Nose reshaping (rhinoplasty)

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who are planning to have their nose reshaped, or who would like information about it.

Nose reshaping (rhinoplasty) is an operation to alter the shape of the nose. It can either make the nose smaller (reduction rhinoplasty), or larger and give it more bulk (augmentation rhinoplasty).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here, as it will be designed to meet your individual needs.

About nose reshaping

The shape and size of your nose is inherited from your parents. Your nose is generally fully developed by the time you are 16.

An operation to have your nose reshaped can help to change the size and shape of your nose. You may decide to have it changed for cosmetic reasons or to restore the shape of your nose after an injury.

Getting advice

It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or give advice about how to choose which hospital to be treated in.

Before opting to have your nose reshaped, discuss what you're hoping to gain from the operation with your surgeon and the result you can realistically expect. It's important to clearly explain what you think is wrong with your nose and understand how it will look after the operation.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Don't have the operation if you have a cough, cold or sore throat because this can increase the risk of an infection afterwards - reschedule it for after you have recovered. If you have any concerns, contact your surgeon for advice.

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your surgeon will examine your nose and measure its shape and size. He or she may take photographs, so that the results of the surgery can be compared with your original appearance.

Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the operation

The time the operation takes will depend on what will be done but it usually takes two hours.

Reduction rhinoplasty

If you're having your nose made smaller, your surgeon will make cuts inside your nostrils to reach the bone and cartilage. Some of the bone and cartilage will be removed or rearranged to achieve the shape you have agreed with your surgeon. The skin over your nose won't be touched - it will shrink down to the new shape. Your surgeon may need to make a cut in your skin between your nostrils. This is called 'open rhinoplasty'.

It may be necessary to also make your nostrils smaller to keep your features in proportion. Your surgeon will need to make cuts in the skin of your nostrils to do this. This will leave fine scars on each side.

Augmentation rhinoplasty

If you're having your nose made larger or giving it more bulk, your surgeon may make a cut inside or between your nostrils and reshape the bone and cartilage. You may need extra bone or cartilage (a graft) to build up your nose. Your surgeon may take cartilage from your ears and bone from the back of your elbow, a rib, your skull or your hip bone. Sometimes artificial implants are used instead.

The cuts will be closed with dissolvable stitches - these will disappear on their own in about seven to ten days. You may also have small pieces of soft plastic inside your nose to prevent scar tissue from forming.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have dressings (packs) in each nostril for a day or two; these will stop you from breathing through your nose. You may also have a splint over your nose to support it - you will need this for about a week.

Before you go home, your nurse will give you some advice about caring for your nose and a date for a follow-up appointment. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Recovering from the operation

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

You may have some minor nose bleeds for a few days. To reduce your risk of bleeding, keep your head up as much as possible and don't have a hot bath for a week or two.

You're likely to feel bunged up for up to two weeks after the operation - your surgeon may give you some drops or spray to help this. You may find the pressure lessens at night if you sleep in an upright position on several pillows.

You will need to breathe through your mouth for the first few days. This can lead to dry lips so use petroleum jelly or lip balm on your lips to stop them cracking.

You shouldn't blow your nose for at least the first week. Your nose may drip, but only wipe it gently. If you need to sneeze, cough it out.

Stay away from dusty or smoky places until your nose has recovered. Don't do any contact sports, such as rugby or football, for at least six weeks.

Contact your GP or surgeon if you develop any of the following symptoms:

• bleeding that doesn't stop within 10 to 15 minutes
  
• inability to drink or swallow normally
  
• high temperature
  
• increasing pain

While there isn't a medical reason why you should stay away from work, you will probably feel more comfortable taking some time off and returning when the bruising has settled.

It may take several months before your nose settles into its new shape.

What are the risks?

Nose reshaping is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

Side-effects of nose reshaping include:

• soreness, swelling and bruising, particularly around your eyes - this can last up to a month
• stiffness and numbness, particularly at the tip of your nose - numbness can last a few months but stiffness may be permanent
• inability to breathe through your nose - this should ease as the swelling settles

Complications

Complications are when problems occur during or after the operation. Complications specific to nose reshaping are uncommon but can include:

• a chest or nose infection - antibiotics can help treat this
  
• a heavy nose bleed either shortly after the operation, or after a week to 10 days - this may require further hospital treatment
  
• changes in the shape of your nose as scar tissue matures - this may require further surgery
  
• damage to the septum (the cartilage wall between your nostrils) - a rhinoplasty may leave a hole that may need further surgery to repair

If your surgeon has placed an implant in your nose, it's possible it may push through the lining of your nose and will 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.

It's possible that you may not be completely satisfied with your appearance after the operation. If so, talk to your surgeon about your options.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.