RHINOPLASTY

INTRODUCTION

The cosmetic reduction of a large nose is a delicate and complex operation performed under general anaesthesia and requires an overnight stay in hospital. Each nose is different and therefore the operation needs to be tailored to your individual needs. You must consider the exact features of your nose that are of concern so that each can be altered. Accurate and precise details must be discussed before surgery and clearly understood by both patient and surgeon. Characteristics such as nose height, length, width, profile, tip and nostril shape can, within certain limits, be altered. Remember that the nose must fit the face.

Photographs will be taken of your nose before the operation as part of the clinical record. These photographs remain confidential and are kept securely.

The hospital holds a pre-assessment clinic (PAC) which is run by the nursing staff. You will be invited to attend one of these clinics a week or two before the operation. They are intended as a medical screen to identify problems and carry out any necessary tests before the day of your surgery. Sometimes it will be arranged for you to see the anaesthetist at this clinic.

OPERATION

Surgery is performed under general anaesthesia and requires an over night stay in hospital. The procedure is carried out through incisions just inside the nostrils and inside the upper lip just above the gum adjacent to the canine teeth. The nasal skin is not cut. The nose, made up of bone in its upper half and cartilage (gristle) in its lower half, is made smaller and then the covering skin will shrink to fit this reduced frame. Thick skin does not shrink as well as thin skin.

Imagine the frame of the nose as a house roof. If the ridge is removed the roof becomes open. By collapsing the sides of the roof the two sides can then be brought together which lowers and narrows the ridge. Refinement to the tip, reduction in length and improvement in the angle between upper lip and nose can all be performed if necessary.

At the end of the operation stitches will be placed inside the nostril but not the mouth, adhesive tape will cover the nose and a Plaster of Paris splint will be strapped to the nose and forehead. A pack (dressing) will be placed in each nostril, partially blocking the air passage and a soft absorbent dressing will be taped over the nostrils to collect any blood or fluid. Strong pain killers will be given by injection to cover the first few hours after surgery. Thereafter paracetomol or a similar mild analgesic will usually be enough to control the pain.

Before leaving hospital you will be given an outpatient appointment but if you have any problems, worries or concerns after discharge from hospital please feel free to telephone for advice. I can generally be contacted on 07850 484 672 but if I cannot be reached immediately a message can be left on my office answerphone (0208 463 0019) and I will get back to you as soon as possible.

Your GP will be given full details of your surgery and progress.

AFTERCARE

On the day after surgery packs will be removed from each nostril. This procedure can sting a little and even cause a little bleeding. Breathing through the nose should then become easier although internal swelling may block the nose for a few days like a cold. After removal of the packs you will be able to go home. Usually by this time you will have two swollen black eyes.

Try to avoid blowing the nose until the splint is removed. Clear the nose by sniffing instead. Slight bleeding and discharge from the nose is best gently wiped away with a tissue.

The Plaster of Paris splint needs to stay on for about a week. Removal of the splint and adhesive tape can be a little uncomfortable but is generally a great relief when completed. The nose at this stage is swollen and will remain so for a couple of weeks.

Numbness may be present on the nose and in the upper lip. This usually settles down but it can persist for months and in rare cases may be permanent. Sensation can alter in the nostrils, which might give you problems when you have a runny nose.

It is sometimes necessary to carry out revision surgery.

COMPLICATIONS

No operation on the human body is without risk. A few of the more common problems are listed below. This list is intended to inform rather than frighten and it does not cover everything that can go wrong.
1. Anaesthesia. The small risk of an anaesthetic applies as in any operation. Smoking increases this risk and can cause coughing at the end of surgery which may lead to bleeding.
2. Sensation. The upper lip and sometimes the nasal skin can be numb after surgery. This usually settles down in a few days but can last for several months and rarely it is permanent.
3. Swelling. Obvious swelling lasts for up to three weeks after surgery but the skin remains stiff and thickened for six months. This will hide fine details of the nasal features for a while but is not generally noticed by other people.
4. Black eyes. This generally settles over ten to fourteen days.
5. Blocked nose. Similar to a cold and will settle after a few days. Although in rare cases it can persist or even become permanent.
6. Nose bleeds. Occasionally heavy bleeds occur which can require hospitalisation.
7. Infection. Rarely is infection a problem but spread must be halted by early antibiotic treatment.
8. Asymmetry. A minor difference between the two sides is often present before surgery and can remain after the operation.
9. Result. In some cases the result achieved is not the same as you expected. This can be for a number of reasons. Often there is a communication problem. It is important that you state your wishes clearly and understand the limitations of the procedure as explained before surgery. Revisional surgery is required in approximately 10% of cases.

08/03/05