SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

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Rhinoplasty (Nose Job)
London | Northampton | Milton Keynes 

You can hide or camouflage any part of your body, except for your nose. Without doubt, our nose is the most prominent part of our face, defining its feature and acting as the visual centre of gravity, the central point where the onlookers gaze naturally tends to focus. No wonder, any imperfection in the appearance of our nose, a slight bend, a small depression or a hump, minimal irregularity of the profile, an unusual angle with our face – small defects that would be easy to ignore elsewhere on our body; unfortunately tends to become the “black hole” on our face.
Rhinoplasty (Nose Job) is the procedure to smoothen out the defects and give your nose a natural, symmetrical pleasing appearance which is in proportion and in balance with your face. But make no mistake – Rhinoplasty is a delicate and difficult procedure that requires dedicated training and exhaustive experience. Even then, in most “experienced” surgeons practice, it is common to require revision procedures in up to 10% patient. There is no universal “perfect” nose – every nose is “perfect” only when it is in sync with the remaining facial features. Hence, I believe in “tailoring” the surgery to your face – In my hands the surgery itself may differ from one person to the other for seemingly similar cosmetic problems with the nose.
In addition, it is vital to remember that our nose has a crucial function – to breath. There is little value in having a beautiful nose that you struggle to breathe through! In addition to addressing the cosmetic aspect, I will also open your airway to restore the full capacity of airflow. This may involve one or more of the following procedures which I carry out at the same time

  1. Septoplasty – If the septum, dividing the inside of your nose into right and left compartment, is bent, I will straighten it up to improve airway.
  2. Turbinoplasty – Turbinate are normal structures running along the side wall of your nose. If enlarged, they will need trimming down to restore airflow.
  3. Grafts – Spreader grafts, Batten Grafts are cartilage grafts required to improve airflow if you have restrictions in certain key areas of your nose. If required, I will discuss those during our consultation

Rhinoplasty (Nose Job) – Procedure Information & Post-Operative Care

https://www.eafps.org/Rhinoplasty.html – provides excellent information about this procedure. For your ease, this has been presented below with some modification to reflect my practice.

  • Rhinoplasty is a surgical procedure that is offered for two reasons. First, it is performed to improve the aesthetic appearance of the nose. Second, it is performed to alleviate a blockage of the nasal airway and to create an air passage that allows for comfortable and unhindered breathing. In most cases, I address the cosmetic (enhancing the appearance of the nose) and functional (improving the nasal airway) aspects of the nose in the same procedure.
    The following are possible reasons why you may seek rhinoplasty:

    • The nose was broken or injured by previous trauma
    • The nose feels blocked
    • The nose is crooked or deviated
    • There is a hump on the dorsum (back) of the nose
    • The nasal tip is too thick, round or uneven
    • The nose appears too long or too short
    • There is an indentation (saddle) on the dorsum (back) of the nose
    • The nose and lip require correction after previous surgery for cleft lip and/or palate
  • Studies suggest a minimal age of 17 years is preferred to perform rhinoplasty as the bony structures of the face near completion at this age and the shape of the bony skeleton of the face will not change much after this age. Infrequently it may be justified to perform the surgery at an earlier time. If this is the case I will talk to you about the possible need for a second operation in future years.

  • You may be an appropriate candidate for a rhinoplasty for one of the following reasons: 

    • you wish to improve the appearance of your nose
    • Trauma or infection has changed the shape of your nose
    • breathing through your nose is obstructed
    • you can improve the obstruction of your nasal airway by pushing the nasal tip up or by pulling the cheek tissues to the side
    • the effects of aging have changed the shape of your nose; you may feel the tip of your nose is hanging and droopy
    • a congenital defect like cleft lip was corrected at a young age, you are now at least 17 years of age and you would like the nasal deformity corrected.
  • The suitability of open or closed approach depends upon what exactly is required to refine your nose. I will explain the appropriate technique after assessment of your nose and discussing your goals

    The open rhinoplasty technique:  

    A small incision is placed across the strip of skin between your nostrils. This incision is combined with incisions on the inside of the nostrils. The skin of the nasal tip is then carefully lifted up and the cartilages and bones of the nose are surgically corrected. At the end of the procedure the skin is redraped and the incisions are closed with fine sutures. The small scar on the skin between the nostrils typically heals well and is barely perceptible in most cases.

