Mr John Marshall - Consultant Otolaryngologist

Cosmetic Rhinoplasty

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Many people would like to improve the appearance of their nose. Common concerns include:

  • The nose is not completely straight. 

  • A bump on the bridge of the nose

  • A wish to alter the tip of the nose

  • Concern that the nose is too big.

This leads some people to consider an operation to improve the appearance. This operation is called rhinoplasty, cosmetic rhinoplasty, nose-reshaping or “nose-job”. These all have the same meaning, but the operation is tailored to address to the underlying problem.

As well as dissatisfaction with the appearance, there may be other problems with the nose such as blockage, congestion, facial pain, sinus problems and snoring. No two noses are the same.

In suitable cases, rhinoplasty is an excellent operation which can improve the appearance of your nose. It may help improve other problems at the same time.

Sometimes problems can be due to previous injury, but often this is not the case.

Rhinoplasty is not for everyone and sometimes a person’s wishes cannot be achieved in which case surgery is best avoided. Whilst this may be disappointing at the time, it is much better than undergoing surgery with unrealistic aims.

If you are considering rhinoplasty, I will be happy to see you for a consultation to discuss your concerns and aims. 
 

Assessment of the nose

 

During an unhurried pre-operative assessment a person’s concerns about their nose are discussed fully in a relaxed and confidential environment. The nose is examined and any problems are discussed. Examination includes an assessment of the inside of the nose including inspection of the nasal septum and turbinates.
Surgery is only considered if the aims of surgery are realistic and achievable. Often a second consultation is arranged to ensure that both surgeon and patient are happy with the aims of surgery and what will be involved.

Failure to take the internal nasal structure into account is one of the reasons for unsatisfactory outcomes in rhinoplasty. As an ENT surgeon specialising in rhinoplasty, I am fully trained to consider the external and internal factors that may affect rhinoplasty outcome. 


Searching the internet for information about rhinoplasty can be confusing and you may come across some words that aren’t fully explained. Here is a short glossary:


Rhinoplasty. Surgery in which the appearance of the nose is altered. Also called “nose-reshaping”, “cosmetic rhinoplasty” and “nose job”.

Septoplasty. An operation to straighten the nasal septum.

Nasal Septum. The vertical partition that divides the nose into two halves.

Columella. The bridge of skin that separates the nostrils.

Septo-rhinoplasty. A rhinoplasty which includes some adjustment to the nasal septum.

External rhinoplasty. (also called ‘Open Rhinoplasty’) Rhinoplasty involving a small incision at the base of the nose, often used for good access to the tip of the nose during surgery.

Tip-plasty. A rhinoplasty that focuses on the tip of the nose.

Turbinates. These are bony structures with a fleshy lining that we all have inside the nose. They help to warm and moisten the air we breathe in, but can cause nasal blockage if enlarged. They can be easily reduced in size if required during rhinoplasty surgery.

Revision rhinoplasty. Rhinoplasty performed in someone who has had one or more previous rhinoplasty operations or other nasal surgery. Such surgery is more challenging for a number of reasons but in selected cases can be effective. This is also sometimes called ‘secondary rhinoplasty’.

What happens when I have a rhinoplasty?

Once the decision to have a rhinoplasty procedure is made, a convenient date will be booked. You arrive usually two hours before the operation and will be given instructions about fasting before your admission.

The operation will be discussed again when you come into the hospital so that any last minute questions can be discussed. As with any operation, you will need to sign a consent form.

I perform rhinoplasty under general anaesthetic, administered by a consultant anaesthetist. This means you will be completely asleep. The operation can take from less than one hour to two hours or more, depending on the complexity.

You should be quite comfortable when you wake up as you will have been given painkillers and local anaesthetic injection whilst asleep. You will have an external dressing on the nose called a splint which usually stays on for about one week. You may have tiny stitches at the base of the nose (if required this will be discussed in advance).

Most people go home on the day of surgery, or stay in one night and go home the following morning. 

The nose may feel quite blocked immediately after the operation but this soon settles. It will be a little sore too and you will be given painkillers for the first few days. The tip of the nose can feel tender or slightly numb for a few weeks after surgery too.

You may have some minor bruising and swelling for 7-10 days after the operation, although I use techniques to minimise the amount of swelling that occurs.

You will have a follow up appointment at about one week for removal of the external dressing (and stitches if you have any).
I normally don’t place any packing or dressing inside the nose. If required I use dissolving dressings so that nothing needs to be removed from inside the nose.

Sometimes for more complex cases a cartilage graft from the ear is used. If this is required it will be discussed at your initial consultation. 

 
If you would like to arrange an appointment to discuss your symptoms further, please do so via using one of the available options on our contact us page