RPL Rhinoplasty Surgery
Procedure The nose shape can cause aesthetic concerns for a variety of reasons. These include a hump on the bridge of the nose, a bulbous or droopy tip, asymmetry, flared nostrils, a small (=underprojecting) or large (=overprojecting) nose and a low columella amongst others. There can be associated breathing problems. A small chin makes a nose look larger and vice versa. In some cases, chin alterations may be beneficial. A rhinoplasty (=nose job) corrects the outer nose and is done mainly for aesthetic reasons. A septoplasty reshapes the midline cartilage of the nose. This is done to predominantly improve breathing. A septorhinoplasty addresses aesthetic as well as functional issues. For functional problems such as breathing difficulty or frequent nose bleeds, an ENT opinion should be sought first. I use an open rhinoplasty approach with cuts inside the nostrils and across the base (=columella) for most procedures such as hump reduction, tip reshaping / repositioning and septum procedures. I feel that an open approach allows for better reshaping of the nose than a closed rhinoplasty approach using cuts within the nostrils only. The scar of an open rhinoplasty is usually very inconspicuous. After dorsal hump removal, the side walls of the bony bridge are also broken (=infracture) to narrow the dorsum or the entire nose. The septal cartilage below is also reduced in height. The side cartilages (=upper lateral cartilages) can be fixed so that airflow is improved. The tip is reshaped by cartilage trimming (=cephalic trim of the lower lateral cartilages), and with dissolving sutures to define the tip (=intradomal sutures) and to narrow it (=interdomal sutures). Cartilage grafts are sometimes used for structural support or augmentation (=enhancement). These can be taken from the septum, ears or ribs. Where available, I use a piezotome which is a fine-powered surgical instrument with less bleeding and swelling. The suture at the base runs under the skin and doesn’t require removal. It dissolves within four months. The nose is usually splinted for one week on the outside with a plastic splint and inside the nostrils with dissolving splints.
Scars Within the nostrils and chevron or "V"-shaped across the base. For nostril corrections, the scars are in the outer creases (=alar creases)
Operation time 2.5 hours
Anaesthesia General for septum or bony surgery. Local for tip and nostrils
Hospital Stay Day Surgery > (Overnight)
Benefits Aesthetic, Psychological, Functional, Symptomatic
Risks Bleeding, Infection, Scar problems (stretched, thick, abnormal pigmentation, red, retracted etc.), Skin discoloration, Wound separation, Slough, Pain, Nerve injury (Numbness), Non- animated nose, Bruising, Swelling, Overcorrection (e.g. saddle nose), Undercorrection, Polly beak deformity, Asymmetry, Inability to correct asymmetry, Aesthetic imperfections, With cartilage grafts: Graft failure & Donor morbidity of septum, ears, ribs [pneumothorax, mediastinitis]), Organ injury, Injury to tear duct / lining of skull, Loss of smell / taste, Breathing difficulty, Hump recurrence, Extrusion of bone / grafts / stitches, Septal perforation, Contour irregularities, Need for further surgery, Allergic reaction, Toxic Shock Syndrome, (General anaesthetic: Chest infection, Heart attack, Stroke, Blood clots in legs & lungs). N.B. Most complications are unlikely. Serious risks or death are rare
Risk factors Smoking / contraception / flights within 6 weeks of surgery, overweight, high blood pressure, bleeding tendency (Stop herbal products or supplements for two weeks before surgery), diabetes
Optimising factors Diet rich in Vitamin C and protein, plenty of fluids, fresh air, scar massage, protection from sun and trauma
Discomfort 1 - 2 weeks
Bruising 2 - 3 weeks
Recovery Light activities 2 weeks, Driving 1 - 2 weeks, Physical work and sports 6 weeks, Unrestricted 3 months
Acceptable appearance 3 - 8 weeks for most patients (This is subjective)
Final result 12 - 24 months
Alternatives No Surgery, Make-up, Fillers, Closed rhinoplasty

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