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

Information is supplied only upon the condition that the viewer will make their own determination as to the suitability of the information for its purposes prior to use.  There will be no responsibility for information that is misused or misinterpreted and the information should not be used as a substitute for consultation with a health care professional.  It is not possible to answer questions regarding individual cases or to enter into individual correspondence.

Rhinoplasty and Septorhinoplasty

Rhinoplasty describes a procedure to change the appearance of the nose; a Septorhinoplasty does this and also corrects the nasal septum to improve the airway.  Septal surgery is discussed above in the Septoplasty and Turbinate Surgery section and this should be reviewed; the comments here will apply purely to Rhinoplasty alone or the rhinoplasty component of a Septorhinoplasty.

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

In a Rhinoplasty procedure there may be components of part, or all, of the following steps: reduction of the dorsum, or top of the nose, particularly if there is a hump; straightening the bony nasal bridge; reduction of the overall size of the nose; tip-plasty to modify the shape of the nasal tip.  Occasionally a cartilage graft may be required, which may be taken from the pinna via very small incision which does not leave any significant cosmetic deformity there; sometimes other graft tissue may be required.

There are limitations to what surgery can achieve and in occasional cases a revision procedure may be required, of varying extent.  The operation is uncomfortable; nasal dressings or packs usually need to be in place post-operatively; dissolving dressings are most comfortable but if packs are required these may need to remain in place overnight.  Sutures placed in the nose are generally dissolving, avoiding the need for removal.

Rarely 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.

Troublesome bleeding, even with the dressings in the nose, can sometimes necessitate repacking, or a return to theatre, prior to discharge home.  It is also possible to develop “secondary” bleeding 7 – 10 days after the operation which can require reattendance at hospital or an Emergency Department.  The nose is also quite wet and oozy after such procedures, but this usually improves after a few days.

Anosmia, a loss of sense of smell (which can also contribute to Ageusia – a loss of taste), may occur after the operation but this (and any taste problem) usually settles over one to two weeks.  In the case of extensive septal dissection there may be a degree of numbness of the upper incisor teeth post-operatively due to bruising of the anterior superior alveolar nerves, which travel along the floor of the maxilla, in the region of the operative area, on their way to supply sensation to part of the upper lip and dentition.  This generally settles after a few days.

An external splint, typically either Plaster of Paris or a Thermoplastic material, is often applied and may need to remain on the skin for one week.  There is also often considerable bruising and swelling and the final marks of this bruising can be visible for up to 3 weeks.  Pre-operative photographs will be required and also post-operative photographs are taken 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 an underlying allergy persists.  It may also be necessary to use further drops and sprays post-operatively to augment the benefit from the operation.

It is possible for the external tissues of the nose to just feel a little different, slightly stiffer and sometimes slightly numb post-operatively.  If septal surgery is also performed there is a small possibility of the nose healing with a hole in the septum 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.  Because the nasal skin may become more sensitive after surgery a strong sunscreen should be worn for 6 months afterwards when outside in strong sunlight.

Post-operatively there may be persisting cosmetic deformity – which can occasionally require revision surgery – and there may be persisting tenderness or discomfort.