Rhinoplasty Procedure Guide

What can a rhinoplasty procedure achieve?

This procedure can achieve many things, including:

• Improving breathing difficulties. Another term for this is functional rhinoplasty.
• Reducing the size and profile of the nose. Another term for this is a reduction rhinoplasty.
• Increasing the size and profile of the nose. the surgeon may refer to this as an augmentation rhinoplasty. This surgery may require the use of a graft or a nasal implant.
• Re-modelling the shape of the tip, bridge and/or nostrils of the nose. This may involve breaking the nasal bone and rearranging the cartilage.
• Altering the angle between the nose and upper lip.

Why have a rhinoplasty?

The nose is the central feature of the face.  In addition, its size and shape contribute to facial balance. While people inherit the features of their nose from their parents, these features usually only begin to develop during the teenage years. As a result, a wide variety of nose shapes and sizes can be found on the faces of those around the world, and everyone has different ideas about what they think a ‘good’ nose looks like.

Consequently, some people are unhappy with the size or shape of their nose. As a result, they may consider having a rhinoplasty. Some people may have experienced trauma or injury that has damaged their nose, and they may wish to fix this. Others may experience difficulty breathing because of their nasal structure and would like to have a nose job to fix this.

There are several different reasons patients may consider having a rhinoplasty. These reasons include the desire to make changes to how they look and to make changes to improve their health. A rhinoplasty can, therefore, achieve the following changes:

Rhinoplasty can alter the whole facial balance; therefore, it is recommended patients take time after the consultation to make sure this procedure is definitely what they want. Furthermore, they should consider how changing the appearance of your nose will affect the dynamics of their other facial features like the eyes, the mouth and the chin.

How much does a rhinoplasty cost?

Rhinoplasty surgery can cost anywhere between £5,000 and £12,000. The price bracket is relatively wide because many variations may be suitable or recommended for each patient’s individual wants or needs. During the consultation, a patient and surgeon agree upon the right procedure type and procedure technique. Only after the consultation will a final price be offered, which will reflect the choices and requirements of the procedure. Higher or lower costs may be incurred as a result of the following variables:

• Surgeon experience
• Anaesthetist experience
• The complexity of the individual procedure
• Surgical techniques (whether it is a revision surgery or Rib Graft, for example)
• The time required in surgery for each patient’s case

The final price will be transparent and include no additional costs. The final price will cover:

• Highly rated CQC hospital cost
• Surgeon and Anaesthetist’s time and expertise
• Overnight stays (should they be required)
• Aftercare and follow-up appointments

Who are the best candidates for rhinoplasty?

Rhinoplasty is a popular cosmetic procedure in the UK for both men and women. Another name for this surgery is a nose job, and it involves altering your nose's size and/or shape. Rhinoplasty candidates may choose to have this surgery because of an issue with the appearance of their nose. They may also opt to have this procedure done because they are experiencing breathing issues. These can include loud, noisy breathing, which is caused by a structural obstruction. In addition, these candidates can also snore very loudly when sleeping due to the same structural issues.
Suitable rhinoplasty candidates are:

• Unhappy and conscious of the current nose shape or size.
• Would like to correct damage or injury which has occurred to the nose.
• Have breathing difficulties because of the nose.
• Snore loudly.
• Have a healthy BMI.
• Are relatively fit and well.
• Have no serious health conditions.
• Have realistic goals for your surgery.
• Feel mentally and emotionally ready for the procedure.

Deviated septum

Many patients can suffer from breathing difficulties because of a deviated (bent) septum. A septum is a thin structure inside the nose made of bone and cartilage and is covered by a mucous membrane (a thick slimy fluid) and small blood vessels.

Ideally, the septum separates the nose directly in half, leaving equal space on the left and right sides, with one nostril for each side. However, a deviated septum does not run straight and can block the passage of airflow in some places.

A patient can be born with a deviated septum, or an injury/trauma can knock it into a new position. As well as breathing issues (through one or both nostrils), other symptoms can include feeling like a have a blocked nose, sinus infections and pain such as a headache.

A septoplasty can be performed to correct the deviation by straightening the septum or removing parts of it. An ENT surgeon would usually perform this operation alone. However, it’s important to be aware that this will not necessarily change the outside look of the nose.

For patients also unhappy with the shape of their nose, a plastic surgeon may be able to perform a septorhinoplasty. This is a specialised rhinoplasty procedure and can be thought of as combining two procedures. First, the surgeon will change the outside of the nose (as agreed with the patient before surgery) and correct the septum to alleviate any symptoms.

