Rhinoplasty: common questions and concerns
Written by:
ENT specialist
Published: 10/07/2024
Edited by: Aoife Maguire
Rhinoplasty, more commonly known as a "nose job," is one of the most frequently performed cosmetic surgeries worldwide. Whether motivated by a desire to enhance facial aesthetics or address functional issues such as breathing difficulties, many individuals consider this procedure to achieve their desired look or improve their quality of life.
Leading consultant ENT surgeon Mr Saleh Okhovat provides a comprehensive overview of rhinoplasty, addressing common questions and concerns to help you make an informed decision about this transformative surgery.
Consent process for rhinoplasty
Initial consultation: during your initial consultation, we have gone over your goals both functional and aesthetic and discussed these in detail along with your, medical history, and any concerns you may have. A thorough physical examination of your nose and facial structure were conducted to determine the best surgical approach. Preoperative photographs were taken to assist in surgical planning and for comparison with postoperative results. Second clinic visit: We have the opportunity here to provide you with written information about the procedure and also give you time to consider your options and discussed any concerns you have. We also have an opportunity to finalise our surgical strategies based on your specific needs and goals Discussion of risks and benefits: Like any surgical procedure, septorhinoplasty involves certain risks and went through the majority of these during your consultations. It is crucial for you to understand these potential complications to make an informed decision. I have summarised these below and have expanded on a few issues we may have briefly touched on, along with their estimated occurrence rates. These will be mentioned on your consent form on the day of surgery so it is important to review these in details and ask any questions you have.
What are the risks associated with rhinoplasty?
There is a risk of infection in about one to two of cases. This can usually be managed with antibiotics but may require additional treatment such as in patient admission for intravenous antibiotics or in rare cases surgery. While some bleeding is normal, significant bleeding can occur in about 1-2% of patients. Severe cases may require medical intervention such as nasal packing, hospital admission and transfusion.
Complications related to anaesthesia, including allergic reactions or adverse effects secondary to the stress of surgery (e.g. Heart attack) occurs in less than one percent of cases. You will be undergoing a thorough pre-assessment prior to your surgery where it is vital for you to inform us of any medical issues and ongoing investigations, medications and previous anaesthetic experience.
Approximately, five per cent of patients may experience breathing difficulties post-surgery due to changes in nasal structure or internal scarring. This may require additional surgery to correct. It is important to note that inflammatory conditions affecting the nose such as rhinitis or sinusitis will continue to need ongoing medical condition following this type of surgery.
Visible scarring is rare in closed rhinoplasty but will occur in open rhinoplasty. The incision is made at the base of the nose (columella) along with two smaller (2-3mm) incision on either side of the nose. These often heal very well however in revision cases or where the patient has overactive scarring tendencies (keloid/hypertrpophic scarring) the scarring can be more prominent.
Temporary numbness is common, but permanent numbness can occur in about one to two percent of cases due to nerve damage. For open septorhinoplasty, we usually estimate the sensation to the tip of the nose to return over a period of three to six months months but this can take upwards of a year in certain cases.
While common and usually temporary (three to six months), prolonged swelling (over one year) or abnormal bruising on the nose can occur in five to 10 percent of patients. There are numerous factors including thick skin, previous surgery etc. That can impact the post-operative swelling and bruising. Occasionally we may need to administer steroids into the nose in order to help reduce the swelling.
Minor asymmetry is a possibility in up to 10 percent of cases, although it is often not noticeable. Small irregularities particularly on the dorsum (top) of the nose can be more noticeable in patients with thinner skin may require corrective procedures. This could range from administration of dermal fillers to the nose to camouflage the irregularity all the way to revision surgery. Nostril asymmetry is also very possible and may persist following surgery.
Around five to 15 percent of patients may be dissatisfied with the aesthetic outcome, potentially requiring revision surgery. The rates of dissatisfaction is much higher in revision cases. We often allow sufficient time, often around 9-12months after surgery) for the nose to completely settle and for the healing to complete before making any decisions about revision surgery. This is so that the true final result of the nose is revealed and we can make accurate assessments of the shape of the nose. Revision surgery may range from a minor corrective procedure to complex redo surgery.
Septal perforation is another risk. This rare complication, occurring in around 1% of cases, involves a hole in the septum, which can lead to breathing difficulties, chronic nosebleeds, and crusting. If it occurs we usually monitor and treat it conservatively for six to nine months before evaluating it's suitability for corrective repair which may not be advisable depending on the size/ site of the perforation. Perforations can also impact the shape of the nose resulting in a rare complication called saddle nose deformity.
Persistent skin discoloration and swelling can occur in about one to two percent of patients. A small percentage of patients (less than two percent) may experience prolonged pain or discomfort in the nasal area.
After rhinoplasty surgery, the nasal tip and the skin of the nose may lose a lot of its elasticity and become firm and rigid. Depending on the type of surgical techniques used sometimes the nasal tip can become permanently fixed and firm in one place."
By providing this detailed explanation, we aim to ensure that you have a comprehensive understanding of the rhinoplasty surgery process and the associated risks, thereby facilitating an informed consent. On the day of surgery, we will go through these again in detail.
If you are considering a rhinoplasty and would like to book a consultation with Mr Okhovat, do not hesitate to do so by visiting his Top Doctors profile today.