Rhinoplasty literally means re-shaping the nose. Rhinoseptoplasty means re-shaping the nose and straightening the internal nasal septum so as to improve the nasal airway. Most people consider having rhinoplasty for months before they actually ask for a referral. Rhinoplasty is performed for crooked noses following injury. At times there is no history of trauma. The person may dislike the hump or just feel that their nose is too large.
Before surgery you need to ensure Dr Dunlop and you both agree on the areas to be addressed eg. the hump or tip or both. Photographs will be taken pre-operatively. Please make sure you do not take any Nurofen or Aspirin products in the two weeks preceding surgery as this will lead to bleeding and bruising. If you have a cold within one week prior to surgery you should re-schedule the operation.
The surgery is performed whilst you are under general anaesthesia. Incisions are internal and all stitches dissolve naturally. However, Dr Dunlop will decide sometimes to perform an external rhinoplasty which is when a cut is made at the base of the nose to increase exposure. In this case nylon stitches will need to be removed. When you wake up there will be a plaster over the nose. Packing is only put in the nose if there is bleeding. However if you have had a septoplasty, splints will remain in your nose for five days. These splints hold the new septum straight as it heals. Usually there is cotton gauze underneath the nose. The nurses will change this every few hours.
After the surgery bleeding and bruising can be minimized by sleeping head up at 45 degrees i.e. 2 pillows for the first night and placing ice over the eyes for the first twenty-four hours (e.g. a bag of frozen peas). Your nose may feel blocked for the first two weeks because of the internal swelling. NO NOSE BLOWING! This may start bleeding.
However, a small amount of blood stained ooze is normal for up to 1 week. Postnasal discharge is increased for up to 6 weeks. Use saline nasal spray six times a day to rinse away the crusts. You will also be given antibiotics to prevent infection. The nose may feel heavy and tight but there is rarely severe pain. If severe pain occurs, contact Dr Dunlop.
Your plaster will be removed after 5-7 days. Please keep it on. The nose is usually still swollen but after two weeks most of the swelling and bruising has settled and you will be able to return to work.
Full healing of the bones takes six weeks and therefore you should not use glasses or sunglasses for three weeks. After that, gradually re-introduce them for short periods only initially (twenty minutes on/off). To avoid inadvertent trauma to your nose while the bones are setting, do not allow small children or dogs to bump your nose. Similarly, no contact sports for 6 weeks.
The healing of the soft tissues of the nose is very dynamic. Subtle changes occur mainly over the eighteen months but even up to several years. You will need periodic review with Dr Dunlop.
Lastly complications of rhinoplasty are few. Most procedures are straight forward. Possible complications include:
Over the first six months as the tissue heals and contracts, you will be able to feel irregularities in the bony framework of the nose. If these are visible a small operation may be required to trim these areas. Ten percent of people have a second operation for this reason or for asymmetries. The cost of a second procedure including time off work is undertaken by the person undergoing surgery. Surgery is an imperfect science. Both the patient and the doctor must have realistic expectations. Improvements can be made, but perfection cannot be achieved. The aim of rhinoplasty is to achieve a nose which enhances the face. Subtle changes are better than dramatic changes. But remember 90% of people need only the one operation.