Turbinate hypertrophy

Turbinates are small ridges made of boney structures layered inside the nose that help to filter and warm up air when breathing in. It’s common for turbinates to become enlarged for a short period of time, for example, when suffering from nasal allergies but for some patients suffering from enlarged turbinates is an ongoing problem.

When enlarged, they take up more space in the nose. The physical symptoms are often a feeling of blocked nose, nasal congestion in alternating nostrils, nasal blockage, noisy breathing and increased nasal discharge. The treatment depends on what is causing the enlargement.

Often medications can be used to treat short-lived symptoms, but for long term issues, a turbinectomy (removal of turbinates) might be recommended. Again, for most patients simultaneously, be most likely to perform this. But for patients also wanting to change the appearance of their nose, a plastic surgeon might be able to perform a turbinectomy at the same time. In this case, the closest turbinate to the nostril will likely be removed/ shaved down.

The surgery is very patient-specific, and a plastic surgeon might recommend patients discuss it with an ENT doctor first. If a plastic surgeon can perform the surgery simultaneously, it alleviates the need for two separate surgeries.

How is a rhinoplasty procedure performed?

A rhinoplasty procedure usually takes anywhere from 90 minutes to 3 hours to perform. Often the anaesthetist uses a general anaesthetic to put you to sleep for the procedure; however, they can use local anaesthetic with sedation too. After the procedure is complete, patients may have to stay in the hospital for 1 or 2 nights.

Consent

Patients will meet the BAAPS/BAPRAS surgeon to sign the consent form before the procedure takes place. This may happen at the pre-operative consultation or on the day of surgery. Although patients may be aware of the risks and complications, it's advised that patients read the consent form fully before signing. The surgeon may use a marker pen to draw some lines on the nose and ask for permission to take some before and after pictures.

Anaesthesia

Patients will meet their anaesthetist on the day of the rhinoplasty surgery. They may decide to use a general anaesthetic to put the patient to sleep for the surgery, or they may decide to use a local anaesthetic with sedation. The choice of which to use will be made during the initial consultation. If they use a general anaesthetic, patients may feel drowsy for a while after.

Incisions

The surgeon can perform a rhinoplasty by using an open or a closed approach. The surgeon will decide which approach will best suit the nose when examining the patient at the consultation.

Closed rhinoplasty 

For a closed rhinoplasty, the surgeon will make an incision inside each one of the nostrils, through which they will perform the surgery. An advantage of this technique is that there will be less swelling and no visible scarring after surgery.

Open rhinoplasty 

In an open rhinoplasty, the surgeon will make incisions inside the nostrils and an extra incision on the outside along the columella, which is the area of skin between the nostrils. The benefit of this approach is that it allows greater alteration of the nose shape, which may not always be possible with a closed approach. This technique is most useful when patients want to increase the frame of the nose.

Grafts and implants

Surgeons do not always require the use of a graft or implant in all rhinoplasty procedures. However, they may use them to define and build the nose in augmentation rhinoplasty.

A graft is when the surgeon uses tissue from the patient's own body and moves it to another part of the body. For a rhinoplasty, this may involve taking cartilage from the ears or bone from the hip, elbow or skull to build up the nose. This means that the graft will consist of its own tissue. Therefore, there is less chance the body will reject it. There is, however, the risk that it may absorb or shrink to some extent with time.

In some cases, a patient's own tissue may be too small or weak to support the changes they would like for the procedure. Consequently, the surgeon may choose to use a synthetic nasal implant. These implants are made out of approved materials such as silicone or Gore-Tex and have the advantage of not shrinking or changing over time.

Closing of incisions

Next, the surgeon will use sutures to close the incisions. In addition, they will pack both nostrils using dressings and apply a splint to the nose to hold it in its new position. This packing will often remain in place for about 7 days after surgery, when it will be removed by either the surgeon or nurse.

Return to the ward

Finally, once the nose surgery is over, the medical staff will take the patient back to the ward. If patients have had a general anaesthetic, they will wake up gradually and may feel drowsy for a few hours. Patients may be able to return home the same day as surgery after 1 or 2 nights, depending on how well the recovery is going.

What to expect from the rhinoplasty consultation

Patients will meet the BAAPS/BAPRAS surgeon for a consultation before having the rhinoplasty. During this meeting, the surgeon will examine the face and nose and ask for permission to take some before and after pictures. The rhinoplasty consultation will usually last between 15 minutes to 1 hour. It will be an opportunity for the surgeon to discuss the procedure with the patient and find out more information about them. They will ask for:

• Current health status
• Any medical conditions
• Past medical history
• Past surgical history
• Any medication use. This includes prescription, over-the-counter and herbal medications.
• Alcohol consumption, smoking, and recreational drug use
• Any allergies
• Goals for the surgery.

