Thinking about nose surgery?

Are you unhappy with the shape or size of your nose? Or do you have difficulty breathing through your nose? Nose surgery (rhinoplasty) may be the answer.

Rhinoplasty improves the appearance and proportion of the nose to balance it with the other facial features. Nasal surgery can also correct impaired breathing caused by structural abnormalities. For the right individual, rhinoplasty can greatly improve appearance and self-esteem.

What are your options?

The approach used for nose surgery depends on many factors including the surgeon’s preferred technique, the patient’s specific needs and their desired outcome.

Rhinoplasty is the term for a number of operative techniques that can improve the aesthetic and functional properties of the nose. It is most commonly performed for nose augmentation (building up) or reduction (the most popular form).

There are two main rhinoplasty techniques – open and closed. Both of these techniques are widely used by qualified surgeons. There are advantages and disadvantages for each method, which have always been a reason for discussion among cosmetic surgeons.

The main difference between the approaches is where the incision is made to access the nasal structure. In open rhinoplasty, the surgeon makes a small incision between the nostrils and then makes additional incisions inside the nose. Closed rhinoplasty involves incisions only in the interior of the nose.

The technique used will depend on the goals and desired results of the patient, and will be decided after careful discussion with the surgeon.

Open rhinoplasty

Open rhinoplasty surgery involves making an incision at the base of the columella, which is the strip of tissue that separates the nostrils. Then the surgeon lifts the nasal skin carefully back in order to be able to work on the cartilage and other tissues inside the nose.

The main advantage of the open rhinoplasty technique is that the surgeon is able to see the inner cartilage network properly and work on the inner structures more precisely and freely. Therefore open rhinoplasty is often chosen for more complicated cases, when more work is required in order to achieve the desired result. This approach is also beneficial for revision rhinoplasty.

The open technique is helpful in complex cases, such as cleft lip operations or when a previous rhinoplasty has left a nose pulled too high and structural grafts are required to bring the nostrils down. In these scenarios, surgeons may prefer the open approach as it offers them greater visibility and access to the internal nasal structures.

Some patients’ fear after rhinoplasty surgery is that their nose will collapse or look artificial or ‘operated on’. The open technique may be more demanding on the surgeon, however it helps to ensure the basic foundation of the nasal structure is kept strong. In turn, this ensures a more predicable shape to the nose after surgery that will resist collapse and maintain a natural shape.

Because an additional incision on the columella is made during open nose surgery, the procedure leaves a small, barely noticeable scar on the underside of the nose. The patient may also experience swelling, bruising, and numbness for longer than if the closed approach is used.

Some surgeons feel that this process is less superior compared to a closed rhinoplasty because it decreases their ability to adequately judge how the nose will look after the procedure is done. This increases the risk to the patient as to whether they will get the exact look they wanted.

Closed rhinoplasty

Prior to the increased popularity of the external (open) approach in the last few decades, the terms rhinoplasty and closed rhinoplasty were almost synonymous.

During the closed rhinoplasty procedure, the incisions are made inside the nostrils. It is considered to be less invasive than the open technique and the main advantage of the closed rhinoplasty technique is that there is no visible scarring after surgery.

Since closed nose job surgery is generally performed to improve minor defects of the nose, the procedure takes less time to complete than the open technique. Usually, closed rhinoplasty may take from one to two hours, whereas open rhinoplasty may last up to four hours.

Healing and recovery time from the surgery is generally faster with closed rhinoplasty. Swelling and bruising can be less dramatic, and lasts shorter when the closed technique is used. Less numbness of the tip of the nose can also be expected.

The main disadvantage of closed rhinoplasty is its limited use. It is best for people who only require minor modifications. For example, a small hump can be corrected, but the patient should be satisfied with other characteristics of the nose.

While it may not offer quite as much freedom to the surgeon, closed rhinoplasty still allows plenty of reshaping possibilities. Bone and cartilage can be removed or, in some cases, taken from another part of the patient’s body and added in for better shape or support.

Revision rhinoplasty

Surgery is not an exact science and results cannot always be anticipated. Despite the best efforts of a skilful surgeon, complications may still occur. Rhinoplasty can be a challenging procedure and the nose can change after surgery in ways that cannot be predicted.

Revision rhinoplasty, which is also referred to as secondary rhinoplasty, is a form of cosmetic surgery that involves making corrections to previous cosmetic procedures. It is necessary for approximately five to 12 percent of those who undergo rhinoplasty, with some only requiring minor changes and others requiring major modifications.

Revision rhinoplasty is considered to be one of the most difficult forms of cosmetic surgery to perform because it requires correcting mistakes while facing the same obstacles that lead to undesirable results after the first surgery.

There are many reasons patients may require revision rhinoplasty. Some may feel that too much bone, cartilage and tissue was removed, resulting in a nose that is too small for their face. In other cases, patients may find the surgery did not remove enough tissue.

