Rhinoplasty Q&A

We asked three of our leading cosmetic surgeons all about rhinoplasty. Find out everything you need to know about common rhinoplasty techniques, how long it takes to recover and more.

Why do you think rhinoplasty is such a popular cosmetic procedure

Mr Alwyn D'Souza - Consultant Otolaryngologist
No other feature affects our look quite as much as the nose. A long, wide, or big nose can dominate the face, whilst a crooked or humped nose can overshadow pleasing facial features. The tip may be boxy, bulbous with flaring nostrils eclipsing natural facial beauty.

If the nose is not in harmony with the rest of the face or does not work well, it can be altered surgically with excellent outcome, if the surgery is carried out appropriately, by an experienced surgeon employing modern rhinoplasty techniques.  People of all ages are looking for such improvements, and the answer is within everyone’s reach, hence why rhinoplasty has become such a common, popular procedure.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
Nose surgery is very popular as it is better understood by everyone. There is also better awareness via the media and internet on how to find a good surgeon and what questions to ask. People also no longer feel that nose surgery is only for celebrities or for the well off.

The goal of nose reshaping or rhinoplasty is to improve the nose aesthetically (without creating a "surgical" look) in order to create harmony with other facial features. It can make a significant contribution to increasing one’s confidence and this is another reason why it has become so popular.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
As a cosmetic surgery procedure, nose reshaping has followed the general trend of an increased public awareness and interest in surgery that can enhance appearance. Media attention to celebrity cases has added to this increasing popularity. At the same time, rhinoplasty techniques have evolved to allow for more predictable and reliable outcomes, lending greater public confidence in the procedure. Finally, to an extent greater than many other cosmetic interventions, the results can quite dramatically improve facial appearance.

What should a patient consider before undergoing rhinoplasty?

Mr Alwyn D'Souza - Consultant Otolaryngologist
The three main considerations are: motives for considering surgery, the surgeon’s skills and the reputation of the hospital.

Self-motivation, personal desire and general good health to undergo surgery are essential. You should consider surgery because ‘you’ want it, and not to please others. You should have a clear and realistic goal of desired outcome. External pressures (surgeon’s team, friends and peers) should not influence your decision. Independent research using good quality, educational (not marketing) websites is essential.

It is important to have an experienced, skilled and compassionate surgeon who specialises specifically in rhinoplasty surgery, including surgery on the nasal septum and turbinates. Finally you should be able see your before and would be after results, produced using morphing software at consultation.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
The most important thing is the surgeon. Nose surgery is the most complex operation in plastic surgery. It involves the bones, cartilages and skin of the face as well as a focus on making it look natural rather than a "fake" look. It requires a surgeon with great experience and skill. I often have to correct nose surgery that was performed elsewhere or abroad where it is cheaper.

Anyone who is concerned about their nose should research on the internet and see a specialist nose surgeon. Rhinoplasty is one of the most complicated operations in plastic surgery as it requires great experience and specialist training.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
The nose occupies a pre-eminent, central, and focal position as a facial feature, and any decision to alter it must not be taken lightly. The benefits must be viewed against the risks- and these can be substantially reduced by a careful choice of surgeon. Rhinoplasty surgery is a subspecialty in its own right, and requires a special expertise if an acceptable and reliable outcome is to be delivered. Patients should therefore choose their surgeon only after thorough research. They should feel mentally prepared for the surgery, should be prepared to accept the complications that may arise, and should harbour realistic expectations regarding their outcome.

What is involved in the procedure? What are the most common techniques used?

Mr Alwyn D'Souza - Consultant Otolaryngologist
The growth in skill and training and as well as technology available today has resulted in two basic techniques:

  1. The open rhinoplasty technique
  2. The closed rhinoplasty technique

The technique employed depends on, the surgeons training and the desired outcome. Open rhinoplasty involves a cut in the midline partition of the nose called the columella and the rest of the incisions are inside the nose. The main advantage of open rhinoplasty technique is excellent exposure of the nasal tip as well as the rest of the nose. This gives the surgeon complete control over the procedure, particularly tip modification and reconstructing the nasal valve etc.

