Rhinoplasty: Motives, procedure, and results

What is it?

Every year, half a million people who are interested in improving the appearance of their noses seek consultation with facial plastic surgeons. Some are unhappy with the noses they were born with, and some with the way aging has changed their nose. For others, an injury may have distorted the nose and a large number of patients seeking rhinoplasty have some form of breathing problem. Unlike most other operations, rhinoplasty is an operation that changes the form and function of an important anatomical feature. Form describes the shape of the nose and functional refers to how the internal workings of the nose are used to keep the airway open. However, simply nasal airway surgery concentrates only on the function part and it is vertical and lateral incisions either inside or outside the nose. The form part of the operation can be done any time after the nasal dorsum becomes stable and that is usually about the age of sixteen or seventeen. Airway surgery can also be done at the same time or after the cosmetic operation. Also it is open to all age groups, from the very young to the very old. An understanding of what the nose looks like is very important, but so too is the understanding of how the nose functions and how the nasal airway is regulated. Rhinoplasty specifically seeks to change indiscriminately an anatomical form or a nasal function or trying to combine both together. The last two sentences are not logical. But some surgeons claim to create a certain nasal shape without any regard to function. And this type of operation will alter the normal valve mechanism and affect the respiratory mechanism of your nose which in turn can lead to chronic nasal obstruction. Every function in the body is under neurological regulation and a constantly patent airway is required to allow a balance, controlled airflow. Rhinoplasty especially choosing an experienced surgeon is undeniably more fulfilling for the patient receiving the operation.

Why do people get one?

There are a number of different reasons why a person might seek a nose job. Everyone has a unique face and nose, and for some people their nose may simply be out of proportion with the rest of their facial features. In other cases, there may be a visible bump on the bridge of the nose, the end might droop down or it might be particularly wide. It’s often the case that people dislike their nose as it’s the centre point of their face and one of the first things that people see when they look at them. Although the way a person looks may not seem that important, especially when considering cosmetic surgery, for those who have a good nose job, the results can often help to improve their confidence overall. Modern rhinoplasties can make changes to the size and shape of a nose seem much more balanced, as before insisting that a patient needs to take a psychological evaluation before having a nose job, the patient can be reassured that the changes made will be subtle but beneficial. Rhinoplasty can do a lot to change the way a person looks, and this flexibility is why it’s such a popular form of cosmetic surgery all around the world. For example, as well as making a nose smaller in general, a surgeon can alter the dimensions of the nostrils, the angle between the nose and the upper lip or even the shape of the nose tip. With such a range of potential outcomes, it’s clear to see why so many people are drawn to seeking a nose job as a way of boosting their self-esteem and getting their confidence back.

Who can get one?

Nasal surgery, and beauty surgery as a complete, is not for every person. We will need to attention on who should no longer have it, and then we will suppose about who should have it. Specifically, sufferers under the age of fifteen or 16 have to no longer have rhinoplasty, until there is a extreme hassle and the nasal shape is inflicting breathing infection. This is due to the fact in advance than this age the nasal bones are however growing. There is no higher age restrict for rhinoplasty, if any man or woman is in fantastic health. However, older humans have to be cautious due to the fact the pores and skin turns into an expanding range of much less elastic as we age, and older human beings may also moreover take longer to heal than youthful ones. Fixes for nostril trauma can be undertaken as rapidly due to the fact the nasal bones have stopped growing, typically spherical age sixteen for girls and age eighteen for boys. Fixes required for respiration problems can be undertaken at any age. Rhinoplasty can be incredibly traumatic and there are dangers associated with surgery. All human beings thinking about surgical treatment due to the truth they are deeply sad about the form or dimension of their nostril should first communicate to an expert in intellectual health. Rhinoplasty is clearly now not for these people.

