Spotlight on: rhinoplasty

The nose is known as the axis of the face – a centrepiece around which all your features take anchor. Variations in the contour of the nose can have a strong but subtle effect on the entire facial appearance.

The decision to consider rhinoplasty – a ‘nose job’ – can be daunting. However, a carefully planned rhinoplasty performed by an experienced surgeon can produce an excellent functional and cosmetic improvement.

What’s involved?

Cosmetic nasal surgery starts with a thorough assessment. The surgeon will take a look at the shape of your nose, from front on, lateral, oblique and inferior views. The shape of your face and skin type is also important. General features such as age, sex, ethnicity and then height and body type also weigh in to the decision-making process. Even your occupation, posture and personality play roles in planning the best nasal contour for you.

Today, both open and closed techniques are widely used by surgeons, each having their own relative merits and disadvantages.

Although the end-goal is often the same – either to build-up (augment) or reduce the nose – the two techniques differ primarily in their access to the nasal structure. In open rhinoplasty, the surgeon will make a small incision between the nostrils, and go on to make a number of additional incisions inside the nose. Closed rhinoplasty, on the other hand, involves incisions made only to the interior of the nose.

Non-surgical techniques have also been adopted in order to correct minor irregularities in the nose, allowing suitable candidates to alter their appearance without having to undergo surgery. So is a perfect nose possible? Let’s look at each of the techniques in more detail.

Open rhinoplasty

During open rhinoplasty, an incision is made at the base of the columella – the tissue and skin that separate the nostrils at the base of the nose. The nasal skin is then carefully lifted back, allowing the surgeon to work on the cartilage and tissue inside the nose.

Because the inner cartilage network and underlying structure of the nose is exposed, the surgeon has greater visibility than with closed rhinoplasty, and is able to work on the inner structure of the nose with more precision and freedom. Open rhinoplasty is therefore often chosen for more complicated cases, where considerable work may be required in order to achieve the desired outcome.

The open technique, for example, can be helpful when performing cleft lip operations, or during revision rhinoplasty when an earlier procedure has left a nose pulled too high and structural grafts are required. In these scenarios, surgeons will tend to favour open rhinoplasty due to the extra visibility given by revealing the internal structure of the nose.

The open technique also helps ensure the basic foundation of the nasal structure is kept strong, facilitating a natural-looking outcome. It also leads to a more stable shape post-surgery, helping to safeguard against collapse.

Because an incision is made at the base of the columella, the open technique will leave a small scar on the underside of the nose. This will fade over time and, in most cases, become barely noticeable. The patient may also experience swelling, bruising and numbness for a more drawn out period of time than with the closed approach to rhinoplasty.

Closed rhinoplasty

Because all incisions are made inside the nostrils, the procedure does not result in visible scarring, and is considered less invasive than open rhinoplasty.

Whereas the open technique may be used to tackle complex cases, closed rhinoplasty is generally used to address minor defects. The operation is much quicker, typically taking between one and two hours – around half the time taken to perform closed rhinoplasty.

Given the minimally invasive approach, healing and recovery time is also less, as are swelling, bruising and numbness of the nasal tip post-surgery.

Often, the type of surgery selected will come down to the preference of the surgeon. Where some prefer open surgery because it unveils the underlying structure of the nose, others prefer the closed approach because it offers better ability to judge the final shape and contour of the nose. This is because there are no external incisions compromising the appearance of the nose.

The closed technique offers surgeons considerable freedom to reshape the nose. Bone and cartilage can both be removed using this technique or in some cases taken from other parts of the body and used to better shape and support the nose. However, despite offering plenty of scope to address minor modifications, the main disadvantage of the closed technique is its limited use. Although suitable for reshaping the contours of the nose, complex cases cannot be tackled as effectively with closed rhinoplasty.

Non-surgical rhinoplasty

Already known for their ability to ease the appearance of wrinkles, fillers are increasingly being used to refine facial contours. Indeed, nasal irregularities can be corrected using either temporary or long-lasting dermal fillers, allowing suitable patients to alter their appearance without the need for surgery.

Non-surgical rhinoplasty can correct minor external nasal deformities, depressions, asymmetries, collapsed nasal bridges and saddle noses. It can also be an effective technique for making corrections post-surgery where the results of earlier rhinoplasty have been unsatisfactory.

A relatively quick procedure, non-surgical rhinoplasty requires no anaesthesia and involves minimal downtime.

Most fillers will leave residual redness and slight tenderness for up to a few days and patients can expect slight swelling and bruising. Unlike closed and open rhinoplasty, the results are immediately evident.

Revision rhinoplasty

Considered one of the most difficult forms of cosmetic surgery to perform, revision rhinoplasty, or ‘secondary’ rhinoplasty, involves the correction of previous cosmetic procedures.

Despite the best efforts of any skilled surgeon, revision rhinoplasty is necessary in five to 12 percent of rhinoplasty cases. Whilst some may require only minor adjustments, others may need major modification, and may be a result of too much or too little bone, cartilage or tissue having been removed, resulting in a nose that is too large or too small for their face.

The techniques adopted for secondary rhinoplasty will vary from one patient to the next and according to the issues that need to be corrected. Implants or grafts may be needed to fill in dips and smooth the contours of the nose, or breathing difficulties caused by the initial rhinoplasty may need to be addressed.

Because the procedure takes place following an original surgery, the presence of scar tissue makes secondary rhinoplasty difficult. Because of this, it is usually recommended that patients requiring revision rhinoplasty wait at least one year from the date of their last nasal operation.