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 Surgery to reshape the nose is a very common plastic surgery procedure and it can both increase or decrease the size of nose. The shape of the tip, the bridge and also the nostrils can be changed as can the angle between the nose and the upper lip. Sometimes breathing difficulties can be corrected at the same time.

The nose is the central feature of the face, many people are self-conscious of shape which they may regard as too big, too small or have some other feature which they dislike. The characteristics of the nose are inherited from parents and develop during adolescent years. They continue until the age of 16, when the nose stops growing. It is, therefore, unwise to operate before this age.

THE OPERATION

In Augmentation rhinoplasty some additional framework is introduced underneath the skin to raise and straighten the bridge-line. Various materials are used for the additional framework such as bone, cartilage and a range of manufactured materials which are safe and well tolerated by the body eg silicone. Each has its advantages and disadvantages which are too complex to discuss in this fact sheet.

The additional framework is usually introduced into the nose through a cut either inside the nostrils or in the strut of skin between the nostrils. If a bone graft is used for the additional frame it is taken either from the crest of the hip, from a rib, from the back of the elbow or from the outer surface of the skull without causing any weakness of the 'donor' bone. If cartilage is used, it is usually taken from the shell of one or both ears or from cartilage inside the nose, which is spare or from the rib framework.

 When the nose has been flattened by injury, it is quite common for the plate of bone which separates the two halves of the nose to be buckled as well. This makes breathing difficult. It can often be corrected at the same time.( Septoplasty).

 If you need only a small implant, it can be done under a local anaesthetic as a day case procedure. For larger reconstructions and if a bone graft from the hip or chest is needed, you will need a general anaesthetic and, may be stay in the hospital for a few days.

An operation called Reduction Rhinoplasty reduces the size of the framework of the nose over which the skin is draped. The skin itself is not touched. The frame of the nose which is made up of bone in its upper half and cartilage in its lower half is approached from underneath the skin through cuts which are made inside the nostrils It is possible to effectively narrow the width of the nose. It is also possible to shorten the nose and to slim down a bulky tip by reducing the amount of cartilage which shapes the end of the nose.

After the operation, you will probably have dressing packs in your nostrils for a day or so which will prevent you from breathing through your nose. You will also have a firm splint over your nose for the first week or two. There should be very little pain in your nose but, if you have a bone graft taken from your hip, you can expect this to be quite painful for about 10 days, particularly when you walk.

Sometimes the size of the nose as a feature of the face is influenced by the proportions of the other features, such as the chin and the cheek bones, and to ''normalise'' the appearance of the face it may be advisable to alter these features as well, either at the same time as the rhinoplasty, or during a separate operation.

CONSEQUENCES

You can expect to have bruising and swelling of your face, particularly around the eyes, which will take up to three weeks to settle and during part of this time your nose is likely to be covered by a firm splint. Once the initial swelling has settled, you will find that your nose feels rather stiff and numb. The numbness will disappear slowly during the next few months but the stiffness is likely to be permanent. If it has been necessary to take a bone graft from another part of the body, you will be left with a scar which may be noticeable if it is on your hip or chest.

LIMITATIONS

Although it is usually possible to make a substantial improvement to the appearance of the nose with the operation, the new frame may feel unnaturally hard. This is because it does not have the consistency and flexibility of the natural frame of the nose. You may also find that the additional frame can be moved about under the skin if it does not become fixed to the existing bony framework of your nose. These limitations need not worry you provided you bear in mind that the operation is done for the sake of your appearance. Particularly if a bone graft has been used, there is a tendency for it to gradually shrink in size during the first year or two after the operation. To help compensate for this, your surgeon is likely to put in more graft than you actually need so that to start with your nose may look over-bulky.

There may be technical limitations to the perfection of appearance that can be achieved. For example, perfect symmetry may not be possible and it may not be possible to make the nose as large as might be desired. An experienced surgeon will be able to advise you what is possible in your own case.

RISKS

Like any operation that is carried out under a general anaesthetic, there is a small risk of chest infection, particularly among people who smoke. There is a small risk that infection could adversely affect the success of the operation. Were it to happen, it may be necessary to remove, temporarily, a manufactured implant if that has been used, or it may cause a graft of bone or cartilage to dissolve. In either event, it should be possible for you to have a further reconstructive operation once the infection has cleared. Sometimes a manufactured implant will extrude through the skin of the nose or its lining and need to be removed. This can happen months or years later, and is more likely if a large implant has been used or if the nose is accidentally injured.

AFTER THE OPERATION

You can expect to have some minor bleeding from your nose for the first day or two and you can gently dab this away with a gauze swab or clean handkerchief. Unless you are advised otherwise, it is best for you to leave any crusts in your nostrils for the first week and then gently cleanse them away with cotton buds. You should keep your head up as much as possible and avoid having hot baths. Do not blow your nose and try your best not to sneeze through your nose.

Stitches inside your nose will probably be of the dissolving type and do not need to be removed. If your stitches are outside your nose, your surgeon will advise you on their care and the time for their removal. You will also have a firm splint over your nose in order to protect the new frame and keep it stable whilst it is settling in. Once the splint has been removed, this protection is gone and you will have to be very careful in the way that you handle your nose for the first six weeks. You should avoid any activities where you might knock your nose and you should not move it from side to side between your finger and thumb. Try your best to sleep on your back. The initial swelling and bruising will probably have disappeared within the first two weeks sufficiently for you to feel confident to show your face in public again.

However, it will take at least three months for the reconstructed shape of your nose to mature and maybe a lot longer if you have had a lot done. Do not be too critical of your nose too early. Minor unevenness of contour is common during the first few months and usually settles with time.

Sometimes (in about 10% of patients) the nose does not look right for the patient after all the swelling has settled. In these cases, it is usually possible for the surgeon to carry out a second operation to the residual problem of appearance but, not until all swelling has settled from the first operation. Most surgeons wait for a year for this to happen. Secondary surgery like this may involve additional expense.