Rhinoplasty (Nose Job) : Benefits, Procedure, Expectations and Complications

The structure of the nose can be modified through rhinoplasty, addressing aspects of bone, cartilage, and skin as needed. Consulting with a surgeon is crucial to determining the suitability of rhinoplasty for individual needs and understanding the potential outcomes it can deliver.

Correct selection of surgical patients and thoughtful preoperative analysis and planning are critical steps for enhancing rhinoplasty results and preventing secondary procedures. The types of nose job includes:

1. Open Rhinoplasty: Involves making a small incision on the columella (the strip of skin between the nostrils) to access the nasal structures, providing better visibility and control during surgery.

2. Closed Rhinoplasty: Utilizes incisions inside the nostrils, leaving no external scars, suitable for minor adjustments and faster recovery.

3. Revision Rhinoplasty: Corrective surgery performed to address complications or unsatisfactory results from a previous rhinoplasty procedure.
   

4. Tip Rhinoplasty: Focuses on refining the nasal tip, adjusting its size, shape, and projection to achieve desired aesthetic outcomes.

5. Septorhinoplasty: Combines nasal reshaping (rhinoplasty) with correcting a deviated septum (septoplasty), addressing cosmetic concerns and functional issues such as breathing difficulties.

6. Liquid Rhinoplasty: A non-surgical procedure using injectable fillers to reshape and contour the nose, offering temporary results without incisions or downtime.

Anatomy and Physiology of the Nose

The nose, an organ for breathing and smelling, comprises various structures that work together seamlessly. It serves as the primary entry point for air into the body, facilitating respiration and oxygenation of tissues. 

Beyond its functional role, the nose contributes significantly to facial aesthetics and influences how a person sounds when speaking. As a natural filter, the nose cleanses incoming air, removing particles and allergens to maintain respiratory health. 

Specialised cells in the nasal cavity detect various odours, providing a sense of smell critical for experiencing the world around us. The anatomy of a nose is:

1. Bone: The top of the nose is formed by bone, providing structural support and defining its shape.

2. Hair and Cilia: Inside the nose, tiny hairlike structures called cilia trap dirt and particles, aiding in filtering the air breathed.

3. Lateral Walls: Made of cartilage and covered in skin, the outer walls form the framework of the nose, including the nostrils and nasal cavities.

4. Nasal Cavities: Two hollow spaces within the nose allow air to flow in and out, lined with mucous membranes that help humidify and filter the air.
   
   

5. Nostrils: These openings on the face lead to the nasal cavities, allowing air to enter and exit the respiratory system.

6. Septum: Comprising of bone and firm cartilage, the septum runs down the centre of the nose, separating the nasal cavities and providing structural integrity.

7. Sinuses: Four air-filled pockets connected to the nasal cavities produce mucous, moisturising the nasal passages and trapping harmful particles.

Individuals seeking rhinoplasty should have complete facial growth. This is because changes in facial structure during adolescence and early adulthood can impact the appearance and function of the nose over time. However, exceptions exist for pediatric patients with facial birth defects like cleft palate. 

Additionally, candidates should be in good health and non-smokers to minimise risks associated with poor blood flow and tissue damage. Rhinoplasty may be considered for teenagers with full parental consent and a thorough understanding of the procedure. 

Ideally, girls should be at least 15 or 16 years old, while boys should be at least 17 or 18 before surgery.

Medical Reasons for Rhinoplasty

Various medical conditions like injuries, chronic allergies leading to nasal inflammation, burns, broken noses, and deformities may require rhinoplasty for functional and cosmetic restoration. The medical conditions for nose job include:

1. Deviated Septum/Chronic Sinus Problems: A deviated septum, a condition where the nasal septum is displaced to one side, can lead to chronic sinus problems, including congestion and nasal allergies, impacting breathing and sleep quality. A nose job becomes necessary to correct the deviated septum, alleviate breathing difficulties, and address associated symptoms like snoring, congestion, and sleep apnea.

2. Cleft Palate or Cleft Lip: It is a birth defect that affects facial harmony and causes difficulties in eating if left untreated. Rhinoplasty is crucial to correct the cleft palate or lip, improving facial appearance and restoring normal function, especially in children.

Aesthetic Reasons for Rhinoplasty

An ideal nose shape, size, and contour contribute significantly to overall facial harmony and appearance. For cosmetic purposes, nose reshaping aims to enhance facial aesthetics by addressing specific appearance concerns and achieving proportional balance.

