Rhinoplasty 'Nose reshaping' is a surgical procedure that can define, reshape and restructure the nose. It is one of the most popular facial cosmetic surgeries and is often referred to as a ‘nose job’.
Rhinoplasty can create a more symmetrical and proportional nose to complement the overall facial aesthetics of the patient but can also serve to correct breathing impairments and repair the effects of trauma, such as a broken nose.
A consultation will determine whether a nose reshaping is suitable for you. This will be based on a variety of factors; you will be asked about your general medical history. Questions will include focus on your general medical history and any previous nasal surgery or injury. If the nose reshaping you require is corrective surgery as a result of a previous Rhinoplasty it is important to wait at least 1 year before any further surgery is attempted. Enquiries will also be made as to your breathing patterns and whether you suffer with any nasal obstruction. Normally such issues can be addressed during the rhinoplasty. Mr. Karidis will then discuss with you why you are unhappy with the shape of your nose.
The most common request with a Rhinoplasty is to reduce the size and alter the shape of a large nose, but occasionally an increase in profile or projection is requested.
As with all cosmetic surgery there is a risk that the surgeon will not give you what you have in mind. Mr. Karidis greatly alleviates this risk by talking in depth with you about what you want out of your nose reshaping. If you don’t have a thought or a picture in your mind about how you would like the nose to be, then at the very least, tell him what it is you don’t like about your nose. This way he can try to explain to you what can or cannot be done. Remember Mr. Karidis will always complete a nose reshaping to what he feels is attractive and proportional in size and shape to the rest of your face. However your input is of vital importance also. Occasionally people like to bring in photographs, at the time of consultation, of a nose which they would like to have. This can give the surgeon a feel for the type of nose you may like to acquire. It is important to realise however, that every individual’s nose is different and so one cannot expect to have a very small, delicate nose made from, for example, one that has a large amount of thickened skin. If this is the case, Mr. Karidis will always try to make this clear to you.
A rhinoplasty operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required. If alar base reductions have been performed during the nose reshaping then the scars will be found tucked into the base of the nostrils within the natural skin fold. These are also generally well hidden by the natural shadow cast by the position of the nose. In complex tip surgery, you may require an external incision (open rhinoplasty) carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately. Through the incisions, once the skin is lifted off the nasal cartilage and bone, any bump on the bridge is removed with a delicate chisel to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) can be altered accordingly. Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. Sometimes this is done with internal stitches, other times a small segment of your own cartilage is used.
When the surgery is complete, small dissolvable stitches are used inside the nostrils and then foamy nasal packs are inserted. These packs are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. Indeed it is exceedingly rare for significant bleeding to occur following a Rhinoplasty. Finally a plaster cast is placed on the bridge and held in place by tape on the forehead and cheeks.
The bridge of the nose is usually protected after the operation by a plaster cast, held in place with tapes across your cheeks and forehead, and which is worn usually for about 7-10 days. During this time you should avoid blowing your nose, stooping, and any vigorous activity and for next three weeks afterwards. After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure (see postoperative instructions). However, rarely it is necessary for medical intervention to stop difficult bleeding.
Once you’re back in you room, you will notice that you will be propped up in bed with a couple of pillows in order to elevate your head. This is necessary to reduce the swelling around your nose. You may or may not have some bruising around the eyes. You will also notice that it will be difficult to breathe through your nose. This is because of the nasal packs. Understandably, most patients report that the packs are the most unpleasant part of the whole operation. This is not because they are painful, but because you are forced to breathe through your mouth until these are removed, the following morning. Of course you will automatically be breathing through your mouth- so don’t panic! The following morning the packs are removed and your breathing will be better, however there will still be significant congestion/swelling within the nose so do not expect to breathe perfectly from your nose. This of course will get better although it will take a number of weeks before it returns to 'normal'. Please also note that once the packs are removed you should expect to get some nasal bleeding in a drip like fashion. A small gauze bolster will be placed under the nose to catch these drips. You will find that within the next few days this will steadily become less until it stops.
