What Is Rhinoplasty?

Rhinoplasty, also known as a ‘’nose job’’ or ‘’nose reshaping surgery’’ is a surgery that changes the shape of your nose. There are three main reasons for someone to get a rhinoplasty. They include:¹

• Functional, for example, to improve respiratory function
• Reconstructive, to repair deformities you are born with or that you got (for example through an accident)
• Cosmetics, to change the aesthetic appearance of your nose

What are the risks?

All operations have associated risks. Some linked to rhinoplasty include:^2,3

• Breathing difficulties
• Altered sense of smell
• Scarring or skin discolouration
• Damage to your cartilage or a hole in your septum (septal perforation)
• Infections
• Heavy nosebleeds
• Dissatisfaction with results
• Requiring more surgeries

What are the side effects?

Again, like all surgeries, there are some temporary side effects that often occur after getting a rhinoplasty.² Some are:

• Light nosebleeds for some days after the operation
• Numbness and stiffness in your nose
• Having to breathe through your mouth for approximately a week
• Bruising around the eyes, swelling and soreness in your face

Anatomy of the nose

Before getting a rhinoplasty, it is important that you understand this is a complex procedure requiring medical and artistic skills due to the anatomy and the importance of your nose. The nose can be divided into two areas, the external and the internal area. The external nose is made of two main types of tissue, the cartilage, and the bone, which are covered by muscles, soft tissue, and your skin. On the other hand, the internal nose is comprised of the septum and turbinates, which are covered by mucosal tissue, similar to the tissue found in your mouth or your intestines. The septum is the structure that is located in the middle of the nasal cavity and divides your two nostrils, while the turbinates are bony outgrowths which allow the passage of air while filtering it and warming it.¹

It is important to note that these tissues vary dramatically between patients and therefore there’s no such thing as an ideal nose, or a nose you deem perfect on someone may not be possible in someone else. Additionally, a specific type of nose does not suit every patient as everyone has a different facial harmony and anatomy. It is advantageous to understand your nose anatomy, especially when discussing your operation with your doctor.

The Rhinoplasty Process

The preoperative assessment

If you’re considering getting a cosmetic rhinoplasty, the first thing you’ll do is to have an appointment with a surgeon. This is the first step of the procedure, known as the preoperative assessment, when your surgeon will ask you questions about your medical story, goals, and expectations. Sometimes your doctor will ask about your family and social relationships to understand you better and assess whether you are a suitable candidate for this procedure. After discussing what you dislike about your nose, your doctor will explain what can be done step by step. Then, you might be shown a computer-generated image to see what can be improved and the possible future appearance of your nose, to help you understand what to expect. It is important that you understand what can be achieved and what cannot be achieved as there is no such thing as a ‘perfect nose’ and your satisfaction after the surgery is important for a successful surgery.¹

If you’re considering a functional rhinoplasty, your doctor will do a general nose analysis to assess your ability to inhale air, looking at overgrowth in your turbinates or if your septum has any deviations. It is also important that you let your surgeon know anything relevant about your medical history, like the history of sinusitis, if you have sleep apnea, any condition affecting your mental health, or if you have taken drugs like cocaine or inhaled medications.

After the general assessment, your surgeon will ask to take photos of your nose prior to the operation. This is often done to help with operation planning but also for medico-legal reasons.¹

The surgical procedure

A rhinoplasty is generally done under general anaesthetic, which means you will be asleep to make sure you don’t move or feel pain when your rhinoplasty takes place. There are two main ways in which a rhinoplasty can be done, open or closed. During an open rhinoplasty, your surgeon will cut between the nostrils, whereas during a closed rhinoplasty, your surgeon will make small cuts inside your nostrils. Although the latter does not leave any visible scars, it is important to understand it is not always possible. Thus, depending on the type of surgery, your surgeon may:

• Remove some bone or cartilage to make your nose smaller
• Take cartilage from your ears or bone from your hips, skull, or elbow to add to your nose and make it larger
• Break the nose bone and rearrange the cartilage to reshape your nose

After the procedure is done, your skin will adapt to your nose and shrink or expand accordingly. The procedure can take between 1.5 and 3 hours, you may need to stay in the hospital for 1 or 2 nights, and you will have a dressing on your nose post-operation for 7 days.²

Recovery and Aftercare

It can take up to 1 year after the operation for your nose to fully recover. Swelling persists for about four to six weeks post operation and will start slowly decreasing after 3 months, but can take up to one year for it to go away completely. It is usually after one year that you’ll see the full results as your nose heals completely.³

To speed up the recovery process and minimise the risk of complications, it is pivotal that you actively take care of your nose. Some ways in which you can do this include:³

• Take over-the-counter drugs (painkillers) as advised by your doctor to reduce inflammation
• Apply cool compresses (not ice) on your face, especially your cheeks and under your eyes, but not directly on your nose
• Avoid any activity that can add pressure or damage your nose, like strenuous exercise, lifting heavy weights, blowing your nose, and wearing heavy glasses that can add pressure to your nose bridge
• Avoid sun exposure on your nose

Going back to your regular activities

You should be able to go back to school or work 1-2 weeks after the operation, but this can vary among patients.

