I choose the technique of your rhinoplasty depending on your suitability for either open or closed surgery. 

Your suitability for an open or closed approach depends upon what exactly is required to refine your nose. I will explain the appropriate technique once I have assessed your nose, and we have discussed your goals.

The open rhinoplasty technique

I make a small incision across the strip of skin between your nostrils. I combine this incision with further incisions on the inside of the nostrils. The skin of the nasal tip is then carefully lifted, and the cartilages and bones of the nose are surgically corrected. At the end of the procedure, I redrape the skin and close the incisions 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 the nasal tip is required or when grafts are needed. 

The closed rhinoplasty technique

I do not need to make any external incisions with this technique. I access the skin and the structures of the nose through incisions on the inside of the nostrils. Once I have corrected the cartilaginous and bony structures of the nose, I close the incisions with sutures. 

I commonly utilise this approach when the area of concern is the bony part or upper 2/3rds of your nose.

Before surgery

Before the day of surgery, I will take a detailed history from you; this will include your past medical history, medications, allergies, smoking habits, previous surgery and more.  I will also ask you about your complaints related to nasal breathing and your wishes regarding the external shape of your nose. 

I will then perform a clinical examination that will include inspection of the inside of the nose with an endoscope. This examination tells me about the condition of the midline partition of the nose (the nasal septum) and 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 I can achieve them. I will take photographs of your nose before surgery in different planes. 

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

After surgery

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 and may experience some bleeding from the nostrils; this typically subsides on its own or with Otrivine nasal sprays.

You should expect moderate swelling and some bruising of the skin following surgery. 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 sometimes 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. You will need to keep your head elevated 30 degrees for the first week after surgery.
• Drink plenty of fluids. 
• 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 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 you can purchase them in any pharmacy.
• You will need to perform nasal irrigations twice a day, the day after surgery.  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 a 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.

What to avoid after surgery

• If you are a smoker, please do not smoke for at least four 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.

Case 1 – Before and After Rhinoplasty

This young patient was concerned about the hump of his nose and their asymmetrical nostrils. He had difficulty breathing since his teenage years. He had a closed rhinoplasty to address these problems. The postoperative pictures were taken at three weeks from the date of surgery

Case 2 – Before and After Rhinoplasty

This patient was distressed with the large bulbous tip of her nose, the uneven profile and “masculine” angulation of her nose. She felt it was “too” big for her face.

She had an open rhinoplasty to correct the defects. These pictures were taken at three weeks following the surgery when she had significant swelling. This settled down over the next month to give a further refined nasal tip and profile.

What is the most appropriate age for a cosmetic rhinoplasty?

Studies suggest that a minimum age of 17 years is preferred to perform rhinoplasty as the bony structures of the face near completion and 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.

Will I be asleep during surgery? Do I need to stay in the hospital?

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.

Will I have an outside cast, inside foil splints and inside packing after nose surgery (rhinoplasty)?

At the end of the procedure, I will typically place small strips of adhesive tape over your nose and put a cast on these strips. You should leave the cast in place for at least 7 to 12 days after the surgery.  I do not usually place packing in the nostrils.

Will sutures be removed after nose surgery (rhinoplasty)?

If you undergo an open rhinoplasty, I place sutures on the skin between your nostrils. I will remove these 5-10 days after surgery and close the incisions inside the nose with absorbable material that don’t need to be removed. 

How long will I need to take off work and sport following surgery of the nose (rhinoplasty)?

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

You should refrain from exercise before removal of the cast and splints. Once I have removed these, you may resume light sport with less intensity. However, please avoid strenuous physical activity for at least six weeks. You should avoid contact sports for at least one year.

Can I wear glasses after nose surgery (rhinoplasty)?

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

Can I sunbathe after nose surgery (rhinoplasty)?

It is advisable to minimize sun exposure during the first year after rhinoplasty surgery, especially in the noon hours. Applying sunscreen and wearing a sun hat is urged. 

May I visit the sauna or steam bath after nose surgery (rhinoplasty)? 

I recommend avoiding these activities for about three months after surgery to allow the swelling to decrease more quickly.

Is nose surgery (Rhinoplasty) painful, and do I need pain medication?

After surgery, pain is mild to moderate for 1 to 3 days and is usually well managed with Paracetamol, Brufen or Codeine. You should not experience any severe pain, and if you do , you should visit your doctor as soon as possible.