Rhinoplasty for cosmetic purposes can involve:

1. Narrowing or widening the nostrils

2. Altering the nose bridge width

3. Reshaping the nose tip

4. Straightening a crooked nose

5. Adjusting the angle between the upper lip and nose enhances facial symmetry and proportion

Nose job isn't just about enhancing appearance. It also targets improving or maintaining nasal function, mainly if breathing difficulties occur due to obstruction. It involves adjusting internal nasal structures to address functional issues. 

Below are the benefits of undergoing the procedure:

1. Improved Appearance: A nose job can enhance the shape and size of the nose. It results in a more symmetrical and aesthetically pleasing facial profile. Some people seek rhinoplasty because they are dissatisfied with the appearance, size, or angle of their nose. 

2. Boosted Confidence: By addressing nasal imperfections, rhinoplasty can help individuals feel more confident. This can improve their self-confidence by being more comfortable with their appearance. The surgery addresses issues like a prominent nasal hump or a drooping or overly elevated nasal tip.

3. Correct Breathing Problems: In some cases, rhinoplasty can correct structural issues within the nose that obstruct airflow. It improves breathing and overall respiratory function.

4. Injury Correction: The procedure can address nasal deformities resulting from trauma or injury, restoring function and appearance.

5. Fix Congenital Defects: Rhinoplasty can address congenital nasal abnormalities. This can include a deviated septum or cleft lip.

The surgeon captures images of the nose from various angles. These photos are visual aids for rhinoplasty before and after comparisons and guide discussions about surgical goals.

Before Rhinoplasty

Prior to the nose job surgery, the medical team follow protocol for a smooth procedure.  

On the Day of Rhinoplasty

After scheduling the surgery, arrange for transportation home if it's an outpatient procedure. You can expect the following on the day of the surgery:

A nose job takes 60-120 minutes. The surgeon evaluates the patient's nasal structure, skin thickness, and overall facial features to determine the most suitable approach for achieving the desired results.

The steps of the procedure are:

1. Anaesthesia: Before the procedure begins, the patient is administered general anaesthesia. It ensures they are comfortable and pain-free throughout the surgery.

2. Incisions: Depending on the type of rhinoplasty (open or closed), the surgeon makes incisions either inside the nostrils (closed) or across the columella (open) to access the underlying nasal structures.

3. Reshaping: The surgeon then reshapes the bone, cartilage, and tissue of the nose to achieve the desired size, shape, and contour. It addresses any aesthetic or functional concerns discussed during the consultation.

4. Closure: Once the reshaping is complete, the incisions are closed using sutures or surgical tape, ensuring minimal scarring and a natural-looking result.

Open Rhinoplasty Procedure

Closed Rhinoplasty Procedure

Septorhinoplasty Procedure

Following the surgery, individuals may experience short-term swelling or discolouration around the eyelids for approximately 2 to 3 weeks. Nasal swelling may endure for an extended period, possibly up to a year.

Reducing sodium intake can aid in alleviating swelling more quickly. It's advised to refrain from applying ice or cold packs to the nose following the procedure.

Recovery Process at Hospital

Recovery of every individual process may vary slightly. Closely follow the specific instructions of the surgeon for the best outcome.

After rhinoplasty surgery, patients are advised to rest in bed with the head elevated above their chest to minimise bleeding and swelling. The patient may experience some discomfort, swelling, and possibly nausea.

Nasal congestion may occur due to swelling or from the presence of splints inserted during the procedure. After shifting the patient to the general ward, the following can be expected in the immediate post-surgery 24-hour period:

1. Internal Bandages and Splint: Internal bandages typically remain in place for 1 to 7 days post-surgery, while a splint may be taped to the nose for about a week to provide protection and support.

2. Drip Pad: Expect bleeding and mucous drainage for a few days following surgery or after removing the dressing. A drip pad, secured with tape, may be placed under the nose to absorb drainage. Ensure the drip pad is not applied tightly against the nose and change it as the surgeon instructs.

3. Vitals Monitored: Close monitoring of vitals like blood pressure, body temperature, etc., in the recovery room by medical staff.

4. Medications: Pain medication will be provided to manage any discomfort. 

At-home Recovery

Patients may receive additional instructions to reduce the risk of bleeding and swelling. Adhere to the guidelines below for several weeks following the surgery:

1. Nasal Care: Refrain from blowing your nose to facilitate healing.

2. Sneezing and Coughing: Keep your mouth open when sneezing or coughing to minimise pressure on the nose.

3. Oral Hygiene: Brush your teeth gently to prevent excessive upper lip movement.

4. Facial Expressions: Limit certain facial expressions, such as smiling or laughing, to prevent strain on the surgical area.