Closed rhinoplasty is where all the cuts are made inside the nose. This is a procedure where a combination of "see and feel" plays an important part. It is almost like doing an operation through a keyhole. Generally speaking all UK surgeons are trained in closed technique, whilst fewer are trained in open technique.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
Nose surgery is usually done with the patient asleep, although small changes can be undertaken under local anaesthetic or with fillers injections. I use keyhole surgery to avoid scars under the nose which is called "closed rhinoplasty". This requires more experience as most surgeons use the "open" technique which unfortunately gives you a scar under the nose.

Closed rhinoplasty incisions are made inside the nose in this way where they are invisible and scar free. To reduce the bump on the nose, certain amounts of bone and cartilage are removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), septal surgery, called septoplasty, is also performed. The incision is placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are closed with fine sutures, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
There are many delicate surgical steps involved, each chosen to alter each anatomical element as the situation demands. Most commonly, a nasal hump is removed and a tip lifted or refined, by both removal of the excess bone and cartilage, and the recreation of a stable nasal architecture by direct repositioning and suturing. Commonly, the nasal bones need controlled fracturing. The surgery may involve more complex manoeuvres, such as nose straightening if a deviation is present, or septal correction if there is an obstruction to breathing. Not infrequently, cartilage grafts are required to build an aesthetically pleasing framework, and these may need to be taken from the septum, the ear, or in more complex cases, the ribs.

What is the recovery like? How much time should a patient take off from work?

Mr Alwyn D'Souza - Consultant Otolaryngologist
Recovery from rhinoplasty is generally not cumbersome. Immediately after surgery a protective hard cast is placed on the nose, and is removed in 7-10 days. Some surgeons use a pack to reduce bleeding in the first 24 hours. As the anaesthetic wears off, it is important to note that most patients report little or no pain, and any discomfort is easily controlled with mild pain medication. Nose will feel blocked, with possibly a dry mouth, because of mouth breathing. You may have some bruising, but not every rhinoplasty patient gets bruising. This settles in 7-10 days. It is worth noting that the nose will look swollen, in particular in the tip area for a few weeks to months after surgery and the end result is evident approximately at the end of 12 months.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
Recovery takes two weeks. My patients go home the same day after surgery with a tape on the nose. They can walk around fine but may get bruising and swelling even after the tape is removed after seven days. Many people go back to work after just one week using make up to cover any bruises. You can exercise after 2-4 weeks.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
The usual down time is two weeks, as there may be some bruising in the area around the eyes. Recovery is normally rapid, with little pain or discomfort. It is usually necessary for a splint to be worn over the bridge of the nose, for a week after the operation. Very occasionally nasal plugs are required for a similar period, if there has been a significant nasal deviation, and septal splinting is required. It must be appreciated that nasal swelling, albeit subtle, may persist for many weeks or even months after the operation, and the final outcome may take some months to be fully appreciated. In most circumstances, however, one's appearance should look relatively normal after two to three weeks.

What are the main potential risks associated with rhinoplasty?

Mr Alwyn D'Souza - Consultant Otolaryngologist
The potential risks of rhinoplasty and complications can be divided into anaesthetic risks and surgical risks. Common risks and complications include, but are not limited to: bleeding, infection, pain, changes in skin colour, poor scars, prolonged swelling, constriction of nasal airways, blocked nose, dry lips and mouth and uneven nostrils as well as cosmetic dissatisfaction. Depression and insomnia may also cause concern. All these settle quickly after surgery.

