What does a septorhinoplasty involve?

The ‘nose job’ is a cosmetic procedure that we are all familiar with, however, the variations of this procedure are numerous, and not always centred on a cosmetic motivation. Mr Joe Marais, a leading consultant rhinologist, explains the different types of rhinoplasty, how these procedures are performed and what patients should expect throughout the process.

What is a “rhinoplasty” or “septorhinoplasty”?

These terms are often used interchangeably, although technically “septo-” means that the nasal septum (the cartilage partition in the nose) has to be corrected as part of the procedure. In actual fact, in many cases, the septum must be dealt with in order to achieve a desirable result and so the two terms become almost synonymous. In essence, there are two goals in any septorhinoplasty:

1. To make the nose look better
2. To ensure proper function (i.e. improve or maintain nasal breathing)

For the ideal result, a surgeon will therefore bear both of these aims in mind and be trained in treating not only cosmetic problems, but also other nasal diseases. This is the task facing a rhinologist, who specialises in all of these aspects of nasal surgery, and is able to improve not just the appearance, but also the function of the nose. Most plastic or cosmetic surgeons are only concerned with the appearance.

What types of septorhinoplasty operations are there?

There are many different techniques in septorhinoplasty surgery but they may be divided into groups by looking at various aspects. For instance, the operation may be a “closed” or “open” procedure depending on how the overlying skin is lifted up to provide access to the underlying cartilages and bones. In an “open” septorhinoplasty, a small incision is made in the columella, (the skin between the nostrils) but this is not needed in the “closed” technique. The former method tends to be used more frequently for repeat operations and operations of a complex nature, involving several abnormalities. The incision usually heals so well that it is virtually impossible to see the little scar a few months later.

Many different structural abnormalities may be corrected, ranging from a simple “hump” on the nose to a twisted or bent nose. The nose may be too wide, too long or the tip may be misshapen. Some of the abnormalities may occur as a result of injury (e.g. a broken nose) or may simply be the way the nose has grown. Each of these require differing techniques to correct.

Whatever the abnormality is, it will have to be analysed carefully to decide the best way to deal with it, to give you an optimum result. You should have a clear idea of what aspects of your nasal appearance and function you wish to have changed. This will help in clarifying what needs to be done. The nose will then be examined both internally (very important) as well as externally. Pre-operative photos will be required, and these will be arranged. After the operation, post-operative pictures are also taken for comparison. This is an important part of the surgery.

What should the end result look like?

You should be aware that whilst it is possible to cosmetically improve a nose – even a badly injured or deformed one – that the final result will be dependent on how bad the deformity was in the first place. A much-distorted nose with lots of abnormalities is more difficult to improve and the end result will not be as good as a nose that has had the same operation, but was not so bad to start off with. This may seem like common sense, but many patients have unrealistic expectations of what can be achieved, and if this is the case, may find themselves disappointed with the result. Mr Marais will explain what he thinks can be realistically achieved with your particular nasal abnormality. You should be very clear on this and it should be clarified in consultation and not just before the operation itself, so that you have time to think it over.

What does the operation itself entail?

A general anaesthetic is required for this procedure. It will take between one and two hours to carry out the operation, depending on the complexity. You should not have anything to eat or drink for six hours prior to the operation. There is not usually severe pain afterwards, but the nose may have some packing in it, to stop any bleeding. You may be kept in overnight and go home the next day. Although there is not usually much pain, you will be given some pain-killers to take home, should you require them. You will be fully awake a short while after the operation (although perhaps a bit groggy) and you will be able to eat and drink normally.

What will I look like afterwards?

You will probably have a Plaster-of-Paris splint covering the nose to protect it and to keep the nose in the correct position for healing. This will be worn for one week. In many cases, you will have black eyes afterwards. This is because the nasal bones are surgically fractured and re-set, and this causes bruising. The black eyes settle in about ten days to two weeks. In rare cases dark rings under the eyes may persist for weeks or months. This is due to dilated veins. The nose itself will be a blocked due to internal swelling after the operation. Again, this takes a week or two to settle. You will notice a little blood on your handkerchief for the first few days, but this lessens as the days go by. Although most of the changes are visible in the first two to three weeks, the external appearance of the nose settles down over a period of months, with minor changes evident as the tissues heal.

How long will I need off work?

Probably about two weeks, not because of pain, but because it takes that long for the bruising and swelling to recede.

If you are interested in having a consultation about rhinoplasty, make an appointment with an expert to discuss the options.