5. Physical Activities: Avoid intense exercises like aerobics and jogging to prevent bleeding and swelling.
   

6. Bathing: Opt for baths instead of showers while nose bandages are on to ensure proper care.

7. Diet: Incorporate high-fibre foods like fruits and vegetables to avoid constipation, which can strain the surgery site.

8. Clothing: Wear clothes with front fasteners and avoid pulling clothing over your head to prevent giving extra pressure to the nose.

9. Eyewear: Avoid resting eyeglasses or sunglasses on your nose for at least four weeks post-surgery to prevent pressure on the nose. Consider using cheek rests or taping the glasses to your forehead until the nose fully recovers.

Don'ts

Do's

First Follow-up

After rhinoplasty, the first follow-up appointment usually occurs within the first week, typically around 5 to 7 days post-surgery. During this appointment, the surgeon examines the healing progress and removes any external splints or internal gauze. 

Any concerns or questions of the patient are addressed regarding their recovery. This initial follow-up helps ensure the patient is healing properly and experiencing a smooth recovery process.

Before consenting to rhinoplasty, the surgeon will thoroughly discuss risks and other concerns, ensuring the patient makes an informed decision. The risks and complications can be:

1. Anaesthesia Risks: There's a slight chance of allergic reactions or breathing issues related to anaesthesia during the surgery.
2. Infection: While uncommon, there is a risk of developing an infection at the surgical site, which may require antibiotics or further treatment.
3. Sensory Changes: Following the procedure, the patient may experience temporary numbness or pain in the area around the nose.
4. Functional Complications: Post-surgery, one might experience temporary or, in rare cases, permanent difficulty breathing through the nose due to swelling or structural changes.
5. Nasal Septal Perforation: Though infrequent, this involves a hole in the nasal septum, potentially requiring additional surgery for repair.
6. Wound Healing Issues: In some instances, wounds may heal inadequately, leading to visible scarring or dissatisfaction with the aesthetic outcome. Post-surgery, temporary skin discolouration and swelling are common, gradually subsiding over time.
7. Aesthetic Concerns: Despite careful planning, the final aesthetic outcome may not meet expectations, requiring additional adjustments or revisions.

When to call a doctor?

Knowing when to seek medical attention after rhinoplasty surgery is crucial to ensure a smooth recovery. If you experience these symptoms, contact your surgeon promptly for further evaluation and appropriate management:

1. Persistent pain

2. Bleeding

3. Breathing difficulties

4. Infections

5. Fever with chills

Delaying rhinoplasty may prolong dissatisfaction with one's nasal appearance. It leads to negative psychological effects such as low self-esteem and body image issues. Functional problems like a deviated septum or breathing difficulties can continue to impede nasal airflow and quality of life.

Conditions such as chronic sinusitis or nasal deformities may worsen over time if left untreated. It leads to more complex surgical interventions and increased risks during rhinoplasty.

The nose correction surgery costs from ₹ 65,000 to ₹ 1,50,000. It depends on factors like:

1. Technique Used: The choice between open or closed rhinoplasty techniques and the complexity of a revision procedure can impact the price.

2. Surgeon's Fee: The fee charged by the plastic surgeon performing the rhinoplasty is a significant factor.

3. Diagnostic Procedures: Any diagnostic tests or imaging studies conducted before the surgery to assess nasal anatomy and health may contribute to the total cost.

4. Hospital of Preference: The choice of hospital or surgical facility where the procedure is performed can affect the overall cost, with higher-end facilities typically charging more.

5. Hospitalisation Costs: Expenses related to hospitalisation, including admission, discharge, and room rent, are included in the bill.

6. Prescribed Medication: The cost of medications prescribed for pain management, infection prevention, and other post-operative needs is an additional expense.

7. Post-surgery Support Devices: Splints, nasal packing, and other supportive devices provided after surgery to aid healing may add to the overall cost.

8. Follow-up Consultations: The number and frequency of follow-up appointments with the surgeon to monitor healing progress and address concerns can affect the total rhinoplasty cost.

The nose is made up of delicate cartilage and bone structures. Rhinoplasty is a medical procedure that can alter the size, shape, or proportions of the nose. Apart from cosmetic reasons, it's often performed to address injury-related issues, correct birth defects, or enhance breathing.

Reach out to HexaHealth for a seamless and patient-centred nose job experience. We prioritise the comfort of the patient above all else. Plus, we make nose reshaping surgery financially accessible by providing free EMI options. Get in touch with us today!

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