Rhinoplasty and Rhinoseptoplasty

Introduction

Rhinoplasty is a cosmetic procedure to sculpt the nose for aesthetic or emotional benefit. Rhinoplasty can be combined with surgery to correct a deviated septum (otherwise referred to as Rhinoseptoplasty.) Surgery is carried out for cosmetic and psychological purposes, as well as for functional issues related to improve breathing through the nose. Nose reshaping surgery can be performed in conjunction with a number of other procedures and minimally invasive treatments, such as chin surgery, lip enhancement and cheek enhancement to refresh the whole face and balance facial proportions (known as ‘Profiloplasty’.) It is also used in reconstructive surgery to reconstruct the nose after trauma or tumour resection.

Below we answer the questions that are posed to us most frequently during pre-operative consultations for Rhinoplasty.
 

What is Rhinoplasty?

Nose surgery is a highly individual procedure, and techniques vary. Plastic surgeons specialised in this complex procedure are highly-skilled at applying both the aesthetic and functional elements.
 

What is the aim of Rhinoplasty?

The nose is a central part of the face, in terms of position and visibility but also symbolically. Surgery performed to improve the appearance of the nose is known as cosmetic rhinoplasty. This procedure is used to achieve balanced natural-looking results, which help improve body image and self-esteem. Rhinoplasty may also be used to correct various aspects of the nose. Surgery can reduce the size of a bulbous nasal tip; smooth the bump in the bridge of the nose; reduce nostril size; narrow a nose that is too wide, and modify a prominent nose.
 

What is the aim of Functional Rhinoplasty?

The nose holds a central role, also in this case, since it is the first organ of the respiratory system. Functional rhinoplasty is used to correct defects that obstruct nasal airflow, such as a deviated septum or enlarged nasal turbinates.
 

Who is an ideal candidate for Cosmetic Rhinoplasty?

Not all patients are suitable for nose reshaping. This choice must be evaluated carefully during post-operative consultations to establish that the limitations of rhinoplasty can satisfy the patient’s requirements. Taking time to establish a positive relationship with the surgeon, and understanding surgical goals and limitations are vital factors for rhinoplasty patients and anyone who undergoes cosmetic surgery to achieve the best possible result. For this reason, we always carry out more than one consultation to plan treatment before surgery.
 

What are the basic surgical incision techniques for Rhinoplasty?

Typically, there are two different placements for the incision sites: inside the nostrils (closed rhinoplasty) or a V-shaped, external incision at the columella, on the narrow strip of tissue between the nostrils (open rhinoplasty). The main advantage of the open incision approach is that it allows complete access for extensive reshaping which cannot be achieved with closed rhinoplasty, given the barely noticeable resulting scars.
 

What type of anaesthesia does Rhinoplasty require?

Depending on the patient’s level of discomfort, a general anaesthetic is usually the best option for rhinoplasty. Other types of anaesthesia, such as a local anaesthetic with intravenous sedation, can be considered after consultation with the anaesthetist.
 

How painful is surgery?

In our experience, recovery after surgery is rarely painful if adequate anaesthesia and pain medication are administered. Most patients experience a moderately comfortable recovery period and may return to work after one or two weeks, providing that they avoid all strenuous activities. Besides general anaesthesia, a local anaesthetic may also be used to ease discomfort after surgery so that the procedure is less distressing. Patients often state that the packing placed inside the nostrils is uncomfortable, but not painful. Typically, the dressings are removed the day after surgery before the patient is discharged, quickly resolving any difficulties breathing through the nose.
 

What can rhinoplasty patients expect during the recovery period?

Patients receive a discharge form with a list of instructions to follow, regarding oral medication and post-operative conduct. This information supplements the pre-operative advice issued during the consultations and shall be reissued when the patient is discharged. It is common practice for us to contact patients daily during the first week after surgery to evaluate health status and closely monitor psychological well-being. The external stitches are removed five days after surgery (internal stitches are non-removable).
 

A splint may be fitted to the nose to maintain the shape, which should be worn for approximately one week.

Follow-up appointments in the week following surgery depend on post-operative healing. The patient should attend check-ups: after one month, after three months, and then annual appointments as appropriate. Patients may resume normal activities relatively quickly, and swelling significantly subsides within a month. However, it is normal to have slight residual swelling for up to a year after surgery.
 

What is Functional Rhinoplasty (Septoplasty or Rhinoseptoplasty)?

The primary goal of functional rhinoplasty is to optimise the airway function. Obstruction of this area is often seen in nasal turbinate hypertrophy, deviated septum, or nasal valve collapse and other issues related to nasal function. Incision placement is the same as open or closed incision rhinoplasty with similar advantages and disadvantages. Primarily, functional rhinoplasty addresses nasal function with techniques such as septoplasty with septum resection, nasal cauterisation, and other related conditions. Post-operative healing is similar to cosmetic rhinoplasty.
 

Can Cosmetic Rhinoplasty be performed with Functional Rhinoplasty?

In most cases, both procedures can be performed in the same operating session.

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What is Reconstructive Rhinoplasty?

Reconstructive rhinoplasty is used to reconstruct partial, subtotal and total tumour or trauma resection. A multitude of techniques can be applied depending on the reasons for surgery. Extensive consultation with the surgeon is essential to define and decide on the most suitable and innovative technique to apply.
 

What is ‘ethnic nose reshaping’?

A so-called ‘ethnic nose’ is a typical feature that can be attributed to a particular race or ethnic culture. Similar issues may be seen in this type of nose, such as weakened or stretched cartilage, a short or flat bone, thick skin and enlarged nostrils. These ethnic groups have a specific set of characteristics of the nose, which can be modified with cartilage plication or tissue grafts to increase the support and definition often lacking.
 

What is Secondary Rhinoplasty?

Revision surgery is used to correct and improve disappointing results of previous surgery. Patients should not consider secondary surgery for at least 12 months after primary rhinoplasty. Revision surgery can be used to treat minor defects, such as asymmetry and small dents or for complete revision. Frequently, non-invasive treatments can treat minor imperfections with hyaluronic acid dermal fillers (non-surgical rhinoplasty).
 

What is Profiloplasty?

Rhinoplasty can be performed in conjunction with other procedures to harmonise facial features (known as profiloplasty). These cases require a detailed evaluation of the nose, chin, mouth and cheek proportions. There is a wide range of techniques designed to improve the aesthetics and contours of these areas. Typically, these procedures are performed over one or more operating sessions. Generally, nose surgery is combined with genioplasty or mentoplasty (chin surgery). Hyaluronic acid fillers or fat grafting can enhance lips. Depending on the patient’s goals, a variety of minimally invasive techniques such as cheek implants, fat grafting and hyaluronic acid filers, can lift and improve cheek contour.