Nose reshaping (rhinoplasty)

Expert reviewer, Anthony Atwood, Consultant Plastic Surgeon
Next review due March 2021

Nose reshaping (rhinoplasty), often called a ‘nose job’, is an operation to change the shape of your nose. You may have one because you’re unhappy with the way your nose looks or if you want to restore its shape after an injury.

Nose shaping for cosmetic reasons isn’t available on the NHS; it’s a procedure that is done privately.

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About nose reshaping

You inherit the shape and size of your nose from your parents. By the time you’re 16, your nose will have stopped growing and will have developed fully. So, if you want an operation for cosmetic reasons, it’s best to hold off until then.

Your surgeon can make your nose smaller in an operation called a reduction rhinoplasty, or larger in an augmentation rhinoplasty. They can change your nose’s size and shape from the tip to the bridge, including your nostrils. Your surgeon can also change the angle between your nose and top lip. It’s important to be sure about what you don’t like about your nose, and to be able to describe the points yourself, so that your surgeon knows what you would like to change.

Our information here explains about nose reshaping generally. Everyone has different needs and expectations. Speak to your surgeon for specific advice and information about any procedure you’re considering.

Getting advice about nose reshaping

It’s important not to rush into the decision to have any cosmetic surgery. Make sure the surgeon you choose is a fully trained plastic surgeon registered with the British Association of Aesthetic Plastic Surgeons or a specialist ENT rhinoplasty surgeon. ENT stands for ear, nose and throat. Do your research and take time to find out about their experience – you may want to talk to people who have been treated by them.

Before your operation, it’s vital to discuss what you’re hoping to gain from it and the result you can realistically expect. You must meet the surgeon who will be carrying out your operation, rather than just a clinic manager or nurse, so that you can discuss all of the pros and cons involved. Before you go to your appointment, write down your wishes and concerns. If you’re unsure about anything, don’t be afraid to ask. No question is too small.

The surgeon will need to check that the operation is right for you. They’ll take into account your age, medical history, and current physical and emotional health. A good surgeon will ask you to book two consultation appointments before you commit to having the operation, with at least a week or two between them. At your first appointment, explain to them what you think is wrong with your nose as well as any points you like. Tell them how you want it to look after the operation – photos are very helpful for being really clear about this. The second consultation is to confirm the details of what you want, especially if the surgeon had suggested anything previously.

After your first appointment, think everything through very carefully. Take as much time as you need and maybe discuss everything with family or friends. Then, using the information and advice from the surgeon, you can decide if an operation will help. Only go ahead with the surgery if you’re happy that your surgeon fully understands what you want. You may be advised to speak to a clinical psychologist as well, to discuss how the operation may affect you emotionally and socially afterwards.

Preparing for nose reshaping

Your surgeon will examine your nose and measure its shape and size at one of your appointments before you have a rhinoplasty. They will take photographs so that after the operation you can compare the results of the surgery with your original appearance.

At these appointments you should have plenty of opportunity to ask your surgeon everything you want to about what will be involved. Make sure you’re clear about the risks as well as the benefits, and what the recovery from the operation involves. You also need to be sure that you understand how your nose is likely to look afterwards.

Your surgeon will explain how to prepare for your operation. For example, if you smoke, it’s important to try to stop at least six weeks before your surgery. This is because smoking increases your risk of getting infections, which can slow your recovery. It’s best to delay your operation if you have a cough, cold or sore throat because these may increase your risk of getting an infection and will slow your normal recovery. Reschedule it for after you’ve recovered. If you’re not sure, get in touch with your surgeon for advice.

It’s important that you feel fully informed so you feel happy to go ahead with your operation. You’ll be asked to sign a consent form.

A nose reshaping operation is usually done under general anaesthesia so you’ll be asleep during the surgery. The anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist or surgeon’s advice and don’t be afraid to ask if there’s anything you’re unsure about.

Your nurse will prepare you for the operation. You may be asked to wear compression stockings. This will help prevent blood clots forming in the veins in your leg. You may also need to have an injection of an anti-clotting medicine as well as, or instead of, wearing compression stockings.

What happens during nose reshaping?

Depending on what you’re having done, a rhinoplasty operation may take from one to three hours.

Reduction rhinoplasty

If you’re having your nose made smaller, your surgeon will usually make cuts inside your nostrils to reach the bone and cartilage. This is called ‘closed rhinoplasty’. It means you shouldn’t have any visible scars after your surgery. This operation takes less time and generally leads to less swelling, so you should recover more quickly afterwards. Not everyone can have a closed rhinoplasty and your surgeon will explain if it’s an option for you.

You may need to have an ‘open rhinoplasty’. This means your surgeon will make a cut across the skin between your nostrils (columella) as well as inside your nostrils. The operation gives good results and is used when you’re having a substantial amount of reshaping done, but you may have a small scar visible on the columella. Your surgeon will remove or rearrange some of the bone and cartilage to change the shape of your nose. They won’t need to touch the skin over your nose – this will shrink down to its new shape.

Your surgeon may also need to make your nostrils smaller to keep your features in proportion. They will need to make cuts in the skin of your nostrils to do this.

Augmentation rhinoplasty

If you’re having your nose made larger, your surgeon may use an open or closed rhinoplasty technique. Your surgeon may need to use extra bone or cartilage to build up your nose. This is called a graft. Cartilage is usually taken from your ears, and bone is taken from your elbow, rib, skull or hip bone. Sometimes your surgeon will use an artificial implant instead.

Your surgeon will usually close the cuts inside your nose with dissolving stitches so you won’t need to have them removed. If you have stitches outside your nose, you may need to have them taken out about a week after your operation.

