Surgery to the nose may be desired because the nose has been injured and is difficult to breathe through properly or is simply misshapen as a result. The natural shape of the nose may be obviously misshapen as a result of a congenital abnormality such as cleft lip and palate or more subtly out of harmony and causing dissatisfaction. Surgery is not normally considered until the nose is fully grown, that is from about 18 onwards.
All these situations can be considered for improvement by nasal surgery, known as rhinoplasty. If the central support of the nose, the septum, needs adjustment, the operation is called septorhinoplasty. The nose needs careful assessment at consultation so that possible treatment can be explained as well as the likely result.
Surgery requires a general anaesthetic (asleep) and a one (rhinoplasty) or two night (septorhinoplasty) stay. If the work is mainly to the bridge of the nose (dehump) all the access is from inside the nostrils with no external scars (closed rhinoplasty). If much work is required to the tip, Mr Matthews may advise an open rhinoplasty which leaves a scar in the skin across the central pillar of the nose about half way between the upper lip and the nose tip. This normally heals very well.
Surgery to the bridge area usually requires remodelling of the bridge area and a splint is applied to the nose at the end of the operation and stays in place for 7 – 10 days whilst the bones set. Contact sports must be avoided for a further 3 weeks. There is, naturally, more bruising around the eyes with bony remodelling and this takes 2 – 3 weeks to settle.
Each nostril is usually packed with a dressing at the end of the operation to reduce bleeding and to provide internal support. Packs are gently removed the next morning (sometimes after 2 nights – viz septorhinoplasty). Whilst the packs are in place it is necessary to breathe through the mouth. Pack removal is not painful, just a little uncomfortable.
At home, it is important to take life gently to avoid bleeding. Depending on work, you should plan at least 12 days off (desk job), bearing in mind that bruising may still be obvious at that stage. For jobs where the nose is likely to get knocked, 3 weeks is advisable.
Most nasal swelling has settled by 3 weeks for closed rhinoplasty but for open rhinoplasty, the tip takes longer, changing subtly over several months. Skin quality also affects this. Similarly, the nose tip can be quite numb for the same length of time after the open approach.
Provided your expectations of surgery are realistic and achievable, cosmetic nasal surgery can provide significant satisfaction and increase of self-confidence, whilst relief of nasal obstruction in the blocked nose is highly beneficial and may even reduce or abolish snoring if the obstruction was the cause.