Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon

Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Rhinoplasty and Septorhinoplasty

A rhinoplasty is a procedure to change the appearance of the nose; a septo-rhinoplasty aims to do this and also correct the nasal septum to improve the airway. Septal surgery is discussed above; the comments here will apply purely to the rhinoplasty.

A rhinoplasty procedure may be performed internally, with even no or minimal skin incisions or externally, as part of which procedures there will be a small incision along the columella, which is the piece of skin at the base of the nose between the two nostrils. The particular approach used will depend on the indications for surgery and the type of deformity. Surgery may be to correct a congenital deformity, one which has developed with natural growth, or which has occurred as a result of trauma or injury.

Essentially in a rhinoplasty procedure, there may be components of part or all of the following steps; it may be necessary to reduce the dorsum, or top of the nose, particularly if there is a hump; the nasal bridge may need to be straightened because of deviation of the nasal bones; the overall size of the nose may need to be reduced; the tip-plasty may need to be performed to modify the shape of the nasal tip. Occasionally a cartilage graft may be required, which may be taken from the pinna, or external ear via very small incision which does not leave any significant cosmetic deformity there. Occasionally it is possible other graft tissue may be required.

It is important to realise that there are limitations to what can be achieved by surgery and in occasional cases a revision procedure may be required, of varying extent. The operation is uncomfortable; nasal dressings may need to be in place post-operatively and occasionally left overnight.

Occasionally a nasal splint, made of silastic, may need to be placed in the nose. This is secured by a stitch and removed after 5 to 7 days and can increase the discomfort and discharge a little.

It is possible to get bleeding, even with the dressings in the nose, which can sometimes mean repacking or a return to theatre prior to discharge home. It is also possible to get bleeding 7 – 10 days after the operation which can mean reattending the hospital or the Casualty department. The nose is also quite wet and oozy anyway after such procedures, but this usually improves after a few days.

It is occasionally possible to get anosmia, a loss of sense of smell, after the operation but this usually settles.

An external splint, in the form of a Plaster of Paris typically, is often applied and may need to remain attached in the skin for one week. There is also often considerable bruising and swelling and the final marks of this bruising can take up to 3 weeks to settle. Pre-operative photographs will be required and also post-operative photographs about 6 weeks after the procedure.

If there is accompanying septal surgery then it can take up to 6 weeks to notice the full improvement in airways of the nose. Occasionally the improvement in airway may not be as great as expected and, in the case of turbinate surgery may not be a permanent cure if the underlying allergy is persisting. It may also be necessary to use further drops and sprays post-operatively to augment the benefit from the operation.


It is occasionally possible for the external tissues of the nose to just feel a little different, possibly, slightly stiffer and sometimes slightly numb. If septal surgery is performed also, there is a small possibility of the nose healing leaving a hole in the septum internally and there may occasionally be a degree of slight numbness of the upper two incisor teeth depending on the extent of dissection although this usually settles spontaneously. At least one week off work would be recommended and nasal trauma should be avoided for at least 6 – 8 weeks.
 

© Vincent Cumberworth 2005