What to expect afterwards

You’ll need to rest until the effects of the general anaesthetic have worn off. You may have some discomfort as the anaesthetic wears off and your nose will feel blocked (as if you have a cold). You'll be offered pain relief if you need it.

You may have dressings (packs) in each nostril for a day or two. These will stop you breathing through your nose. You may also have splints inside your nostrils as well as over your nose for around a week to keep the nasal bones in place.

You may be able to go home on the same day or need to stay in hospital for one or two nights. When you’re ready to go home, make sure someone can take you and ask someone to stay with you for a day or so if possible.

Your nurse will give you some advice about caring for your nose when you go home. You’ll be given a date for a follow-up appointment.

Recovering from rhinoplasty

Your nose may feel a bit tight and sore after your operation, especially around the tip. 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. If you have any questions, ask your pharmacist for advice.

Having a general anaesthetic may really take it out of you. You may find you’re not as coordinated as usual or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon and anaesthetist’s advice.

There are some things you can do to help speed up your recovery.

  • Keep your head up as much as possible. Use an extra pillow or two when you sleep for a few days after your operation.
  • Keep the splints on your nose dry, and don’t have a hot bath until the splints have been removed.
  • Don’t blow your nose in the first week after your operation, only wipe it gently. If you need to sneeze, try to do it with your mouth open as this will help to protect your nose.
  • Don’t remove any crusts in your nostrils until you see your surgeon to have the splints removed.
  • Stay away from dusty or smoky places until you’ve recovered.
  • Don’t do any strenuous exercise or contact sports, such as rugby or football, for four to six weeks. You may be able to go swimming after around three weeks. Get advice from your surgeon before the operation if these are activities you do normally.
  • If you wear glasses, you may find it more comfortable to tape them to your forehead for a while, rather than rest them on the bridge of your nose.

You’ll probably feel ‘bunged up’ for a week or two after your operation and will have to breathe through your mouth. Your surgeon may prescribe a nose spray to ease your blocked nose.

Contact your GP or surgeon if any swelling, redness or pain in your nose gets worse or if you develop a high temperature.

Everyone recovers from surgery differently. You may find that you need to take a couple of weeks off work, depending on your job. Some people may go back to work sooner than this. You’ll probably feel more comfortable waiting until the swelling and bruising have gone down. This may take a couple of weeks. Ask your surgeon about when you can get back to other activities. It’s best to wait a week or two before you fly. You should wait a few days before you drive – check your car insurance first.

The stitches inside your nose should dissolve on their own. Stitches on the outside of your nose are usually removed after a week. Your splint can usually come off around the same time too.

Be prepared for it to take several months before your nose completely settles into its new shape.

Side-effects of nose reshaping

After rhinoplasty, you may have a few side-effects for a short while. These include:

  • soreness, swelling and bruising, particularly around your eyes
  • stiffness and numbness, particularly at the tip of your nose – this can last a few months
  • difficulty breathing through your nose – this should get better as the swelling goes down
  • light nose bleeds for a week or so
  • sensitivity to the sun – wear strong sunscreen, especially on your nose, and a hat for at least six months after your operation

Complications of nose reshaping

Rhinoplasty can cause a few complications. These include:

  • difficulty breathing – it’s normal to have some difficulty breathing through your nose straight after your operation but it’s possible it can be permanent
  • infection
  • nose bleeds – these may happen either shortly after your operation or later after a week or so
  • damage to the cartilage wall between your nostrils (the septum)
  • a change in your sense of smell
  • scars – the scars will be red, then purple and then gradually fade, but sometimes your surgeon may recommend an operation to make them less noticeable

If you’ve had an implant or a graft, there’s a very small risk that it can push through the lining of your nose or the skin. This can happen if the pocket for the graft or implant is too small. This can happen several months, or even years later, especially after an injury. If the implant does start to come out, you’ll need to have it removed, but you can have a new one put in later.

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

Frequently asked questions

  • If you injure your nose and need an operation to restore its shape, this may be covered by the NHS. The operation may also be available on the NHS if you need a rhinoplasty to breathe properly. If you want the operation purely for cosmetic reasons, you’ll have to pay for it. The cost can vary from about £4,500 to £7,000 depending on where it is done and your surgeon’s expertise.

    The package fee for a cosmetic operation usually covers all costs of your treatment, such as hospital charges, surgeon’s and anaesthetist’s fees and follow-up consultations. The costs vary from surgeon to surgeon and clinic to clinic. You should be given a fixed price after your initial consultation, and your surgeon will explain all of the costs involved.

    You can get surgery abroad for a lower cost, but there’s no guarantee of how safe this will be or of your surgeon’s ability. It’s possible you may end up having to pay again to correct an outcome you’re unhappy with.

    Never base your decision on costs alone when deciding where to be treated. Always consider the expertise of your surgeon and the quality of the hospital or clinic when making your decision.

  • The shape of your nose can be improved, but it may not be possible to make it perfectly straight especially after injury. Any changes your surgeon makes to your nose shape will also need to keep the rest of your features in proportion. Therefore, it may not be possible to change the shape of your nose dramatically. It can be difficult to reduce the size of your nostrils without cutting your skin and leaving scars.

    Before opting for nose reshaping, discuss with your surgeon what you’re hoping to gain from the operation and the result you can realistically expect. An experienced surgeon will be able to give you plenty of advice about what’s possible for you.

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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, March 2018
    Expert reviewer, Anthony Atwood, Consultant Plastic Surgeon
    Next review due March 2021