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Nose re-shaping (rhinoplasty)
Published by Bupa's health information team, June 2008.
This factsheet is for people who are planning to have their nose re-shaped, or who would like information about it.
Nose re-shaping operations can make the nose smaller (called reduction rhinoplasty), or make the nose larger or give it more bulk (called augmentation rhinoplasty).
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
The shape and size of your nose is genetically determined and is inherited from your parents. Your nose is generally fully developed by the age of 16.
Rhinoplasty can help change the size and shape of your nose. It may be done for cosmetic reasons or to restore the shape of your nose after an injury.
It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or give advice about how to choose which hospital to be treated in.
Before opting for rhinoplasty, discuss with your surgeon what you are hoping to gain from the operation and the result you can realistically expect. Clearly explain what you think is wrong and what you want changed and understand how your nose will look after the operation.
Preparing for your operation
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
You should ensure you are free from a cough, cold or sore throat at the time of your operation because this can increase the risk of an infection afterwards. If you have any concerns, contact your surgeon for advice.
The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the operation.
You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your surgeon will examine your nose and measure its shape and size. Your surgeon may take photographs, so that the results of surgery can be compared with your original appearance.
Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
About the operation
The operation takes 60 to 90 minutes.
Cuts are made inside your nostrils to reach the bone and cartilage. Some of the bone and cartilage is removed or re-arranged to achieve the shape you have agreed with your surgeon. The skin over your nose is left untouched and shrinks down to the new shape.
Sometimes a cut is made in the skin between the nostrils. This is called 'open rhinoplasty'.
To keep your features in proportion, it may be necessary to make your nostrils smaller. This is done by making cuts in the skin of the nostrils. This will leave fine scars on each side of your nostrils.
A cut is made inside or between your nostrils and the bone and cartilage is re-shaped. You may need extra bone or cartilage (a graft) to build up your nose. The cartilage may be taken from your ears. If bone is used, it may be taken from the back of your elbow, a rib, the skull or the hip bone. Sometimes artificial implants are used instead.
The cuts are closed with dissolvable stitches. You may also have small pieces of soft plastic inside your nose to prevent scar tissue from forming.
What to expect afterwards
You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will have dressings (packs) in each nostril for about a day, which will stop you from breathing through your nose. You may be asked to stay in hospital overnight, so that the packs can be removed in the morning.
You will have a splint over your nose to support it for seven to 10 days.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your nose and a date for a follow-up appointment before you go home.
Dissolvable stitches will disappear on their own in seven to ten days.
Recovering from rhinoplasty
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
You may have some minor nose bleeds for a few days. To reduce your risk of bleeding, keep your head up as much as possible and don't have a hot bath or drink alcohol for a week or two.
You will feel bunged up for a few days but don't use any nasal sprays or decongestants. You may find the pressure lessens at night if you sleep in an upright position on several pillows.
You will need to breathe through your mouth for the first few days. This can lead to dry lips so use petroleum jelly or lip balm on your lips to stop them cracking.
You shouldn't blow your nose for at least the first week. Your nose may drip, but you should only wipe it gently. If you need to sneeze, cough it out.
Stay away from crowded places for a week after your operation to reduce your risk of infection. Don't do any contact sports, such as rugby or football, for at least six weeks.
Please contact your GP or surgeon if you develop any of the following symptoms:
bleeding that doesn't stop within 10 to 15 minutes
inability to drink or swallow normally
Whilst there is no medical reason why you should stay away from work, you will probably feel more comfortable taking some time off and returning when the bruising has settled.
It will take several months before your nose settles into its new shape.
What are the risks?
Rhinoplasty is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.
Side-effects of rhinoplasty include:
soreness, swelling and bruising, particularly around your eyes - this can last up to a month
stiffness and numbness, particularly at the nose tip - numbness can last a few months but stiffness may be permanent
unable to breathe through your nose - this should ease as the swelling settles
scarring - you will have permanent scars on your hip or chest if you have bone taken from your rib or hip
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complication specific to rhinoplasty are uncommon but can include:
chest or nose infection - antibiotics can help treat infection
heavy nose bleed either shortly after the operation, or after a week to 10 days - this may require further hospital treatment
temporary loss or reduction in sensitivity to smell - this may become permanent
changes in the shape of the nose as scar tissue matures - this may require further surgery
damage to septum - this lies between your nostrils and may require further surgery
If you had an implant, it's possible it may push through the lining of your nose and need to be removed. This can happen months or years later, and is more likely if a large implant has been used or if the nose is accidentally injured.
It's possible that you may not be completely satisfied with your appearance after the operation.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
- British Association of Aesthetic Plastic Surgeons (BAAPS)
020 7405 2234
- The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)
020 7831 5161
Nose re-shaping Q&As
See our answers to common questions about nose re-shaping, including:
- Augmentation rhinoplasty. British Association of Aesthetic Plastic Surgeons (BAAPS). www.baaps.org.uk, accessed 8 May 2008
- Reduction rhinoplasty. British Association of Aesthetic Plastic Surgeons (BAAPS). www.baaps.org.uk, accessed 8 May 2008
- Cosmetic surgery to the nose - Rhinoplasty. The British Association of Otorhinolaryngologists ENT.UK. www.entuk.org, accessed 8 May 2008
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by cosmetic surgeon Anthony Attwood, MB BS, FRCS (Ed.), and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: June 2008.