The Rhinoplasty Operation. Tel: 09 529 5783
Rhinoplasty is performed under general anaesthesia and may take from two hours to three or more for complex revision cases. The typical time for primary surgery is two hours. For many patients day surgery is appropriate but sometimes a single night stay in hospital is advisable. If you smoke you should stop at least one month prior to surgery as smoking increases your risk of complications. During surgery the nose is injected with long-acting local anaesthetic to reduce bleeding and to provide post-operative pain relief. The nose will be numb when you wake up.
Incisions are made within the inside of the nose and across the columella – the piece of skin between the nostrils. This is known as “open” Rhinoplasty and allows the greatest degree of control over the shape of the nose. Small two-millimetre incisions are placed on either side of the nose to allow the bones to be mobilised. These small incisions and the columella incision become near invisible over time.
Reducing a large nose involves removal of cartilage and bone from the bridge. The cartilage of the tip may be reduced in size or reshaped to refine a broad or bulbous tip. If there are breathing problems surgery will be performed within the nose to correct the airway. A crooked nose will require manoeuvres to straighten both the bony and cartilaginous skeleton. At the end of the procedure it is sometimes appropriate to reduce large nostrils by removing a wedge of tissue at the nostril base. A small nose may require augmentation with either grafts or an implant.
In the 1970s and 1980s on-lay cartilage grafts became popular to help define the nasal tip. Long-term follow-up has proven these grafts to be unsatisfactory as many became visible under the skin over time. Structural inlay grafts, however, remain an indispensible tool for the Rhinoplasty surgeon.
These grafts are usually harvested from the septum within the nose, but occasionally ear or even rib cartilage is preferred, particularly for difficult revision surgery. Appropriately placed and contoured, these grafts should not become visible and provide the vital structural integrity required to give predictable results. “Spreader” grafts and “Columella Strut” grafts are now routine. For a low bridge line finely diced cartilage wrapped in fascia forms an excellent natural “implant” for augmentation.
At the end of the procedure incisions are closed with fine dissolving sutures and a splint is applied. If there has been septal work splints and packing may be placed within the nose. The packing is removed at 24 hours and the splints at one week.
Rhinoplasty is usually not painful but some discomfort and stuffiness is to be expected. Tablet medication will be prescribed to control any discomfort. Bruising may develop under the eyes for one to two weeks afterwards. Some patients bruise very little, whereas others may bruise more. [ after surgery ... ]