Choosing a Surgeon

If you have a rhinoplasty in England, it is important that you check if their clinic is registered under the Care Quality Commission (CQC). All independent hospitals and clinics providing cosmetic surgery must be registered with the CQC.

It is also important to check your surgeon is registered with the General Medical Council (GMC), as they must have a license to practice. It is also important that you check the British Association of Aesthetic Plastic Surgeons (BAAPS) or the British Association of Plastic Reconstruction and Aesthetic Surgeons (BAPRAS) to see if your surgeon is included in this list (2).

It is also advisable that you read reviews, and testimonials and seek referrals from previous patients, as well as check for any disciplinary action against the surgeon.

When having your first appointment with the surgeon, it is important to ask them questions and express your specific goals and concerns. Assess how your surgeon communicates and ensure you feel comfortable with them. Trust your instincts during the consultation and make sure they understand your goals and concerns and set realistic goals. Don’t forget to ask about:²

• Their qualifications and experience
• The number of operations performed by them and the number where there’ve been complications
• What type of follow-up there is available if things go wrong
• Patient satisfaction rates

Cost and Insurance

Cosmetic rhinoplasty is rarely funded by the NHS. This means that you’ll have to fund it yourself or get help through medical insurance, as well as finding a private practice to perform it. In the UK, the surgery can vary from £2000 to £6000 pounds, although most cost between £3000 and £4000. The price depends on the complexity of the procedure, where you do it, and who your surgeon is. Nose reshaping surgery can also be done safely abroad at a starting cost of £1200, although travel and accommodation costs should be considered too.

The rhinoplasty cost should include all aspects of the operation, from hospital charges, operation equipment, fees, recovery, aftercare and follow-up consultations. However, it is important to find out what the price you are given actually covers to avoid any unexpected additional fees being added to your bill. Additionally, it is important to consider other things when getting a rhinoplasty aside from the cost of the procedure. Doing this with an experienced surgeon will be better than with an average surgeon with not much experience, as performing rhinoplasty is complex and requires both precision and artistic skill. Getting nose reshaping surgery with an experienced doctor may even save you money by reducing the chance of requiring additional surgeries to achieve your desired outcome.⁴

What to do if your surgeon decides you may not need a cosmetic rhinoplasty?

A rhinoplasty is a permanent change and therefore a significant decision to make, therefore requiring a considerable amount of time for self-reflection. Before asking to get the surgery, it is important to reconsider what truly bothers you about your nose and whether there are aspects you can learn to appreciate.

If you have decided you want a nose reshaping surgery, and your surgeon decides you don’t need it, it is important to understand that a surgeon will have a thorough understanding of the procedure, have seen many others like you and that they want the best for you. While rhinoplasty can address certain concerns, it is equally important to have realistic expectations, as the benefits you may obtain from the procedure may not outweigh your risks. However, it is completely reasonable to seek second opinions if you're uncertain. Consulting with another experienced surgeon might provide additional insights and help you make an informed decision. In addition, accepting yourself and your facial features is key for your mental and physical well-being. Everyone has unique beauty and individuality which makes us ourselves.

Summary

A rhinoplasty, also called a nose job, is a medical procedure that is done by a surgeon to change the shape of your nose. There are several reasons to which this is done, such as cosmetic, functional, and reconstructive. Like any other surgery, getting a rhinoplasty carries risks, such as an altered sense of smell, septal perforation, heavy nosebleeds, or patient’s unsatisfaction. The process can be summarised in three steps: the preoperative assessment when you have an appointment with your desired surgeon to understand your goals and associated risks, the surgery itself, and up to a year of recovery and aftercare before seeing full results. Because rhinoplasty is a very complex and expensive operation often not funded by the NHS, it is key that you find a fully licensed, experienced surgeon in a registered clinic that you can trust, and understand that the cost should not be the only factor to consider to achieve your desired outcome.