Rhinoplasties, or cosmetic nose surgery or nose jobs, can aim to:
- Remove an unsightly bump
- Reduce a significant tip
- Refine or make nostrils symmetrical
- Redesign a bone (notably westernise an Asian nose)
- Reduce or enlarge a nose disproportionate to the rest of the face
- Treat respiratory problems by correcting a deviated nasal wall (septoplasty) or a hypertrophy of the turbinate bones
- Correct a broken nose
- Correct the slope of the nasal point due to age or to achieve rejuvenation without needing a facelift
The aim of this surgery is to embellish the face by changing one or more aspects that are aesthetically displeasing to the patient whilst maintaining a natural and viable look in terms of morphology. The desired shape is determined by the patient and surgeon by analysing photographic clichés, enabling the best compromise to be made between:
1. the psychological aspect (what the patient wants and what would be best adapted to their personality)
2. the morphological and aesthetic aspect (what would be best adapted to the shape of the face)
3. the technical aspect (what the surgeon considers to be technically viable).
It should be pointed out that the upper part of the nose is made of bone and the lower part of cartilage. These have different healing capacities and reactions vary from patient to patient. The surgery is thus based on virtual projections: the surgeon cannot commit himself to producing an identical result, but will do everything for the results to be as close to the cliché as possible.
The operation can be performed on its own or, potentially, when an overall improved facial appearance is desired, at the same time as genioplasty (cosmetic surgery on the chin). It is necessary to wait until the patient has stopped growing (16/18 years of age) before proceeding with this type of surgery.
In most cases, only intranasal incisions will be made and the surgeon will carry out the entire operation by passing through the nostrils. He will remodel the bone and the cartilage that make up the solid nasal infrastructure. At the end of the operation, he will place an exterior cast and tubes in the nostrils to maintain the shape achieved. Afterwards, the skin’s elasticity should enable it to redrape on the new bone and cartilage structure. Skin quality and the way it reacts will thus be key in the final result.
When a nose has been operated on before, it may be necessary to initially pass externally, leaving a scar in a visible place (under the tip). To refine nostrils it is necessary to make an incision on each side at the foot of the nasal wings.
Non-surgical therapeutic alternatives
Filling products injections
By means of targeted injections of filler such as hyaluronic acid, it is now possible to slightly modify volumes in order to:
- Conceal a small irregularity of the dorsum (the bridge) of the nose,
- Redesign a new bridge, straighter on a slightly deflected nose or thiner on a nose a bit broad by injecting 2 parallel and central lines,
- Soften a nose too bony,
- Lift a tip that has a bit fell down with age. This effect is obtained thanks to a small over-thickness on the tip of the nose,
- Conceal the retrusion of the base of the nose responsible for the hollowing of the top of the nasolabial fold (by injecting the alar base)
Nevertheless, experience shows that with fillers to keep a natural look it is important to remain reasonable in terms ofvolume injected so as not to unbalance the ratio osseous tissues/soft tissues.
As for a surgical rhinoplasty, it will be necessary to evaluate and discuss the effect of injections on the general harmony of the nose before performing them. For instance, a change aiming at correcting the bridge of the nose front view can, in some cases, slightly modify the profile.
Injections are not very pleasant and results are temporary (1 to 2 years) but the effect is immediate, aftereffects are very light, with no or little social exclusion.
Botulinum toxin can be used to treat some nasal distortions of muscular origin:
For instance a targeted injection can correct an ageing nose which, due to continuous contraction of elevator muscles of the base of the nostrils, always seems to grimace whereas there is no osseous deformation. The nose looks as if it were pulled up on its base and looking down on the fore part of the tip. The injection will restrain this negative elevator action and redress the nose
Some distortions of the nasal dorsum, due to bridles related to some mimics, can also be corrected by selected injections of botulinum toxin.
Practical recommendations prior to the operation
Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. The operation will be cancelled if you are ill, or for women, if you are pregnant on the day of the operation.
Due to the risk of necrosis it is imperative that the patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….No progestin treatment (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms and scar inflammation.
