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On The Nose

Published:
20/07/2017
Author:
Dr Sawjin Tew

Rhinoplasty, or surgery to change the shape of the nose, was one of the earliest plastic surgical procedures performed. Rhinoplasty is precise surgery, measured in millimeters, and relies on understanding of the anatomy and its surgical relevance. The different regions of the nose are interdependent, hence modification of one part of the nose can secondarily affect another area. 

The nose consists of a framework of cartilage and bone, held together by connective tissue and ligaments, and covered by soft tissue and skin. Modification of the framework has to allow for natural forces from contraction of the skin and soft tissue that can influence the final result.

Rhinoplasty can help correct birth deformities, injuries to the nose and some breathing problems.

Techniques have evolved over time. A generation ago, “closed rhinoplasty” without involving any skin incision was popular, whereas now, “open rhinoplasty” allows visualization of the underlying framework in its undistorted state, and systematic modification of that framework to achieve the desired result. “Open rhinoplasty” allows placement of cartilage grafts and refinement of the tip with sutures. If the surgeon is familiar with both techniques, then he/she can customize the operation to suit the patient’s goals, as there are advantages and disadvantages of both approaches.

The nose cannot be considered in isolation, but needs to be considered in relation to the shape of the face and jaw. Studies of attractive faces reveal certain proportions and relationships between different parts of the face. Asymmetry of the face can be associated with an asymmetrical nose, making rhinoplasty a challenging procedure if the aim is to create a nose that would fit in with an asymmetrical face.

Photographs are very useful in evaluating a patient’s nose, to help the patient understand the nose he/she was born with. The patient is asked to collect pictures of noses that he/ she likes. Computer imaging can help the patient picture what he/she would look like with a new simulated nose, and helps the surgeon understand if the patient’s expectations are realistic and if the goals are reasonable. The surgeon and the patient would need to agree on the improvement that can be achieved before surgery can proceed.

Common requests in rhinoplasty are:
1. removal of the hump over the bridge of the nose
2. straighten the nose
3. refinement or modification of the tip of the nose
4. narrowing of the nostrils
5. changing the length the nose
6. changing the width of the bridge of the nose
7. changing the projection of the tip of the nose
8. changing the angle between the nose and the upper lip

Risks of rhinoplasty include bleeding. It is important to stop any medication or herbal preparation that increases the risk of bleeding after surgery. Infection is unusual after rhinoplasty. Numbness to the skin of the nose may persist for months after surgery. The surgeon would need to be aware of any medical conditions that may increase the patient’s risk of a general anaesthetic.

Recovery from rhinoplasty surgery takes about 2 weeks. However, the swelling can take several months to settle, and sometimes, it is not possible to see the final shape of the modified tip of the nose for months. 

Perhaps more than any other operation in plastic surgery, rhinoplasty exemplifies how art and science come together in plastic surgery.

Cost

Approximately $7000 to $9000, with some rebate if the operation was performed for medical reasons

How long off work?

About 2 weeks

Hospital stay time

1 night

Time for surgery to take full effect

12 to 18 months
 

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