NOSE SURGERY (RHINOPLASTY)

What is Rhinoplasty?

A functional nose operation is done to straighten a nose which has been previously broken leading to change of the shape of the nose. Frequently this causes airway obstruction on one or both sides. A functional rhinoplasty is usually performed with the help of an Ear, Nose and Throat surgeon to straighten the septum (cartilage wall) between the 2 airway passages in the nose.

A cosmetic rhinoplasty is undertaken to change the shape of all or part of a nose which is functioning normally.

A functional rhinoplasty is usually performed under general anesthetic. Via incisions made inside the nostrils, the nasal bones usually have to be cut and repositioned, the septum usually has to be straightened by an ENT surgeon and on occasion the cartilage in the tip of the nose may have to adjust.

In a cosmetic rhinoplasty, the techniques used will vary widely and will depend on what the object of the operation is. Usually, incisions are made inside the nostrils. Through these incisions it is possible to cut and re-position the nasal bones, add or remove bone, adjust the cartilage in the tip of the nose, add or remove cartilage, adjust the shape and size of the septum and lastly adjust the position and size of the nostrils.

helpful advice

General Questions

Dr. van Oudenhove and the staff work as a team professionally and discreetly to make your experience as smooth and comfortable as possible. Here are some of the commonly asked questions and answers we've put together to enable our client's in making the most informed decisions.

What is the procedure?

We usually perform this procedure under general anesthetic. When only minor adjustments of the nasal tip cartilage is required, a local anesthetic with sedation is appropriate. The incisions are usually made inside both nostrils.

Where extensive surgery is required, we often join the incisions inside each nostril across the midline where the Upper lip and nasal tip meet. If we need to add cartilage to the nose in the form of a graft, this is usually harvested from the back of the ear or even rib cartilage. Once the necessary adjustments to the nose have been made, the incisions are sutured with dissolving stitches and both nostrils are plugged temporarily. A plaster of paris cast is then placed to cover the nose and extends onto both eyebrows.

Are there any Complications?

Post operative bleeding is very common in the first 24 hours after surgery. For this purpose, a gauze drip pad is placed across the nostril. This can be changed as frequently as is necessary.

Swelling and bruising affecting the cheeks, nose and eyelids is also very common. This is usually worst the morning after the operation. In some cases the swelling may be so severe as to prevent opening of the eyelids for 24 — 28 hours. This usually subsides quite quickly.

Pain is not a major feature of rhynoplasty. One must expect minimal to moderate pain associated with the discomfort of not being able to breathe through the nose until the plugs are removed 24 — 48 hours post operatively. The plaster cast is usually removed 10 days post operatively.

Other complications in the first few weeks are highly unlikely and seldom occur. These include collapse of the altered bony structure. This requires repeat correction as quickly as possible. In the long term, it is possible that there may be a perforation of the septum.

It is extremely important to understand that because of the nature of the procedure, no exact end result can be predicted. No exact end result can be promised.

Our pre- and post operative advice

Before surgery please do not take any products that contain Aspirin or high doses of Vit.E for 3 weeks prior to surgery.

Smokers should discontinue smoking, if this is not possible, they should cut down to 3 – 4 cigarettes a day before surgery and avoid all smoking for 24 hours before surgery. Smoking causes Coughing especially after an anaesthetic which causes discomfort and might even cause bleeding after the operation. Also, smoking irritates the nasal passages, further increasing the risk of bleeding.

Please report any signs of a cold, infection, boils or pustules appearing within 3 weeks of surgery.

The night before and the morning of surgery please wash your hair with an antiseptic shampoo.

Post operatively, it is very important to sleep on 3 — 4 pillows or raise the head of the bed. Bedrest for 24 hours is strongly advised with assistance to go to the bathroom. A soft diet usually requires little or no chewing and is advised. Avoid very hot foods or liquids. We do not recommend hot or warm compresses.

As mentioned above, please expect to find the nose blocked with plugs for the first 24 — 48 hours as well as a plaster cast over the nose for 10 days. There will be a slow oozing of blood from the nostrils. This is managed by changing the gauze drip pads regularly.

The post operative discomfort is mainly due to the plugging of the nose and pain is usually minimal.

Please be warned to expect extensive swelling and bruising around the eyes and upper cheeks. This is usually more severe on the second day and settles over the next few days. There may also be a blood-shot appearance to the whites of the eyes.

After the nasal plugs have been removed it is advisable to irrigate both nostrils with a solution of warm tap water (1 glass at 37°) containing half a teaspoon of salt, half a teaspoonful of sodium bicarbonate and 2 – 3 drops of vanilla essence. This irrigation solution is allowed to gently wash through the nostrils using a syringe while standing over the basin. This irrigation procedure needs to be repeated 2 – 3 times a day until the solution runs back clear. There is a lot of dried blood and mucous which needs to be cleared from the nostrils in the first few post operative days. Do not sneeze or sniff or dab your nose. Do not bend your head forwards. Do not attempt to clean your nose with cotton wool buds.

Please avoid all smoking for 10 days after surgery. Do not use nose drops unless instructed to do so and do not blow your nose for 3 weeks after surgery.

Wear comfortable loose fitting clothes that do not have to be pulled on over your head. You may wash your hair on the 5h post operative day providing you have someone to help with the face-up position.

Avoid sport and strenuous physical activities for +4 weeks.

Avoid prolonged exposure to sun and or heat for 3 months post operatively.

Finally it is vital to understand that it takes about 6 months before one is looking at the final result of nose surgery. This is difficult to understand but one cannot stress enough the need to be patient for 6 months.

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