Risks to consider

In addition, any procedure carries possible risks. It’s best to be aware of these and have an honest and open discussion with your surgeon about what you can do to minimize your risks. For rhinoplasty, general risks include an infection or a reaction to the anaesthetic. More specific risks include permanent difficulty breathing through your nose, unsatisfactory cosmetic result, too much of your nose being taken away, burst blood vessels or blood clots that appear as a red or lumpy area on the skin of your nose, scarring and changes to skin sensation: the tip of your nose or the front two upper teeth may be numb in the short term and permanent in rare cases but is considered to be very unlikely. Post-operative risk: Be aware that the nose changes shape over time and it cannot be guaranteed that your rhinoplasty result won’t change as you get older. ‘Cartilage warping’ with some shape change and twisting can occasionally occur many years later.

Preparation

Patients preparing for rhinoplasty will be given a complete list of preparation guidelines. These guidelines can typically include taking certain vitamins and medication, like ibuprofen, for example. Patients may also be asked to stop smoking for a period before and after the surgery, as smoking can increase the risk of infection. For people who smoke regularly, this period can be difficult, but it’s for the best long-term outcome of the surgery. Another important preparation step to consider is that patients will require time off work to recover from the procedure. This can vary greatly from person to person, with some patients only needing a few days off work and others requiring up to a couple of weeks. However, this can be a very important factor to consider when deciding whether to go through with the surgery, especially for people who have very much sedentary lifestyles. Rhinoplasty is usually performed as either a closed procedure, where incisions are hidden inside the nose, or an open procedure, where incisions are made across the narrow strip of tissue that separates the nostrils. I had so many bugbears with my nose but I am over the moon with my results. The whole process was very straight forward and Mr Kazzazi made me feel at ease with everything from my very first consultation. He is very professional and explained the procedure from start to finish. He gave me a lot of docs to read before deciding if I wanted to go ahead with my op which I found very helpful. I am so glad that I had the procedure! I am much more confident now and I don’t have anything to worry about, all thanks to Mr Kazzazi. He is a very skilled surgeon and I would totally recommend him. He has changed my life and I can’t thank him enough. At London Rhinoplasty our reviews can be verified through a number of platforms including Google and Trustpilot. I have never used fillers before and I can see that fillers in right hands would be amazing but that dr made me yelling when he injected the fillers into my chin. It was really painful and the dr was drip feeding the area so lot of unnecessary pain. And that wasn’t cheap; for 0.7 ml he charged £250. I will go to Lithuania to do it because it is done by doctor, not by any one who fancy take that money. Thanks so much for this article. Great timing! I was about to book an appointment with a surgeon to chat about a rhinoplasty! And now I realise the importance of checking as many potential surgeons as possible. And again, thanks OP for taking the time to outline all the additional costs too. This is just what I needed.

Procedure

In a closed rhinoplasty, incisions are made within the nose, whereas in an open rhinoplasty the incisions are made across the tissue between the nostrils. After making any necessary incisions, the surgeon gently raises the soft tissues covering the nose and begins to sculpt the inner bone and cartilage to create the desired shape. The nature of this sculpting will depend on your individual needs and the goals of the surgery. If the patient has a deviated septum, the surgeons will straighten the septum and reduce any projections inside the nose so that breathing is not obstructed by the procedure. What follows after the bone and cartilage has been sculpted depends on the desires of the patient and the decision between an open or closed rhinoplasty. With a closed surgery, the skin and tissue is redraped over the structure and the incisions are closed. With an open surgery however, the nose will be repositioned to allow for visualization of the internal structures. The surgeon and the patient will have previously discussed what shape the nose will take and so at this stage, the surgeon will make the necessary adjustments to meet the wishes.

Anesthesia

Once the patient is in the operation theater, he will be administered with either a local or a general anesthesia. Local anesthesia is the best option for patients who are carrying out minor surgeries. The patient will remain fully conscious and will respond to the surgical instructions. Rhinoplasty is considered a minor operation and local anesthesia is used in many cases. General anesthesia is preferred when large amount of work is being carried out, or in revision surgery which can take a long time. The patient will remain unconscious throughout the surgery. It may be necessary for the patient to stay in hospital overnight if the operation has been performed under general anesthesia. The length of the surgery will depend on the patient and the work being carried out, but typically it can last from between 60 minutes to 90 minutes. After the anesthesia has been administered and the patient has been prepared for surgery, in the first instance the surgeon will elevate the skin of the nose from the supporting framework of bone and cartilage. He will then perform the necessary contouring before placing the skin back over the new framework.will make the necessary adjustments to meet the wishes.

