Rhinoplasty is the oldest facial plastic surgery going back thousands of years. Today, it is the most desired cosmetic procedure among men, and the second most popular procedure among women after breast augmentation.
Also known as a “nose job,” rhinoplasty is the most complex cosmetic surgery procedure. The procedure requires both maintaining and improving the function of the nose while achieving excellent cosmetic results. This surgery requires the skills of a specialist and an individualised approach for every patient that considers the limitations of the patient’s nasal structure, the desired results, the effects of surgery on the function of the nose and both short-term and long-term results. This is why it is essential to seek out a specialist surgeon who understands the complexities of this procedure and performs it as a large percentage of their practice.
Dr. Gerarchi of Sydney is a rhinoplasty specialist. Over half of the nasal surgery procedures he performs are complex revision cases that are the result of undesired results from previous surgery. Functional or cosmetic problems as a result of an initial procedure are not so easily corrected, which makes it essential to choose the right plastic surgeon the first time.
Reasons for Rhinoplasty Surgery
Nasal surgery is performed for a wide range of reasons ranging from functional or reconstructive to cosmetic, or some combination. The nose may be made longer or shorter, larger or smaller, narrow or wider. Cosmetic issues like an off-center nose or humps may be corrected, breathing passages may be opened up, or the nose may be refined with subtle changes. The following are common reasons to consider nasal surgery.
Many patients choose nasal surgery to correct a nasal fracture. When injury occurs to the facial bones, appropriate treatment is necessary as soon as possible. Nasal fractures are also the most common type of fracture to the face and they often go unrecognized at the time of the accident or trauma. After injury to the nose, it is recommended to get an early assessment by a nose specialist to recommend the proper action and to exclude any internal nasal injuries that may cause long term problems. If addressed very soon after the injury, simple surgery may be performed to treat the fracture. If the fracture goes undiagnosed or untreated, more formal surgical intervention may be required.
Deviated Septum Repair
A deviated septum is a condition in which the center cartilage of the nose, or the nasal septum, is off-center, which can create breathing difficulties. The condition is usually more pronounced on one side and it may result in sinusitis, or chronic sinus infections. About 80% of septums are off-center to some degree and the condition may be present from birth or it may be the result of trauma, and may progress or become worse with time. Surgical correction of a deviated septum through surgery can result in dramatically improved breathing.
Many patients also choose surgery to improve the appearance of their nose. The nose is the most prominent facial feature, and its appearance can affect the balance of the entire face. If you are unhappy with the appearance of your nose — whether it seems too large for your face, appears crooked, is too wide or has a noticeable bump — these issues can likely be addressed through this procedure. Nose surgery has a very high patient satisfaction rate and the potential to boost your self-esteem and improve your quality of life.
Nasal surgery can achieve very dramatic results, but there are limits. It is very important to have realistic expectations for the most successful results. During your consultation with Dr. Gerarchi, he will create a personalized treatment plan and discuss just what is possible with your nose. Computer generated imaging is usually performed to give you an approximation of how your nose will look after surgery.
Approaches to Rhinoplasty: An Open and Shut Case
There are two primary ways in which nasal surgery may be performed: open and closed. Dr. Gerarchi is skilled and experienced in both techniques. An open approach offers greater access to the structure of the nose for more accurate treatment of problems and to restore support to the nose. This technique will require a very fine incision at the base of the nose. This incision will heal into a fine-line scar that is very well hidden and hard to notice.
The closed technique does not require an external incision, as all incisions will be made inside of the nose. This technique has limitations as to what it can achieve, however, and it does not offer the same reliable long-term results, except in very select situations. Dr Gerarchi will discuss with you which approach will give you the best long term outcome. If you want a nose that looks as great ten years later as it does during the first year, grafts or supports will be necessary to maintain the structure, and this usually requires the open technique.
Rhinoplasty: What to expect
Your Consultation in Sydney
During your consultation for nasal surgery, you will have the opportunity to discuss your goals for the procedure. Be as open an honest as possible during the consultation as it will make your surgery as safe and successful as possible.
Dr. Gerarchi will perform an examination of the interior and exterior of your nose and take detailed photographs of the nose. He will also discuss your desired outcome. Be as thorough as you can and discuss the specific issues you have with your nose, whether they are cosmetic or functional. Using the photographs, Dr. Gerarchi may use computer imaging software as a guide to what you can expect after your procedure and for greater understanding of your goals for the surgery.
Nasal surgery may be performed as a day or overnight procedure, depending on the complexity of your case. Most patients will have a cast placed on the nose and stitches between the nostrils. These will be removed one to two weeks after your surgery. There will also be absorbable sutures placed inside of the nose. These will not be removed but dissolve on their own over 5-6 weeks. Dr. Gerarchi may place splints inside of the nose.
Bruising and swelling may occur around the cheeks or eyes, although this varies by patient. Swelling typically reaches a peak about two days after the surgery, then subsides over the next one or two weeks. Applying a cool compact to the eyes for the first two days can help to decrease swelling. Black eyes my persist for days and typically dissipate on their own within two weeks. The Face Institute also recommends using Hirudoid cream that we can provide to treat bruising following surgery.