When you return to your room after surgery you will be sat up in bed with pillows behind your head to help keep bruising and swelling to a minimum. Your nose may feel slightly blocked for the first 12 hours as a result of nasal packs sitting inside the nostrils to prevent bleeding. Stuffiness can continue for a couple of weeks upon removal of the packs due to some swelling in the nostrils. Although it is very unlikely that you will feel much pain, you will be provided with pain relief to ensure that you remain comfortable. You are likely to have a plaster cast fitted across the bridge of the nose, held in place by tape at the forehead and cheeks. This will remain in place for approximately 7 days following surgery and removed at the clinic.
During a nose reshaping it is common for the nasal bones to be broken and reset, as a result of this you should expect to have “black eyes” and some swelling of the face. This usually settles by about 2 weeks although as soon as the plaster cast is removed you may, in fact, apply light make up to mask this if you like. Also any congestion within the passages of the nose from surgery will settle in the first 3-4 weeks. During the initial weeks, and sometimes months, the nose tip usually feels numb. This invariably recovers as the nerve supply to the skin regenerates.
It is very important to realise that even once the plaster cast is removed from the bridge of the nose there will almost certainly be a significant degree of swelling still present. Therefore the shape of the nose at this stage is not the final one. Moreover, many times the nasal bridge looks quite narrow and slim immediately once the plaster is removed, but then subsequently swells up again due to normal healing process. This obvious swelling will however rapidly decrease in the ensuing 3-4 weeks and the nose will begin to settle. However, it is important to remember that even after this time, the shape of the nose is still not the final one. This is partly because of scar tissue which will form underneath the skin of the nose, as a result of the surgery, and which will have a subtle volume effect on the final shape giving rise to some fullness and width to the nose. These internal scars gradually change their shape (called scar maturation) and resolve in time. The process of scar maturation will take up to one year, sometimes longer, to complete and therefore only after this time is the final ultimate shape of your new nose apparent. As a simple guide in assessing the progress of your nose, you should gently squeeze the tip of a normal unoperated nose, and then your own to compare the firmness. The firmer it is the more time is required for it to settle.
A nose reshaping, or rhinoplasty is usually performed using a general anaesthetic, this frequently requires an overnight stay in hospital. A local anaesthetic can be used for more minor work such as narrowing of the nostrils. In the latter instance then this can be performed as a day case.
A rhinoplasty procedure takes approximately 1 hour to perform.
Remarkably enough, pain after a nose reshaping operation is not usually a problem. It is easily relieved by an injection in the first few hours and a mild painkiller such as paracetamol as necessary afterwards.
In most instances, all the incisions for a rhinoplasty, are placed well within the nostrils and therefore cannot be seen. However as mentioned already (see Operation), in some instances external scars may be needed to reduce the nostril size or to perform more complex nasal tip work. Although these scars are usually red and lumpy for the first few weeks, they do tend to settle in time. However, you must bear in mind that it is impossible to predict the final appearance of any scar.
All surgery carries some uncertainty and risk. When a rhinoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Infection, as in any operation can occur but is thankfully quiet uncommon. Occasionally though, a “Blind boil” type infection may occur on the skin of the nose. These can be quite uncomfortable and may take a week or so before they finally settle. Nosebleeds can also occur. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure (see postoperative instructions). However, rarely it is necessary for medical intervention to stop difficult bleeding. Irregularities of skin, bone or cartilage may occasionally appear following nose reshaping surgery. These may show up on the surface as slight depressions, dips of bumps. Although through conservative measures and time, most of these situations improve, additional surgery may occasionally be required for correction (2% incidence). Some degree of nasal obstruction may also ensue after the surgery. Usually this short-lived and is a result of a mild pre-existing nasal obstruction which may not have been noticed prior to the surgery, but became somewhat exacerbated following the surgery. In this situation, revision surgery to improve the situation is sometimes warranted. Thread or spider type veins can also sometimes appear on the skin of the nose following surgery. These are usually permanent although they can be treated effectively by laser. It is also quite possible that surgery on a badly deviated or bent nose may not result in a perfectly straight, well-aligned nose. Many reasons may be responsible for this but it is conceivable, in particularly difficult situations, that two or more procedures may be required to remedy these noses. You will be advised at the consultation what the likelihood of this occurrence will be with you.
