Rhinoplasty

Rhinoplasty is a surgical procedure that reshapes the nose by altering its bone, cartilage (the firm but flexible tissue that gives the nose its shape), or skin.

During the operation, a surgeon makes carefully planned cuts to reach the underlying structure of the nose. Bone may be shaved or repositioned, cartilage may be trimmed, added to, or rearranged, and the skin is then re-draped over the new framework. The result is a nose that looks or functions differently from before — or both.

Rhinoplasty is used for both cosmetic reasons — improving the appearance of the nose — and functional reasons — correcting breathing problems. A surgeon will assess which type applies before recommending the procedure.

• A nose that is too large, too small, or not in proportion with the rest of the face.
• A dorsal hump (a bump along the bridge of the nose).
• A wide, bulbous, or asymmetrical (uneven) nasal tip.
• Nostrils that are too wide, too narrow, or flared.
• A crooked or off-centre nose.
• A deviated septum (when the wall dividing the two nostrils is shifted to one side, making breathing difficult).
• Nasal collapse or weakness that causes the airway to narrow during breathing.
• Nose deformity resulting from injury or trauma.
• Birth defects affecting the shape or structure of the nose.
• Revision (correcting the results of a previous rhinoplasty that did not heal as expected).

Rhinoplasty is usually not recommended in certain situations. Your doctor will explain whether any of the following apply to you.

• Patients whose facial bones are still growing — typically anyone under 16 to 18 years old.
• Active skin infection or inflammation around the nose.
• Uncontrolled systemic conditions (such as unmanaged diabetes or blood-clotting disorders) that increase surgical risk.
• Unrealistic expectations about what surgery can achieve.
• Certain psychological conditions where the patient's concern about their nose is disproportionate to any actual difference — a doctor may recommend counselling before surgery in these cases.

Rhinoplasty is a well-established surgical procedure, but like all operations it carries recognised risks that a patient should understand before consenting.

• Swelling and bruising around the nose and eyes, which is expected and usually settles over weeks to months.
• Temporary numbness or altered sensation in the skin of the nose or upper lip.
• Bleeding during or after the operation.
• Infection at the incision site or inside the nose.
• Difficulty breathing through the nose in the early recovery period.
• Asymmetry (the two sides of the nose look uneven after healing).
• Scarring — external scars are usually very small, but healing varies between individuals.
• Changes in skin texture, including thickened or irregular skin over the nasal tip.
• Septal perforation (a small hole forming in the wall between the nostrils) — this is uncommon.
• Reactions to anaesthesia (the medication that keeps the patient asleep or comfortable during surgery).
• Unsatisfactory cosmetic outcome requiring revision surgery.
• Prolonged or permanent changes in the sense of smell — rare.

Good preparation reduces the chance of complications and helps recovery go more smoothly. Your surgical team will give you personalised instructions, but the following describes what is typically expected.

Before the operation, patients are usually asked to fast (eat and drink nothing) for a number of hours — the exact duration depends on the type of anaesthesia planned and the hospital's protocol. Smoking slows wound healing and increases the risk of complications; most surgeons ask patients to stop smoking for several weeks before and after surgery. Alcohol should also be avoided in the days leading up to the procedure. Certain medications — including blood thinners, aspirin-type painkillers, and some herbal supplements — can increase bleeding and are typically paused before surgery. The team will review all medications and supplements the patient is taking.

Pre-operative tests commonly requested before rhinoplasty include:

• Blood tests to check overall health and clotting ability.
• A physical examination of the nose, including the inside of the nostrils.
• Photographs taken from multiple angles to assist with surgical planning.
• Nasal endoscopy (a small camera passed gently into the nostril) if a breathing problem is being corrected.
• In some cases, imaging such as CT to assess bone and internal structures.

On the day of surgery, the procedure itself typically follows these steps:

• 1. The patient is prepared and anaesthesia is administered — either general anaesthesia (the patient is fully asleep) or local anaesthesia with sedation (the patient is relaxed and drowsy but not fully unconscious), depending on the planned extent of surgery.
• 2. The surgeon chooses an approach: open rhinoplasty (a small incision across the columella, the strip of tissue between the nostrils) or closed rhinoplasty (all incisions hidden inside the nostrils). The choice depends on how much reshaping is needed.
• 3. The skin is gently lifted to expose the underlying bone and cartilage.
• 4. The surgeon reshapes the bone and cartilage according to the surgical plan — removing, repositioning, or adding tissue as needed. If cartilage needs to be added, it is often taken from the patient's own ear or rib.
• 5. If a deviated septum is being corrected at the same time (a procedure called septoplasty), this is done at this stage.
• 6. The skin is re-draped over the new framework and secured with fine sutures (stitches).
• 7. A splint or cast is placed over the outside of the nose to protect the new shape while initial healing begins. Soft internal packing may also be placed inside the nostrils, though not all surgeons use this.

Recovery from rhinoplasty takes place in stages. Most patients are monitored for several hours in a recovery area before being allowed to go home the same day, though some hospitals keep patients overnight. The full healing process — especially the settling of swelling — can take up to a year or more, even if the patient feels largely normal within a few weeks.

• Head elevation: Keeping the head raised (for example, sleeping with extra pillows) is usually recommended in the first days to weeks to reduce swelling.
• Splint or cast: The external splint is typically worn for about one week and removed at a follow-up appointment.
• Bruising and swelling: Noticeable bruising around the eyes is common in the first one to two weeks. Most visible swelling reduces over several weeks, but subtle swelling — especially at the nasal tip — may persist for many months.
• Avoiding pressure on the nose: Glasses that rest on the nose should be avoided for a period recommended by the surgeon. Sunglasses may need to be worn differently or taped to the forehead.
• Physical activity: Strenuous exercise, heavy lifting, and contact sports are restricted for a number of weeks. The surgeon will advise when it is safe to resume.
• Blowing the nose: Patients are typically advised not to blow their nose for several weeks after surgery to protect healing tissues.
• Sun exposure: The nose should be protected from direct sun to prevent uneven pigmentation (skin darkening) while healing.
• Wound care: Any external sutures (stitches) are usually removed within one to two weeks. The team will explain how to clean the area.
• Follow-up appointments: Regular check-ups are needed to monitor healing — initially frequent, then spaced out over months.
• Smoking: Continued smoking after surgery significantly slows healing and increases complication risk; most surgeons strongly advise against it.
• Emotional adjustment: The final appearance of the nose may not be fully visible until swelling has completely resolved. It is normal to feel uncertain about the result during the healing period; open communication with the surgical team is encouraged.