Swelling will be noticeable when the splint is removed, but it can also increase afterwards. The majority of swelling subsides within four to six weeks. Subtle swelling can remain for up to one year or longer. Most patients feel comfortable going in public about two weeks after the procedure.
Many patients experience nasal congestion like a head cold after surgery. This usually lasts for around six weeks. Some nasal drainage tinged with blood is also normal during the first few days. You may also have a stiff upper lip, which should go away within two or three weeks. Itchiness or numbness, especially in the tip of the nose, or a wooden feeling to the nose, are also very common and subside on their own. It may take months for your nose to feel normal, however.
After Your Surgery
You will receive detailed care instructions about what you should and should not do after rhinoplasty. It is very important to follow these instructions for a successful surgery.
Any activities that may interfere with healing should be avoided. This includes drinking alcohol and smoking. You should expect to take a break from normal activities for at least two weeks.
You should also take care to protect your nose during the recovery process. The nose should not be rubbed, bumped or touched, and smiling should be minimized to avoid movement of the nose. Try not to blow your nose or sniff too much during the first three weeks to avoid irritating healing tissue. If you need to sneeze, express it through the mouth but do not try to muffle the sneeze. Heavy exercise and contact sports should be avoided for at least two months.
Dr. Gerarchi will also instruct you to sleep on your back for a few weeks to avoid pressure on the nose, which can cause increased swelling or movement of the nasal bones. Rest with your head elevated on two or three pillows and avoid sleeping on your side or pressing the nose into a pillow.
Use sunscreen for a few months following your procedure, as direct sunlight can cause permanent marks on your nose. Do not wear glasses for at least three weeks after nasal surgery to avoid pressure on the nose that can change its appearance or function. Contact lenses, however, may be worn as soon as the day after the procedure.
Medication and pain relief
Dr. Gerarchi will prescribe antibiotics that should be taken during the first week to further minimise the small risk of infection. You may also be prescribed oral pain medications to help manage any discomfort. This medication may cause constipation, so it is important to drink plenty of water and eat a diet high in fibre. A mild laxative may also help.
Avoid any medication containing ibuprofen or aspirin, as these medications can increase the risk of bruising and bleeding. Avoid ibuprofen and asprin for two weeks before and after surgery.
The cast on your nose should remain dry until it is removed. Dr. Gerarchi will prescribe an antibiotic ointment , which must be applied around the nostrils and stitches to help prevent crusting and improve healing. An over-the-counter FESS saline spray should also be used up to four times a day to keep the inside of the nose moist.
Follow-up Appointments After Surgery
When your surgery is booked, a follow-up appointment will also be scheduled. You should contact us immediately if you experience excessive pain, abnormal swelling, fever or bleeding before this appointment, however.
At the follow-up appointment, the cast and non-absorbable sutures will be removed. Dr. Gerarchi may also recommend applying a silicone gel onto scars twice a day to improve healing and reduce scar visibility. You will see the results of your procedure once this cast is removed, but your nose will still be swollen and you will not see the final results yet.
Your nose may be re-taped to control swelling. Dr. Gerarchi will also give you care instructions to perform exercises that decrease swelling or help mould the bones. Anti-inflammatory injections may also be given to reduce swelling.
The number of follow-up appointments will depend on the patient. In most cases, follow-up appointments take place one week, six weeks, three months, six months, one year and then annually after surgery.
What is a rhinoplasty?
A rhinoplasty, more commonly known as a nose job, is a type of facial plastic surgery that is designed to improve the appearance or function of the nose. This procedure can change the width, height, size and shape of the nose and also address underlying functional problems for improved breathing.
Are there risks of rhinoplasty?
While this surgery is an effective, safe procedure, there are risks, as with any surgical procedure. Rare complications of this procedure include scarring, excessive bleeding and infection, as well as the chance that a revision rhinoplasty will be necessary.
How soon can I return to work?
Most patients can return to work two weeks after surgery, assuming they are comfortable enough with their appearance. Some swelling and minor bruising may still be present, but is usually easily coverable with make-up
How long do rhinoplasty results last?
Rhinoplasty permanently alters the appearance and form of the nose.
Does it leave scars?
With a closed rhinoplasty, incisions are made inside of the nose with no visible scarring. With open nose surgery, a small incision is made on the underside of the nose between the nostrils. This results in a small scar that is well hidden.
The before and after photographs shown are of Dr Gerarchi’s patients and the surgery has been performed by Dr Gerarchi in Sydney. They are for illustrative purposes only. They show the results achieved by individual patients and are no guarantee of the outcome to be expected by any particular individual considering surgery. Surgeons of good reputation do not guarantee outcomes. Unexpected events and individual healing characteristics can affect the outcome of any surgery.
Please feel free free to call us on (02) 9412 4599 or email if you would like any additional information about this procedure.