In surgery there is never such a thing as a guaranty or warranty. There are many factors that can affect the outcome of any surgery and these are not always within the patients or surgeons control such as swelling, scar tissue, movement etc. Thankfully however despite these, 97-98% of Mr. Karidis’s patients are satisfied with the outcome of their surgery. There are however 2-3% of patients who may feel that the shape of the nose at the end of 9-12 months is not quite what was hoped for. This happens more frequently in noses that have been the subject of severe nasal injury or previous nasal surgery. In these situations further procedures may be necessary to achieve correction and of course all possible options will be discussed with you. When secondary (from a previous operation) or revision surgery is carried out however, a higher incidence of complications and a higher degree of uncertainty with respect to the final results may be expected.
The single most important factor in the success of this type of surgery is the surgeon you will be using. Although choosing a fully qualified and experienced Plastic surgeon will go some way towards ensuring a good result, you have to understand that in the end you are at the mercy of that surgeon’s sense of aesthetics. This is because he cannot wake you up half through the surgery to ask if you are happy with the result or whether he should do more! So how do you ascertain a surgeon’s sense of aesthetics? By seeing previous work that he has done-the more the better in fact! Mr. Karidis is very upfront with his and provides a large number of before and after photos of his previous patients who have agreed to have their photos used for this purpose. This way you get a sense of what that particular surgeon is striving for. If you happen to feel happy with the results of his previous work then at least that suggests that you both share the same sense of what desirable results should be. Of course do bear in mind that it’s important to understand that every result you see will be somewhat different and that your result will also be unique.
Mr. Karidis does not use computer imaging for his patients as he feels that this can be somewhat misleading. Although it is fairly straight forward to install the appropriate software on his computer and then come up with a projected image of your “new” nose, you have to understand that actually achieving this “nose” is not guaranteed. In fact the final result, most times deviates from these images. As a result Mr. Karidis feels this is misleading and does not want to offer this to his patients. Of course he will discuss in detail at the consultation what is that bothers you the most and how this could be improved- and will show you examples of his previous work to give you some understanding of things that can be achieved.
Most patients like to stay out of the public eye while their plaster cast is on. Once this is removed however, you will gradually start to resume your daily activities. This will largely depend on the amount of bruising and swelling you experience after the rhinoplasty surgery. Most bruising has dissipated by about 10-14 days, although there may be some slight residual bruising present. If you are a female, then this can usually be masked quite easily with makeup. Most people are back to work by about 10days. Although slight swelling may still be present at this time, it is not usually noticeable to the majority of people. By 3-4 weeks most people are back to their normal routine and are enjoying their new nose. You will however need to avoid any contact sports for 3 months, whilst the nasal bones heal completely.
As you will feel somewhat nasally for the first couple of weeks it is probably not a good idea to fly as you may find it difficult to equalise your ears with the change in cabin pressure. You can however consider flying from about 3 weeks onwards.
In accordance with the National Healthcare Commission guidelines, and according to the last five years of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis has performed on average 140 Rhinoplasty procedures per year. In the last 10 years he has performed over 1200 Rhinoplasty procedures.
Please ensure you notify medical staff of any heavy nose bleeds, pain, excessive swelling or a persistent high temperature (above 37.5 degrees for 12 hours or more). Most often there is nothing to be concerned about, however, it is always best to check!
Rhinoplasty is a plastic surgery procedure that aesthetically corrects, reconstructs, restores, and, or enhances the size or form of a nose; Often and typically referred to as ‘Nose Surgery’ or ‘Nose Job’.
Sometimes following a Rhinoplasty patients compliment their treatment with a HydraFacial to unclog congested pores or undergo a short course of laser treatment to help minimize any broken blood vessels on or around the nose.
A Rhinoplasty procedure can often correct unwanted bumps or reduce the overall size of the nose. It can also restore the aesthetics of the nose following trauma, injury or previous surgery. In order to achieve the best outcome, Mr. Karidis advises anyone hoping to have a corrective Rhinoplasty procedure to wait 1 year after any previous nose surgery.