The incision

Unlike many other surgical procedures, a rhinoplasty is performed inside the nose, so you’ll have no visible scarring on the skin of your face. The surgeon can gain access to the cartilage and bones that support the nose from inside your nostrils. To do this, the soft tissues covering the nose need to be carefully lifted. These tissues, called the nasal mucosa, are gently pushed aside. Just enough bone and cartilage to allow for the desired change is removed or rearranged. If the size of your nose is to be reduced, the septum (the partition in the middle of the nose) can be altered to make this possible. At the end of the operation, the skin is put back, and dissolvable stitches are used to hold the mucosa in place. These stitches do not need to be removed. If the surgeon’s aim is to increase the size of your nose, perhaps because it is crooked, it may be necessary to take some cartilage from your ears to provide support for the nose. If there is a small hump on the bridge of your nose, this is often removed through a cut made inside the nose. The bones that are found either side of the nose and close to the corners of the eyes can then be repositioned to make the nose narrower. This would also involve fracturing these bones. When the bones are broken as part of the procedure, visible bruising can occur and it is sometimes necessary to make small cuts next to the nostrils. This type of incision, often referred to as « open rhinoplasty », leaves a small scar, but this is usually barely visible. Such cuts are usually made on the side of the nose that is being worked on, so they can be difficult to see. The surgeon will discuss with you before the operation what type of rhinoplasty is most suitable for you, and what the possible risks and benefits of the procedure might be.

Reshaping the nose

The first step in reshaping the nose involves gaining access to the structure of the nose itself. Roughly 2cm of skin is raised off the cartilage and bone of the nose. This approach is made through what is technically known as an ‘open approach’. The manoeuvre itself is to create a series of intercartilaginous incisions to the area of the nose where the surgery is to be performed. This is done on the underside of the nose in what is technically known as the ‘columella’. The columella is the small narrow strip of skin that separates the nostrils and from this position the surgeon is able to have a full geometric view of the nasal architecture in order to reshape the nose in rhinoplasty. The nasal skin is then carefully raised and supports to the nose i.e. septal cartilage and the nose’s valve area can be seen. By performing this step first, when the nose is being reshaped, experience rhinoplasty surgeons such as Mr Julian Rowe-Jones, a Consultant Rhinologist is able to visualise the changes to the nasal structure. The incisions made in the skin of the nose in order to carry out rhinoplasty can be seen in the figure on the left. Rhinoplasty is different essentially every time it is done. Each nose has its own unique set of structural relationships and each patient has their own unique ideas and concerns about their nose. The true art of rhinoplasty therefore is to be able to understand what is possible with a given nasal architecture, and to create the type of nose that the patient has in mind.

Closing the incision

Next, the incisions are closed and a splint is applied. Incisions are closed with sutures and skin adhesives or surgical tape are used to close the incision on the columella. The splint immobilizes the nose and protects it from being bumped, and it holds the shape of the nose as it heals. If you’ve had any work done on your nasal tip or nostrils, a small pack may be placed in the nostrils and bandages or splints are used to support the outside of the nose while healing. By supporting and stabilizing the structures of the nose, the splint helps bones and cartilage to heal in the correct position. Each surgeon has their own way of closing incisions, whether that’s with stitches or dissolvable sutures, and their own way of applying a splint. But the goal is always the same: to protect the nose from trauma and to ensure it heals in the right shape.