It is strongly advised that patients are as honest with the surgeon as possible at this consultation so they can gather accurate information about you. Being open and honest allows the surgeon to formulate a clear picture of the patient's health and, in turn, allows them to make appropriate decisions. Conversely, if the information provided is not accurate, patients may hinder the surgeon's ability to make good decisions about the care offered. Furthermore, it is in the patient's best interests for the surgeon to have a true idea of their personal goals for the rhinoplasty. This way, they can assure patients whether or not their goals are realistic, and as a result, patients are more likely to be happy with the final results.

Questions to ask during the rhinoplasty consultation

While the consultation is an opportunity for the surgeon to ask questions, it is also the time when patients get to ask any questions they may have. Therefore, it is recommended that patients spend some time thinking of questions beforehand and writing them down. Consequently, patients will feel prepared and less likely to forget to ask what is important to them. Below is a list of questions patients may like to ask:

• Is rhinoplasty suitable for me?
• Which surgical approach do you think is best for me?
• Will I be in pain after the surgery?
• Will there be any scarring, and if so, where?
• How long will it take to recover from the rhinoplasty?
• Do you think my expectations are realistic?
• Have you got any before and after pictures of rhinoplasties you have done previously?
• What are my options if I am not happy with the results?

What are the main rhinoplasty risks and complications?

Before patients consent to having a nose job, they should take time to consider the risks and complications of the procedure. Many of the rhinoplasty risks and complications are rare, and patients may think it unnecessary to know about them. It is, however, vital that patients fully educate themselves on them.
All surgeons strongly recommend that patients wait at least two weeks after the consultation before agreeing to have the surgery. This will give you time to make an informed decision about the procedure.
Rhinoplasty risks and complications include:

Bleeding

Minor bleeding is common after this procedure. In addition, it is common to experience mild nosebleeds. The surgeon will be able to give the patient advice on how to manage these if they occur and how best to avoid them.

Heavy bleeding is rare but is possible and may be severe. This can happen directly after the procedure or a few weeks after and requires immediate medical attention. 

Infection

Surgery is invasive and introduces the risk of infection to the body. If patients develop an infection because of the surgery, they will notice that things are not settling down as expected.
Signs of infection to look out for are:

• A temperature of 38° C or over
• Redness at the wound line that begins to spread away from the wound
• Yellow pus-like or foul-smelling fluid from your wounds
• An increase in pain or discomfort that is your pain medication does not help. 

Mild infections (often wound infections or delayed wound healing) usually settle down with antibiotics. However, there is a small chance that an infection may affect the final results of the operation. If this were the case, the patient might require further surgery. 

Difficulty breathing

It is quite common to have difficulty breathing through the nose during the first week after the operation. This may be due to the swelling within the nostrils. This is because the swelling reduces the area of the nasal airway. Although uncommon, these breathing disturbances may continue and become permanent. This should, however, not be the case as all rhinoplasty procedures try to optimise breathing. 

Altered sense of smell

A change in smell is temporary in most cases and is usually only noted when tested for by a doctor. A total, permanent loss of smell is an infrequent complication of a nose job. 

Damage to the nasal septum

Damage to the cartilage wall in the middle of the nose (the septum) may occur during this procedure. Depending on the extent of damage, medical and/or surgical options are available to fix this.  

Graft or implant migration

In cases where an implant has been used in an augmentation rhinoplasty, there is a small risk that the implant may make its way out through the skin of the nose or its lining. This may occur out of the blue, months or years after the operation. It may also happen if there is an injury to the nose. Patients may require another operation to fix this.

Scarring

Scarring from your nose job is normally not visible, especially if your surgeon uses a closed incision approach. However, the extent of scarring is highly dependent on the ability of your skin to heal. You may like to ask your surgeon about the scars specific to the technique that they choose for you. 

Aesthetic

There is always the risk that you will be unhappy with the result of your procedure and the appearance of your nose. Therefore, we advise patients to choose their surgeon carefully and make sure they fully understand your goals before you have your surgery.

Rhinoplasty revision

In patients who require further rhinoplasty-related surgery, there is a risk that the structure of the nose may collapse. This is because the nose is a delicate structure. Therefore, re-operation is only recommended in a small number of cases.

How to prepare for rhinoplasty?

After surgery, patients will want to relax as much as possible to aid in recovery. Getting things prepared before surgery can help to do this.

Household work

It is recommended that patients try to get some of the big jobs out of the way before having surgery. For example, patients may like to do the washing, take out the bins and do a general clean the day before the procedure. This way, patients will hopefully not have to stress or worry about doing these things in the first few recovery days.

