following your surgery and this should keep you comfortable.
e) The nose may be stiff and tender for an indefinite period of time.
f) The nose often feels numb or has altered sensation after surgery, often subsiding over 12 months. However, this sensory change will be permanent to some extent.
g) No guarantee can be given in relation to size, shape or character of the nose following surgery.
h) Occasionally, additional surgery is necessary to correct minor irregularities.
i) The sense of smell may be impaired following surgery, and in rare cases lost or distorted permanently this will affect the sense of taste.
j) Breathing may occasionally be more difficult following this surgery. This may be a permanent or require secondary surgery.
k) Change in the voice quality may occur permanently as a result of this surgery.
l) Rarely skin may be damaged or lost as part of the trauma of the surgery and may leave a permanent mark on your nose and face.
m) Any operation on the nose and/or septum runs the risk of what is called a CSF leak as a resulting from leak of the fluid around the brain through the base of the skull and into the nose. It will require attention and a neurosurgical opinion and in some cases requires surgery. Any clear fluid discharge from the nose should be reported to your surgeon.
n) Operations on the nose which often involve fracturing the nasal bones may occasionally result in damage to the tear draining mechanism, resulting in clear discharge of tears from the nose. These are often self-limiting but you should inform your surgeon if you notice this.
o) If rib cartilage is need from your chest wall for your surgery, this will involve another incision on your chest. This is often about 5-7.5cm. The site may be visible and will result in a scar to any other surgery. Occasionally and especially in thin people, contour irregularities may persist as a result of the rib harvest. In rare cases harvesting of the rib may result in a hole to the lining of the lungs requiring extended hospital stay and possible insertion of a chest tube. Dr Farhadieh will discuss this at length with you if it’s part of your surgery.
p) There will be a scar associated with this procedure.
q) It is possible, though unusual, to experience a bleeding episode during or after surgery. Should postoperative bleeding occur, it may require emergency treatment to drain accumulated blood or a blood transfusion. The risk of increased bruising or bleeding can be reduced by abstaining from medications such as aspirin, anti-inflammatory drugs, or other blood thinning agents, for at least 2 weeks prior to surgery.
r) Septal perforations may occur as a result of this surgery.
s) Most patients will need to take at least 10 – 14 days off from work. Heavy lifting, vigorous exercise or any activity that increases blood pressure should be avoided for at least 4-6 weeks from surgery.
t) Minor asymmetries are a natural fact of life and irregularities may be seen and/or felt through the nasal skin as the nasal bones and cartilages realign postoperatively. This is a normal part of the healing process.
u) The final aesthetic outcome may not be to your satisfaction.