Results

Internally, the nose can be reshaped in many different ways. Different areas of cartilage can be removed or altered making it possible to change virtually any aspect of a patient’s nose. Typically, techniques which preserve the natural support of the nose such as « cartilage-sparing » sutures and cartilage weakening are preferred. This is critical in maintaining long-term stability of the shape of the nose. Thanks to advances in technology, I am now able to simulate possible results using « Morphing » software. This software allows me to upload a patient’s 3D image of their face and alter the shape of the nose on the computer. Using this tool, I can demonstrate the potential results of a rhinoplasty to patients visualising how different changes to the tip, dorsum or base might look on their own faces. However, it is important to remember that there are some limitations. Firstly, it is impossible to predict with absolute certainty the results of any operation. Skin thickness, nasal strength, airway function and the healing process can all affect the final result. Secondly, testing the limits of the skin’s ‘shrink-wrap’ effect can have negative consequences (especially in patients with thick nasal skin). When the bony and/or cartilaginous support framework is over-reduced, it can result in an overly pinched, diminutive and unattractive appearance. In short, it is important not to underestimate the difficulties in visualising nose shape and in achieving a balanced and proportionate outcome.

Cost

Well, so how much cost should you expect for a good rhinoplasty surgery? Just like the rhinoplasty surgery itself vary greatly, so do the costs. Costs of a rhinoplasty may vary considerably depending on the type of the surgery (whether it is a reduction surgery that is meant to reduce the size of the nose or a cosmetic nose surgery that is meant to give a new shape to the nose), the country and the area in that country where the surgery is carried out, the surgeon performing the surgery, any extra charges in the process, whether it’s a primary or a revision rhinoplasty, any tests and medication that may be needed for the surgery, where the surgery will be performed and any special after care that may be necessary. In the United Kingdom, the prices of rhinoplasty may vary depending on the specific hospital’s location and reputation, anesthetist’s fee, surgeon’s fee and any after care that may be required. However, you can obtain a rough estimate for the UK surgery by considering the following; an average cost falls between €3,250 and €5,560 while a correction of a deviated septum and a nose straightening may cost between €2,000 and €5,000. A simple investigation for a rhinoplasty cost revealed that the typical fee for a surgeon is around €4,000 to €4,500 and that private hospitals may charge a fee of around €2,500 for the hospital charge and €1,500 for the bed. Also, tests and medication may be necessary and they may roughly cost between €150 and €275. On the other hand, in the United States, the USA national average of surgeon fee is about $4,545 but this may also vary from state to state. However if you have a good health cover and meet all the requirements, your insurer may be able to cover the surgery. Also, there are basically two types of rhinoplasty; (i) functional rhinoplasty that is meant to correct nasal obstruction and (ii) cosmetic rhinoplasty that is meant to change the physical appearance of the nose. Well in connection to the information discussed above, coserv.com reveals that functional rhinoplasty cost in the USA may range between $3,000 and $5,000. However, a rough guide for a cosmetic rhinoplasty suggests that the total cost for the surgery typically ranges between $5,000 and $10,000 as of 2011. For the reason that the USA is a big place with 50 states with varying cost of living, the anesthetist’s fee, and the experience of the surgeon as well, the cost of a rhinoplasty may vary from place to place. Ergo, knowing what you need and understanding your requirements may assist in obtaining better results while having a reasonable cost too.

Choosing a plastic surgeon

The plastic surgeon you choose will be a major key to the success of your rhinoplasty – both in the outcome as well as the process. You should give careful consideration to who will actually perform the surgery. First and foremost, only consider a plastic surgeon who is certified by the American Board of Plastic Surgery. This is a highly rigorous process that includes a degree from an accredited medical school, a minimum of 5 years of surgical residency under the supervision of other certified surgeons, a further 2 years of professional practice, and successful completion of comprehensive written and oral exams. In addition to the general areas of surgery and facial surgery, the surgeon should have specific experience with plastic surgery to the nose. Some of the most reputable certification to look out for in this regard include certification in Head and Neck Surgery and certification in Facial Plastic and Reconstructive Surgery. Beyond the technical beard certifications, it is always worth investigating how much experience the surgeon you are considering has had with rhinoplasty surgeries specifically. Be sure to ask any potential surgeons about their history with the procedure; most will be more than willing to share their past successes and client testimonials. It is absolutely crucial to schedule a face-to-face consultation with any potential plastic surgeon prior to agreeing to let them perform your rhinoplasty. Check to see if they offer any free consultation as part of the selection process. Be sure to come prepared with a full list of questions to ask the surgeon. This can include questions about their experience as outlined above or more general questions about their aesthetic approach to rhinoplasty and their opinion on what they consider a successful outcome. The surgeon’s answers to these questions as well as your own self-confidence in them and their practice can be invaluable in making the final decision of who will perform your rhinoplasty. And remember that cost should not be the top influence when deciding who to go with for your surgery. A less experienced or less reputable surgeon may offer cut-price or discounted surgeries as a means of attracting more patients. However, the line of ‘you get what you pay for’ is a very relevant and important factor when considering your surgery. Surgeons who are established and successful in their field are so for a reason – never risk your health, your appearance, and your self-confidence by putting cost as the overriding factor in your decision. With a bit of careful research, it is perfectly possible to find a plastic surgeon who is suited and experienced enough to feel like the perfect match for your individual rhinoplasty needs. And you will reap the rewards of this selection process in the quality of the results you can look forward to.