It is important to bear in mind that the vast majority of procedures go according to plan. The chances are excellent that you’ll be happy with your surgery, especially if you acknowledge that the full results may not be immediately apparent. By changing the most prominent feature on their face into a more desirable shape, many patients gain a feeling of increased self-confidence, improvement in body image, and general well being.
You will be advised to sleep on your back with your head elevated until after the plaster cast is removed in order to minimise swelling to the tissues and keep the cast securely in place. You will be advised to avoid stooping, blowing your nose, having hot showers or doing any vigorous exercise for some weeks post surgery. This is in order to prevent heavy nose bleeds after surgery. You should not wear glasses across the bridge of the nose for a couple of weeks.
It is very common to have some bruising around the eyes for around 7 – 10 days. The use of arnica tablets is likely to improve this, however you may want to apply make up to the area to help camouflage the bruising in the meantime. It is important to remember that on removal of the cast, swelling to the bridge and/or tip of the nose may be present. Thus, it takes some time to see the final result of your surgery. Small refinements take place over the course of approximately one year so please do not panic if you feel ‘uneven’ initially. You may notice a numb sensation or tingly in / around the tip of the nose for some weeks post surgery. This will resolve as the swelling settles and is nothing to be concerned about.
After your operation you may feel a little drowsy from the anaesthetic and other medications. Therefore we strongly suggest that, if possible, you nominate a friend or family member to collect you. Alternatively, we can assist you in booking a cab whilst you are in hospital.
Yes and we look forward to seeing you at the clinic around 7 days after your surgery in order to remove the cast and check all is healing well. This is usually extremely exciting as it will be the first peek at your new nose! Providing all is well, you will usually see Mr. Karidis at around 4 weeks post operation for a routine check up. Further appointments can of course be made if necessary.
A surgeon fee, anesthetist fee and hospital fee will be required. You will be given a breakdown of these costs on the day of your consultation.
It is always useful to allow yourself plenty of time to recover and organise sufficient time off work as appropriate. 7 - 14 days off should give you sufficient time to allow any obvious bruising and swelling to subside. A little make up may be required at that point to cover any remaining bruising. Ensure any blood tests or other tests that are required are undertaken well in advance to avoid any potential delays.
Having described many of the possible effects from Rhinoplasty surgery it is important to bear in mind that the vast majority of procedures go according to plan. The chances are excellent that you'll be happy with your surgery, especially if you realise that the results may not be immediately apparent. By changing the most prominent feature on their face into a more desirable shape, many patients gain a feeling of increased self-confidence, improvement in body image, and general well-being.
SENIOR NURSE PRACTITIONER KAROLINA SAYS...
"Take your arnica regularly as recommended as this will help with any postoperative bruising."
SENIOR NURSE PRACTITIONER KAROLINA SAYS...
Take your arnica regularly as recommended as this will help with any postoperative bruising.
NURSE SUZI SAYS...
"A balanced healthy diet, rich in protein will help you heal from surgery - try drinking a fresh green juice every morning"
NURSE SUZI SAYS...
A balanced healthy diet, rich in protein will help you heal from surgery - try drinking a fresh green juice every morning
NURSE SUZI SAYS...
"Write down any questions and take them into your consultation with Mr Karidis – that way you won’t forget anything"
NURSE SUZI SAYS...
Write down any questions and take them into your consultation with Mr Karidis – that way you won’t forget anything
NURSE SUZI SAYS...
"Prepare your body for surgery by keeping it soft and supple by moisturising skin twice daily (avoid vitamin E containing products)"
NURSE SUZI SAYS...
Prepare your body for surgery by keeping it soft and supple by moisturising skin twice daily (avoid vitamin E containing products)
NURSE SUZI SAYS...
"Always wear sun block (SPF 50+) over surgery scars to stop pigmentation "
NURSE SUZI SAYS...
Always wear sun block (SPF 50+) over surgery scars to stop pigmentation
NURSE SUZI SAYS...
"Stock up on comfy lounge wear for after your surgery – front opening tops are ideal"
NURSE SUZI SAYS...
Stock up on comfy lounge wear for after your surgery – front opening tops are ideal