This information sheet is intended to help you understand the operation and the aftercare that will be necessary to achieve best result possible.

What is a Rhinoplasty?

The nose is the central feature of the face. Many people are self-conscious of the size, which they may regard as too big or small. They may dislike the shape or some other feature. The characteristics of the nose are inherited from parents. Development is during the adolescent years and continues until the age of 18, when the nose stops growing. It is, therefore, unwise to operate before this age.

A Rhinoplasty or ''nose job'' is surgery to reshape the nose. This is a very common plastic surgery procedure and it can either increase or decrease the size of nose. The shape of the tip, the bridge and the nostrils can be changed as can the angle between the nose and the upper lip. Sometimes breathing difficulties can be corrected at the same time.

The operation is usually carried out under general anaesthetic.

An information leaflet is available which will provide you with the details you require regarding your anaesthetic (The Trust Information Leaflet ‘You and Your Anaesthetic’).

An operation called Reduction Rhinoplasty reduces the size of the nose. Think of the frame of the nose, as being like the roof of a house. In order to straighten the nose and bring the bridge closer to the face, cartilage is cut away. Then, to restore a new ''ridge'' or bridge-line, the two sides of the nose are bought together by cutting the bones of the nose where they join onto the cheekbones. This operation effectively narrows the width of the nose. If doing this makes the nostrils seem too wide, cutting out a small piece of skin can narrow them. It is also possible to shorten the nose and to slim down a bulky tip by reducing the amount of cartilage that shapes the end of the nose.

If you have some difficulty breathing through your nose, it may be possible to improve this at the same time. This is referred to as a Septoplasty. The proportions of the other features e.g. the chin and the cheekbones, influence sometimes the perception of the size of the nose. To create a balanced appearance it may be advisable to alter these features also, either at the same time as the rhinoplasty, or at a separate operation.

What are the limitations?

The object of the operation is to make your nose look right for you so that you become less self-conscious of it. It is therefore most important that you are clear in your mind what it is that you dislike about the appearance of your nose and that you are able to explain this to your surgeon.

The surgeon will then be able to tell you what is surgically possible and what is not. For instance, if the skin on the tip of your nose is thick and oily, it may not be possible to reduce its bulky appearance as much as you might like because, generally, it is not possible to thin the skin without leaving scars. If you are in middle age or if you have a very large nose, there may be a limit to the amount of reduction that can be achieved to the size of your nose. If your nose is bent from previous injury, it may not be possible to make it perfectly straight. Large nostrils can be difficult to reduce without cutting the skin and leaving noticeable scars.

• The scars from surgery are usually hidden from view inside the nostrils. In some procedures it may be necessary to make two small scars, one on either side of your nose, just below each eye. Occasionally it is necessary to make an incision inside your mouth.
• Each nostril is usually packed with a ribbon of gauze. This is done at the end of the surgery whilst you are still asleep. It is usually removed within the next two days depending upon the type of surgery.
• There is always some bruising and swelling, particularly around the eyes. This can take up to three weeks to disappear completely.
• You may need to wear a firm splint over your nose for a ten-day period.
• To start with, you will look different and not quite 'you' because of your altered nose. Remember that it takes a few days for your mind's eye to adjust itself to your new appearance and to recognise it as 'you'.
• It takes at least three months for all the swelling to settle, if there are any minor problems with the shape soon after the operation, do not worry, they will almost certainly improve with time.
• Your nose will also feel rather numb and stiff for several months, particularly around the tip.
• Occasionally, heavy nose bleeding either shortly afterwards or a week to 10 days complicates the operation post-operatively. This may require treatment in hospital. This can often be due to an infection.
• Breathing through the nose may be difficult after the operation. This should improve as the swelling settles. Occasionally, though, this difficulty persists and may be permanent.
• There have been reported cases of an alteration in the sense of smell following rhinoplasty surgery.
• Sometimes (in about 10% of patients) even after the swelling has settled, the nose does not look right for the patient. It is usually possible for the surgeon to carry out a second operation to improve the appearance, but this cannot be done until all swelling has settled from the first operation. Most surgeons wait for a year for this to happen.
• Sometimes irregularities can be felt beneath the skin over the nose. These may require a second operation if they are troublesome.

After the operation you will return to the ward. For most patients the length of stay is for 1-3 days after the operation. Any packs are removed and you are allowed home. You will be given an appointment to have the splint removed at approximately 10 days in a plastic surgery dressing clinic and another for review in an outpatient clinic to see a doctor in approximately three months.

The pain-killing tablets you will be given on discharge should control any discomfort.

For most patients this operation does not involve these complications and they are pleased with the results of surgery. This sheet is not a complete list of all the possible complications, but it is provided to act as an additional source of information, following your discussion about the operation.

If you require any further information or advice please contact:

Sister or Nurse in Charge Plastic Surgery Out Patient Department, RVI

Telephone:  (0191) 282 4228 (direct line) Monday – Friday 8am – 5pm, or

Sister or Nurse in Charge Ward 47, RVI

Telephone: (0191) 282 5647 (direct line) anytime