Shopping

It is likely that patients will not feel like going to the supermarket to do a food shop in the first few days after the rhinoplasty. Therefore, it is advised that patients do a big food shop and stock up the fridge a day or so before they come into the hospital for the surgery. Patients may even like to make some meals and freeze them. This will mean that they won’t need to worry about cooking for a few days as the nose begins to heal.

Children and pets

To minimise stress levels during the recovery, they may like to organise some family or friends to help look after young children and pets.

Eyecare

No pressure must be applied to the nasal bone in the weeks following your rhinoplasty. Consequently, if patients normally wear glasses, they should avoid using these for the first 6 weeks after surgery, at least. Patients may like to purchase some prescribed, temporary contact lenses for this recovery period before the operation.

Driving

Patients will be unable to drive themselves home after the surgery. They may like to ask a family member or friend if they will be able to drive them home after surgery.

Diet

After the surgery, the BAAPS/BAPRAS surgeon will recommend eating high-protein, low-sodium foods, including fresh fruits and vegetables. In addition, they should try to stay hydrated with water and caffeine-free beverages. Perhaps consider avoiding consuming high amounts of salt and sugar during the recovery period.

Clothing

Following the rhinoplasty, patients should wear items of clothing that fasten easily from the front or the back. Avoiding clothing that needs to be pulled over their head will help to avoid the surgery area.

Sleeping

Patients may find it more comfortable to sleep propped up after surgery, making sure there are plenty of extra pillows. In addition, it is advised that patients rest and sleep in an inclined position on their back for the first few days. This will help to avoid contact with the surgical area and will also help reduce swelling.

The surgeon will give you specific advice on your rhinoplasty preparation. Following the surgeon’s advice will help to achieve the results patients desire

Pre-op appointment

This appointment is essentially a health check to ensure patients are suitable for surgery. Many parts of the assessment can be undertaken by the patient via a questionnaire a few weeks prior to the surgery date. Once the questionnaire is submitted, an individual assessment will determine if a face-to-face appointment prior to the surgery date is needed or if the patient can have their pre-op assessment on the same day as their surgery. For some locations, it is routine to have the assessment a few days to a week before surgery. It is vital to attend the pre-operative appointment.

What happens at a pre-operative assessment?

This can vary from location to location but it will generally consist of:

• A questionnaire on physical and mental health, including any medication
• Height and weight measure
• Blood tests
• Blood pressure measure and sometimes a physical examination

Occasionally patients will have an MRSA screen, this consists of taking swabs from parts of the body to check if the patient is an MRSA carrier.

The aim of the assessment is to ensure that patients are as fit as possible prior to the operation. Typically patients will only hear back about their results if there is an issue.

What to expect after a rhinoplasty?

The consultant will speak to the patient about their rhinoplasty aftercare during the consultation for the surgery. They will give specific time frames for when patients can begin to start activities like driving, exercising and when they can go back to work.

Below are some general rhinoplasty aftercare tips:

Directly after the surgery

If the surgeon decides to use a general anaesthetic, patients will awaken slowly after the surgery. Memory and concentration may be affected; however, this will only last for one to two days. If the surgeon chooses to use a local anaesthetic, patients may experience altered sensation on the nose, but this will eventually wear off. Patients will not be able to breathe through the nose for a while after the surgery.

Returning home

Patients will usually be able to return home on the same day or sometimes an overnight stay is needed. However, they will be unable to drive, so they should arrange for someone to collect you from the hospital. Before patients leave the hospital, the surgeon will arrange within 1 to 2 weeks for a follow-up appointment. They will examine the nose, remove any non-dissolvable sutures and may replace the dressing if necessary. They will also advise the patient on the next steps of care. Post-op appointments are vital for ensuring healing is going to plan, patients must attend these.

Pain management

Patients should expect to experience some pain, swelling and bruising around the nose and eyes after rhinoplasty surgery. This can take three to six weeks to settle. In the meantime, patients can manage it using a cool compress and over-the-counter pain relief such as paracetamol. Patients should also sleep with their head propped up by pillows for a couple of days. This will help to reduce swelling and, in turn, pain. 

Dressings

The surgeon will likely “pack” both nostrils with dressings and apply a splint to the nose to maintain its new shape. Because of this, patients must remember to breathe through their mouth following the rhinoplasty. For example, if patients need to sneeze, they will need to try and remember to do this with their mouth open. In addition, patients should avoid blowing their nose or removing any crust until the surgeon removes the splint. They usually remove the splint around seven to ten days after the operation during the follow-up appointment.