    I use this approach when significant alteration at nasal tip is required or when grafts are needed. 

    The closed rhinoplasty technique: 

    No incision is placed on the skin and the structures of the nose are approached through incisions on the inside of the nostrils. When the corrections of the cartilaginous and bony structures of the nose are completed, the incisions are closed with sutures. I commonly utilise this approach when the area of concern is the bony part or upper 2/3rd of your nose.  .  

  • I will take a detailed history. This includes your complaints related to nasal breathing and your wishes regarding the external shape of the nose. You will also be asked about your past medical history, medications, allergies, smoking habits, previous surgery and more.  

    I will then perform a clinical examination. This will include inspection of the inside of the nose with an endoscope. This tells me about the condition of the midline partition of the nose (the nasal septum) and about the mucosa on the side of the nasal air passage (the turbinate).  

    I will also discuss in detail which changes to the outside shape of the nose are realistic and how they are achieved. Photographs of the nose will be taken prior to surgery in different planes. You must discuss your wishes and expectations with me during consultation. 

    If you have previously undergone rhinoplasty or and I feel that the cartilage obtainable from your nose will not be sufficient for shaping and reconstructing your nose, I may need to harvest cartilage either from your ear or your rib cartilage.

  • I perform the surgery while you are asleep under general anaesthesia.  

    The operation is usually performed as an outpatient day case procedure unless done later during the day, in which case you may need to stay overnight.

  • At the end of the procedure I will typically place small strips of adhesive tape over your nose and place a cast on these strips. The cast on the outside of your nose should be left in place for at least 7 – 12 days after the surgery. 

    I do NOT usually place packing in the nostrils.

  • You can typically get up and walk around the evening of the surgery or the following morning. You will have a splint on your nose. You may have some bleeding from the nostrils. This typically subsides on its own or with Otrivine nasal sprays.

    You should be prepared for moderate swelling and some bruising of the skin. The degree of swelling differs from patient to patient. A cold mask may be placed over your eyes and above the splint to decrease swelling and bruising. Most of the swelling and bruising will subside in 7-14 days although some swelling can persist for up to 2 months.

    You should expect to see the final appearance of your nose at the end of 1st year.

    Postoperative Care Instructions:

    • The first night keep your head elevated—the higher the better. Sleeping in a recliner can help. Then keep your head elevated 30 degrees for the first week after surgery.
    • Drink plenty of fluid. Use a cool-mist humidifier at your bedside to help moisturize membranes in your nose and mouth.
    • Avoid any travel requiring rapid elevation changes, i.e., airline or mountain travel for 2-3 weeks.
    • Nasal Saline Spray: Nasal saline mist spray must be used every 2-3 hours after surgery and can make your nose more comfortable after surgery.  These sprays are over-the-counter medications and can be purchased in any pharmacy.
    • Nasal Irrigations:  You will start the Nasal irrigations the day after surgery.  This must be performed at least twice daily.  At first they will feel strange if you haven’t done them before.  Soon, however, they will become quite soothing as they clean out the debris left behind in your sinuses after surgery.  You can expect some bloody discharge with the irrigations for the first few days after surgery.
      • You can make up the mixture using this recipe: mix ¼ teaspoon of non-iodised salt with ¼ teaspoon of baking soda in 250mL of room temperature tap water – Use a squeeze bottle to flush the solution gently through one nostril and allow it to come out through the other nostril or from your mouth.
      • Alternately, the “Sinus Rinse” system by NeilMed is available at many pharmacies with prepared packets of salt-baking soda mixture.
  • Rhinoplasty is a technically difficult procedure. Expertise and experience is required to obtain favourable cosmetic results.  

    The most frequent untoward effect of nose surgery is an unsatisfactory cosmetic (appearance) or functional (breathing) result.  