Frequently asked questions

Is it painful?

Pain is a tricky notion. Many things help us understand what patients will experience after rhinoplasty in terms of pain. During our initial consultation the topic of post-operative pain is something I discuss. I find that many patients have concerns in relation to this. There’s also a range of literally pain-reliefs that have been researched in the post-operative period. Studies on pain after rhinoplasty show that younger patients experience higher levels of pain after surgery. Also, people who are having difficulty at the office actually reported less pain than those who are not working at all or working from home. Theoretically, you might suggest that if things are going worse at work, there’s less pain felt after rhinoplasty. Certain patients often report mental symptoms in addition to pain, such as anxiety, depression or fatigue. These may or may not occur with a patient at a given time however all have been reported in the literature. Also, certain conditions or issues that might have caused the patient to have surgery in the first place – such as a deviated septum or large turbinates – might have been investigated or operated on. This is because the robustness can be created. The robustness of a psychological factor is often determines by examining how well it’s been measured, how well its been defined and used in research in different ways and how well it’s been replicated or supported by similar (independent) findings. When a patient tells us that he or she feels ‘less pain than others’, it’s likely that means they have lower levels of pain than the normal post-surgical pain. However, the term ‘normal’ post-surgical pain itself encompasses a wide range of findings and a lot of studies, which focuses on measuring the efficacy of pain relievers in the post-operative period, have shown that pain is reduced when we give a form of pain relief. This can include drugs, local anesthesia agents, compression or irrigation devices, or even measures that change the way the brain experiences pain, such as virtual reality equipment. So, in short, pain and pain-relief after rhinoplasty can be quite a complex issue and its definitely something that should be addressed during consultation.

How is it different from a septoplasty?

It’s a good question to ask. A septoplasty is a procedure that’s carried out to correct a deviated septum. The septum is the part of the nose that separates the nostrils. It’s made up of a piece of bone at the back and a piece of cartilage at the front. When this is bent or off-centre, it can cause difficulty with breathing. A septoplasty won’t change the way you look. It may sometimes be combined with a rhinoplasty if the appearance of the nose is also a problem. A cosmetic rhinoplasty, however, is an operation that’s carried out to change the appearance of the nose. It involves making small cuts inside the nostrils. This means there won’t be any visible scars. The skin covering the nose is then lifted up, so the surgeon can see the bone and cartilage underneath. Depending on the result you’re looking for, parts of the bone and cartilage may be removed or tissue may be added, either from another part of the body or using a synthetic material. Then the skin is put back, and stitches and a splint are put in place to help the nose keep its new shape while it heals. I think it’s important to understand the difference between a cosmetic rhinoplasty and a septoplasty, so that patients have a good idea of what to expect when they’re thinking about these operations. A rhinoplasty, however, is an operation that’s carried out to change the appearance of the nose. It involves making small cuts inside the nostrils. This means there won’t be any visible scars. The skin covering the nose is then lifted up, so the surgeon can see the bone and cartilage underneath. Depending on the result you’re looking for, parts of the bone and cartilage may be removed or tissue may be added, either from another part of the body or using a synthetic material. Then the skin is put back, and stitches and a splint are put in place to help the nose keep its new shape while it heals.