The operation will be cancelled if these advices are not adhered to: assessment, no food or drink, stopping smoking…
When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE.
Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)
Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up.
Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.
Anaesthetic and hospitalisation
The operation is performed at the clinic and can be carried out:
- either, as in most cases, by spending one night in hospital and under general anaesthetic. The operation lasts 1 to 2 hours
- or in ambulatory without hospitalisation under assisted local anaesthetic when only soft tissue and cartilage area is being operated on. The duration of the operation in this case is roughly 45 minutes.
When the operation is carried out with a hospitalisation
Prepare comfortable clothing for when you leave the hospital that is easy to put on. You can usually leave the clinic the day after the operation.
In case of outpatient surgery (without hospitalisation)
You will usually be discharged a few hours after the operation. However, in certain cases (nausea, stress..) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.
You should arrange for someone to be with you at home. In fact, you should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).
Before leaving home prior to the operation, ensure that you have prepared everything for your return:
– Prepare a light meal
– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.
For the first few days at home you must relax as much as possible and avoid any over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.
It is important that you do not smoke for 15 days in order to facilitate healing and to reduce the risks of necroses.
In theory no pain will be experienced, but there will be some level of discomfort from the plaster and dressings.
Bruising around the eyes will continue for 6 to 20 days and can be concealed with make-up.
Swelling is at his height on the 3 rd – 4 th post-op day and then fades progressively, but the nose will take several months to reach its definitive shape. Just like the bruises, swelling and potential hardening vary from one side to the next. Often asymmetry appears after the operation, yet this does not have any negative effects on the final result.
In addition to common products such as Arnica, cold compresses calm bruises and swelling, enabling them to heal more quickly. It is also possible to drain the face by temporarily adopting a sleeping position with the chest slightly raised.
If you wear glasses, you will not be able to place them on your nose when you leave the hospital. They will be placed on the cast (then taped on your forehead after the plaster is removed if you cannot go without wearing them.) Contact lenses can be worn from the day after the operation.
Note down the telephone number of the office (01 45 53 27 17 from France and 33 1 45 53 27 17 for international call) and the number of the clinic, in your mobile phone. Do not hesitate to call us if you are worried. Call us if you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.
Leave from work: 1 to 2 weeks depending on your professional activity
Dressing 1 to 2 days
Cast 7 days (if the operation was or included to correct a bump)
Bruises 7 to 15 days around the eyes
Swelling very visible for 15 days
Exercise combat sports that can lead to blows on the nose can be practised after two months, but you should be aware that a violent blow, even long-term, can harm the result.
In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with surgery, you should be aware of the risks and possible complications.
General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics
Infections are rare, despite the natural presence of bacterial flora in the nasal crevices. However, it is also very important to respect antiseptic and antibiotic prescriptions after surgery. If infections occur, surgical draining may be necessary.
Haematomas are very rare complications in nasal surgery, but need to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.
In the first hours after the operation there is generally moderate bleeding. Exceptionally, a haemorrhage can occur that will need to be treated in the operating theatre.
The extent of healing when one or more external incisions are made, notably to refine nostrils, is unpredictable. Immediately after the operation a scar may inflame or weep, requiring specific local treatments that can often be long. Respect of advice concerning cleanliness, smoking cessation and monitoring sessions play an important role. In the mid-term, a scar can sometimes develop poorly: thicken, expand, form keloids. This essentially depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)
Risks from anaesthetics
Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.
(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)
Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues
The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up results are evoked prior to any aesthetic operation.
Rhinoplasty – specific information :
– Imperfections of the result
Certain problems linked to results stem from misunderstanding between the patient and surgeon concerning the aim of the surgery or from decisions taken without due consideration. This risk can be limited by careful reflection prior to the operation. A patient, who initially asked for a certain shape of nose, may wish to undergo a second operation to accentuate or reduce the initial result. In general this happens when something has changed in a patient’s life, e.g.: a young woman wanting a softer nose after giving birth, another one wanting a straighter and less small nose after having taken on additional job responsibilities.