    A secondary or touch up surgery may be required to obtain the intended result. Secondary procedures may be minor; some may be performed under local anaesthesia and / or as an outpatient procedure. The need for a secondary procedure does not signify poor quality of the initial surgery. In the most experienced hands, rates of secondary procedures of 5% -10% are expected. Secondary or touch-up procedures are typically performed one year or later after the initial surgery.  

    Other complications occur infrequently. However, these can include:  

    • Bleeding: may occur after the surgery and last for up to 4 weeks. Most bleeding is self-contained but if your nose is bleeding uncontrollably then you need to contact my secretary during normal office hours or the local A&E out of hours.  
    • Infection: the risk of infection is very low after rhinoplasty. If swelling, redness or pain increases or you have a fever after surgery, you should notify my secretary.
    • Hypertrophic scars: if you have undergone a closed technique rhinoplasty your scars will be hidden inside your nose. If an open technique rhinoplasty has been performed you will have a small scar that is usually hardly visible between the nostrils. Rarely this scar may not heal properly and leave a perceptible scar requiring scar revision. 
    • Discoloration: after surgery there may be bruising around the eyes and occasionally on the nose. This bruising usually subsides after 2-4 weeks. Very rarely the colour of the nose skin may become darker or redder, which may persist up to a year.
    • Loss of smell: this occurs rarely after surgery, is almost always temporary and can last 6-12 months.
    • Numbness of the nose: a certain amount of numbness on the nose is expected after surgery and is almost always temporary. The numbness usually subsides after 6-12 months. It can involve your upper teeth.
    • If you are a smoker, please do not smoke for at least 4 weeks after surgery.
    • Nose Blowing and Straining:  You should avoid straining, heavy lifting (> 20 lbs) and nose blowing for at least 14 days after surgery.  Straining or nose blowing soon after surgery may cause bleeding.
    • If you have to sneeze, keep your mouth open to prevent nasal irritation.
  • If you have undergone an open rhinoplasty, sutures have been placed the skin between your nostrils. They will be removed 5-10 days after surgery. The incisions inside of the nose are closed with absorbable material and do not need to be removed.

  • Generally speaking the swelling and bruising around your eyes and nose may last up to 2-3 weeks. Most patients are 2 weeks off work after nose surgery.  

    You should refrain from exercise prior to removal of the cast and splints. After these have been removed, you may resume light sport with less intensity. However, please avoid strenuous physical activity for at least 6 weeks. Contact sports are typically avoided for at least one year.

  • After the cast on your nose has been removed I would ask you to refrain from using glasses for 4 weeks. You may need to obtain contact lenses for this duration. 

  • It is advisable to minimize sun exposure during the first year after rhinoplasty surgery. This includes avoiding the sun, especially in the noon hours, applying sunscreen and wearing a sun hat.

  • I recommend avoiding these activities for about 3 months after surgery in order to allow the swelling to decrease more quickly.

  • After surgery pain is mild to moderate for 1 to 3 days and is usually well managed with Paracetamol, Brufen or Codeine. Severe pain is not expected and if you are experiencing this then you should visit your doctor as soon as possible.

  • Case 1

    This young patient was concerned about the hump, asymmetrical nostril and difficulty in breathing since his teenage years. He had a closed Rhinoplasty to address his problems. The postoperative pictures are taken at three weeks from the date of surgery


    PREOPERATIVE PICTURE

    POSTOPERATIVE PICTURE AT 3 WEEKS

    PREOPERATIVE PICTURE

    POSTOPERATIVE PICTURE AT 3 WEEKS

    CASE 2

    AD was distressed with the large bulbous tip, the uneven profile and “masculine” angulation of her nose. She felt her nose was “too” big for her face.
    She had an open Rhinoplasty to correct the defects – Pictures were taken at three weeks following the surgery. At three weeks, she had significant swelling which settled down over the next month to give a further refined nasal tip and profile.


    PREOPERATIVE PICTURE

    POSTOPERATIVE PICTURE AT 3 WEEKS

    PREOPERATIVE PICTURE
    (notice the uneven light reflecting off)

    POSTOPERATIVE PICTURE AT 3 WEEKS
    ( Smooth straight light reflecting off now)

    PREOPERATIVE PICTURE

    POSTOPERATIVE PICTURE AT 3 WEEKS