Returning to work

After the procedure, it is recommended that patients take around two weeks off before returning to work. In addition, patients must avoid dusty or smoky areas and heavy lifting for at least four to six weeks.

Returning to exercise

Patients should avoid strenuous activity, heavy lifting and contact sports for at least four to six weeks. 

General tips

Patients should try to avoid blowing their nose and sneezing after rhinoplasty surgery. In addition, if patients usually struggle with allergies, they may like to avoid any known triggers. It is also advised that patients avoid hot baths and getting the splint wet after the procedure.

Final results

Patients may see an instant difference to the nose in the first few weeks following surgery. Despite this, it can take around 6 to 12 months to appreciate the full cosmetic results, so it is important to be patient.

Usually, the scars tend to be pink and raised in the first few weeks after surgery, but they will eventually fade to faint white lines over the following months. As the incisions used for this procedure are either inside the nostril or on the skin area between the nose's nostrils, scarring will be well hidden.

The nose will feel stiff following an augmentation rhinoplasty (enlarging the nose), and this is likely to be a permanent change. This is because it no longer has the flexibility of the natural frame of the nose. However, most rhinoplasty patients say that you get used to this change with time. 

Following the surgeon’s specific rhinoplasty aftercare advice will reduce the risk of complications and help achieve the best results from the procedure.

There is a limitation to the amount of rhinoplasty reduction that can be achieved if you have mature skin or a very large nose. This is due to the elasticity of the skin and its reduced ability to shrink down to a smaller frame. Equally, it may not be possible to make the nose as large as you may desire. 

In addition, if you have had a change in the contour of your nose from an injury, it may not be possible to completely correct this. It's important to have realistic expectations and discuss your goals with your surgeon who will let you know what's possible.

This procedure is not usually available on the NHS for cosmetic reasons. However, it may be provided by the NHS if you require the surgery to help with breathing difficulties although wait times may be long. Do speak with your GP about any concerns you may have about nasal breathing issues. Patient Care Advisers are always on hand to discuss the various types of rhinoplasty procedures and what they can address.

The majority of plastic surgeons are happy to see you for your first consultation without having a referral from your GP. If however, you plan to go ahead with your rhinoplasty, your surgeon may ask to contact your GP. This will be so that they can gather information about your past and current medical history.

Certain medical conditions may require a GP sign off prior to having surgery, but your personal Patient Care Adviser will let you know if that is necessary.

Your BAAPS/BAPRAS surgeon will advise that you wait for at least 6 weeks after rhinoplasty surgery before wearing glasses. This will prevent the application of pressure to the nasal bone.

You should ensure that if you must wear glasses that they are loosely fitted and padded in order to protect the results of your rhinoplasty. You could also use a nose guard or tape to lift your glasses off your nose or consider looking into contact lenses.

There can be an increase in the risk of complications from surgery if you are a smoker. We strongly recommend that you stop smoking and using all nicotine products at least six weeks before and after rhinoplasty surgery. Furthermore, if you can reduce your alcohol consumption before your surgery, this can also benefit you.

Taking recreational drugs will also increase the risk of complications occurring during and after your procedure.

This appointment is essentially a health check to ensure patients are suitable for surgery. Many parts of the assessment can be undertaken by the patient via a questionnaire a few weeks prior to the surgery date. Once the questionnaire is submitted, an individual assessment will determine if a face-to-face appointment prior to the surgery date is needed or if the patient can have their pre-op assessment on the same day as their surgery. For some locations, it is routine to have the assessment a few days to a week before surgery. It is vital to attend the pre-operative appointment.

What happens at a pre-operative assessment?

This can vary from location to location but it will generally consist of:

• A questionnaire on physical and mental health, including any medication
• Height and weight measure
• Blood tests
• Blood pressure measure and sometimes a physical examination

Occasionally patients will have an MRSA screen, this consists of taking swabs from parts of the body to check if the patient is an MRSA carrier. The aim of the assessment is to ensure that patients are as fit as possible prior to the operation. Typically patients will only hear back about their results if there is an issue.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/cosmetic-procedures/nose-reshaping-rhinoplasty/ NHS
• https://baaps.org.uk/patients/procedures/13/rhinoplasty_augmentation British Association Of Aesthetic Plastic Surgeons
• https://www.bapras.org.uk/public/patient-information/surgery-guides/rhinoplasty British Association of Plastic, Reconstructive and Aesthetic Surgeons
• Understand.com Understand
• https://www.enthealth.org/ ENT health

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. In addition, before publishing, all the information is reviewed by a surgeon specialised within the relevant field.