Other problems are caused by unexpected tissue reactions specific to the patient that can lead to an excessive, insufficient or asymmetric result. This risk especially concerns patients with a poor quality of skin, but retractile fibroses are always possible. If resulting imperfections are not easy to bear, they can potentially be corrected by further surgery, generally much less intense than the first operation, but it is necessary to wait until the end of the healing process before proceeding to a second operation.
The operation can lead to general temporary problems (3 to 6 months) with regards to sensitivity in the upper lip and nose region.
Potential rhinoplasty complications
– Loss of vision
Fortunately this risk stemming from surgical error is more than exceptional, but it has been reported in the international scientific litterature.
– Necroses and skin seizure
These are rare but still possible. Simple wounds or erosions usually heal without leaving marks, whilst necroses, also rare, require specific care that is often long and leaves a small scar. The risk increases greatly if a patient smokes or through repeated or major traumatisms. Sniffing cocaine habits is contraindicated for the operation since it leads to septum (nasal wall) necrosis in the long-term.
Two to three months after the operation, a first evaluation of the result can be made. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.
Usually an appreciable aesthetic result is achieved with real psychological benefits. When a septoplasty, or surgery on the turbinate bones, is performed, the patient’s comfort is also greatly improved.
By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.
Some information is available in English on the page « Nose surgery » of the ISAPS’website (International Society of Aesthetic plastic Surgery) section : « Info for patients ».
You will also find some information in French on the page « Rhinoplastie » of the SOFCPRE’s website (Société Française de Chirurgie Plastique Reconstructrice et Esthétique).
Specific information delivered on this website is based on Doctor Le Louarn’s practice and on his scientific works:
1 – LE LOUARN C. : Conférencier : les Rhinoplasties
X1ème congrès de la SOFCEP – Strasbourg 11-12/9/1998
2 – LE LOUARN C. : La rhinoplastie : nouvelle possibilité technique
SOFCPRE – Xème Video-Forum de chirurgie plastique et Esthétique 26-27/06/1998
3 – LE LOUARN C. : Instrumentation de chirurgie esthétique du nez . brevet INPI 96 03042
Regarding nose surgery, the following publications and works can also be listed (this list is obviously not exhaustive and may be amended):
1 – GUYURON B., JACKOWE D. : Modified tip grafts and tip punch devices
Plast. Reconstr. Surg. 2007 Dec ; 120(7):2004-10
2 – AIACH G. : Abord externe et greffes cartilagineuses : une association très complémentaire
External transcolumellar approach and cartilage grafting: a very complementary association
Rev Stomatol Chir Maxillo Fac. 2003 Sep;104(4):215-22
3 – KELLY MH, BULSTRODE NW, WATERHOUSE N. : Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation.
Plast Reconstr Surg. 2007 Nov;120(6):1654
4 – GOLA R. : La rhinoplastie fonctionnelle et esthétique
Springer-Verlag France 2000 : ISBN 2-287-59688-7
5 – AIACH G. : Atlas de Rhinoplastie et de la voie d’abord externe
Masson 1996 et 1993 : ISBN 2-225-85205-7
6 – AIACH G., MADJIDI A. : Développements récents dans la rhinoplastie esthétique – Recent developments in aesthetic rhinoplasty
Ann Chir Plast Esthet. 1995 Dec; 40(6):615-38.
7 – PECK G.C. & PECK G.C. Jr : Rhinoplasty : classic problems and complications
Chapter 1 in Complications and Problems in Aesthetic Plastic Surgery
Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6
8 – GRUBER R. : Rhinoplasty and open Rhinoplasty
Chapter 2 in Complications and Problems in Aesthetic Plastic Surgery
Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6
9 – REES T.D. : Rhinoplasty
Part 2 in Aesthetic Plastic Surgery, Volume I
Edited by Thomas D. REES – Saunders 1980 : ISBN 0-7216-7519-0
10 – SHEEN J.H . : Aesthetic Rhinoplasty
The C.V. Mosby Company 1978 : ISBN 0-8016-4575-1
11 – JOST G. : Rhinoplasties
Atlas de Chirurgie Esthétique et Plastique – Chapître 2 (Atlas of Aesthetic Plastic Surgery)
Masson Editeurs – 1975