The exact procedure will vary from one patient to the next, as the issues that need to be corrected will vary with each individual. If dips were created in the nose, for example, the surgeon may need to use implants or grafts to fill in the dips and to smooth out the contour of the nose. If breathing problems developed from the original rhinoplasty, the surgeon will need to address this issue as well. Alternatively, the surgeon may need to correct areas of skin that are too thin or too thick, which may involve adding skin grafts or removing scar tissue.

Regardless of the procedure that needs to be performed, the task of performing a revision rhinoplasty is more difficult than the original procedure because of the development of scar tissue. In order to successfully complete the procedure, the surgeon needs to separate the bone and the cartilage, which is more difficult to do when scar tissue has developed. Therefore, the procedure becomes increasingly more difficult when the amount of scar tissue from previous surgeries is increased.

Although there are risks involved with revision rhinoplasty, (similar to the risks of the initial procedure) it is a necessary step to repair a nose that looks unnatural or that is causing breathing difficulties.

It is generally advised that patients requiring revision rhinoplasty should wait at least one year from the date of their last nasal operation. As the procedure is more complicated than original rhinoplasty, patients should choose a surgeon who has extensive experience in revisions.

Ethnic rhinoplasty

Ethnic rhinoplasty is a term used to describe rhinoplasty procedures performed on non-Caucasians. Among rhinoplasty surgeons, ideal nasal proportions have historically been based on Caucasian white females and many non-Caucasian individuals have adopted Westernised standards when considering rhinoplasty. However, the standards of beauty vary across cultures and are increasingly being defined by more multicultural standards.

The aim of ethnic rhinoplasty is to create a balanced aesthetic outcome that preserves the patient’s ethnic identity. As with all nose surgery, each case is individual and the surgeon should consider the patient’s other facial features to achieve balance and harmony.

Ethnic rhinoplasty can help those who have and dislike certain features, including the wide, flat bridge and the ‘hump’ in the ridge of the nose, that are common in some cultures.

The demand for cosmetic rhinoplasty within ethnic populations has risen dramatically in the last two decades. Evidence of this trend was provided by a survey conducted by the American Academy of Facial Plastic Surgery, which revealed that African Americans and Hispanics were more likely to seek rhinoplasty than any other facial cosmetic procedure.

It is typical for people of all races to want a change of appearance in their nose. Most people, regardless of nationality, want a symmetrical, pleasing nose that suits their face, skin type and personality.

Some ethnicities have nasal characteristics that are unique to each race. Asian people tend to have a flat nasal bridge (dorsum) and the tip is often rounded and the nose quite broad. People of African descent have noses with wider bases and less sharply defined tips. These people, as well as many Hispanics, also have thicker skin on the tip of the nose, giving it a rounded, bulbous appearance.

Patients with a ‘Roman’ or ‘Grecian’ nose typically want to straighten a bump on their nose and/or refine a bulbous or droopy tip.

There is no generic ethnic rhinoplasty, however, there are some surgical approaches to different nose types – often categorised by ethnicity – that may be broadly applied. For example, one relatively common goal of the Caucasian rhinoplasty is to decrease the overall nasal size in the pursuit of an aesthetic ideal. This may be accomplished by reduction of the dorsal hump or trimming of the lower lateral cartilages.

With a subtle approach, the nose can be corrected without diminishing the cultural background of the patient.

As Mediterranean faces usually have fuller features and thicker skin, the nose should be surgically refined without creating a very fine tip, which would not suit the other features. It is similar for Asian patients, who commonly desire a more narrow nose. It should not be narrowed excessively as a tiny tip will look unnatural on an Asian face.

It is interesting to note there has been an increase in the demand for non-surgical rhinoplasty by Asian patients, most commonly to build up the bridge of the nose. Many have turned to dermal fillers, as they offer subtle, natural-looking results which will not detract from their ethnicity.

Whatever the patient’s race or gender, the goal of rhinoplasty is usually the same: to change the nose to give the face a better sense of balance and symmetry.

Non-surgical rhinoplasty

A relatively recent breakthrough in the cosmetic industry is non-surgical rhinoplasty. Irregularities can be corrected using dermal fillers (either temporary or long-lasting), which allows patients to change their appearance without having to undergo surgery.

This relatively quick procedure requires no anaesthesia and offers minimal downtime. Most fillers will leave residual redness and slight tenderness for a few hours to days, slight swelling and occasional bruising, however the results of injectable rhinoplasty are typically immediate.

Candidates for this procedure are typically those with minor external nasal deformities, depressions, asymmetries or who have a collapsed nasal bridge or saddle nose. It can also be effective for post-surgical rhinoplasty corrections where the result has been less than satisfactory.

Other applications for non-surgical rhinoplasty are bridge augmentation, correction of a hump on the dorsum of the nose, making the nose rounder if the bridge is squarish or beaky in shape, and rounding and shaping of the nasal tip. The tip of a drooping nose can also be lifted by 1 or 2mm by injecting the filler at the base of the nose so that it forces the tip up.

For people who have realistic expectations of what can be achieved without surgery, non-surgical rhinoplasty using cosmetic injectables can offer an effective option in achieving a harmonious and aesthetically pleasing result.