The risks can be minimised by detailed pre-operative consultation and choosing the appropriate surgical team, understanding the limitation of rhinoplasty, not smoking and reducing alcohol, adopting a healthy lifestyle, as well as following the surgeon’s instructions carefully. Help from friends and family also ensures a positive outcome.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
The main risk is an unnatural look. Some surgeons remove too much from the nose and this leaves it looking strange or a ski-jump. The other risk is not getting exactly what you wanted as the surgeon didn't actually understand what you were after. You will need a surgeon with experience and good reviews online to deliver a good outcome.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
The greatest risk is dissatisfaction with the outcome- something that can be greatly reduced by a detailed professional consultation. The consultant should attempt to depict, as clearly as possible, the agreed and desired surgical goal, such that both patient and surgeon share a common and realistic objective. Asymmetries and deviations can quite reasonably occur and have to be accepted as possibilities, especially if revisional work is performed. Also in revisions, damage to the overlying skin is a dreaded consequence. Other standard surgical complications such as infection and bleeding are relatively uncommon. The personal impact of nasal aesthetic surgery should remain in perspective- any patient who relies too heavily on the outcome bringing them happiness is at risk for serious and damaging psychological consequences.

Based on your experience, what do you think are the primary benefits of having a "nose job"?

Mr Alwyn D'Souza - Consultant Otolaryngologist
In my view, a rhinoplasty when performed well, should result in an un-operated natural looking nose that primarily offers the following benefits:

  1. Improves nasal airway, thus optimising nasal function
  2. Improves aesthetics of the nose, thus enhancing facial beauty
  3. Combination of the above with improved quality of life and social interaction

All these of course have a positive impact on our personal and social life.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
It can change your life. In the same way we think nothing of correcting buck teeth or big ears, a large nose can have a devastating effect on confidence - both socially and at work. Correcting a big nose, removing a bump or a round ball-like end of the nose can transform your confidence and success in life. My patients tend to smile more after surgery and often come out of their shell. Some have surgery before a wedding when they finally feel it’s time to deal with this issue that has bothered them for years.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
A successful rhinoplasty can be a life changing event - lending greater confidence and, with that, social success. It fundamentally enhances facial aesthetics in an enduring manner, largely unaffected by facial ageing. Nasal disfigurements such as deviations after accidental fracture can carry a social stigma, which a surgical correction might remove. Female patients, after nasal reduction of a hooked or overly large nose, feel that they look more feminine. After correction of a drooping tip, they may feel less "witch"-like. Fundamentally, an attractive nose creates an essential central focal point for an aesthetically pleasing face.

What are some of your career highlights to date?

Mr Alwyn D'Souza - Consultant Otolaryngologist
My foremost reason for spending years of my life in training, both in ENT/Head and Neck surgery as well as Facial Plastic - Reconstructive Surgery is simply the passion for ‘reconstructing faces’. The greatest day in my professional life so far has been when a patient of mine said to me “Mr D’Souza, thank you for giving me my nose back”. In a nutshell this patient had lost over half of her nose to skin cancer affecting the nose. After completely removing all the cancer I reconstructed the nose, using, her own rib, and skin from the forehead, resulting in a natural looking aesthetic nose that she had in before she was affected with cancer. I have authored textbook chapters, teach and lecture at courses and seminars both nationally and internationally. I am also a member of several educational committees in this field.

Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
I was fortunate enough to go to Malawi to operate on patients who had no medical care and very basic facilities. This led me to a lifelong commitment to MSF who do such great work for patients in vulnerable regions of the world - I ran the Paris Marathon to raise funds for MSF.

I have been awarded membership of the American Society of Plastic Surgeons (ASPS). I was elected to the council of the British Rhinoplasty Society. I was featured an issue of Tatler magazine as the leading UK plastic surgeon for nose correction.

Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
There is enormous satisfaction to be had from a "nose- job" well done - and from contributing in a very meaningful way to the enhancing of an individual's life experience! I have been fortunate to have been involved in many such transformations over the years. Experience, and the adoption of new techniques, has allowed me to continually mould and enhance my personal skill set in the pursuance of perfection. After all, nasal aesthetic surgery is, in many ways, the ultimate endeavour for the compulsive perfectionist.

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