Rhinoplasty is usually preformed under general anaesthetic as a day stay procedure. Occasionally an overnight stay is necessary particularly if grafts from the ear or rib are necessary.
Rhinoplasty is rarely done on a growing nose and then only if there are major breathing issue. Usually by the late teens, development of the nasal skeleton is complete and rhinoplasty can be undertaken to achieve a stable long term result.
The operation may be done entirely within the nose (internal rhinoplasty) but usually involves a small cut under the nose and possibly a tiny ( 3 mm) cut on either side (external rhinoplasty). These cuts heal to leave virtually invisible scars.
The skin is elevated from the nasal skeleton which is then modified to the desired shape. After the changes are made, the cut under the nose is sutured with fine nylon and the internal nasal lining with dissolving sutures. The nose is then taped and covered with a small plastic cast to reduce swelling. It is very unusual to require any nasal packing. The cast and nylon sutures are removed in the clinic one week later.
Preparing for Surgery
Complete the hospital admission form including detailed medical questionnaire and return to the hospital as instructed. If functional surgery ( correction of nasal obstruction) is planned, arrange prior approval from medical insurer.
Stay healthy as nasal or chest infection in the 2 weeks prior to surgery may postpone the procedure.
To reduce risk of bleeding, avoid aspirin and medications containing aspirin for 2 weeks prior to surgery and 2 weeks after, unless otherwise instructed. Likewise avoid smoking which reduces the skin's ability to heal and increases the risk of infection.
A course of Arnica taken after surgery may be helpful in minimising facial bruising but discuss with your surgeon.
When and where will the operation be done?
We can generally find a convenient date for you at one of the following hospitals. Please fill in your pre admission hospital forms and send them back 7 days prior to surgery. Contact the hospital the working day prior to your scheduled surgery to find out admission times.
Dr McIvor has regular theatre lists at the following hospitals:
Southern Cross Gillies Hospital, Epsom
Southern Cross North Harbour , Glenfield.
What do I do on the day of surgery and what shall I bring into hospital?
DO NOT eat anything for at least six hours prior to your operation to prevent vomiting and other complications during your operation. You will be advised from what time you should starve by the Hospital the working day prior to surgery.
X-rays or scans that have been done for this problem. Dr McIvor may need to review them before and during surgery.
Nightwear, day wear, dressing gown, towels, toiletries, slippers, books/ magazines and a pen. It will be helpful to arrange for a relative or friend to wash your nightwear etc. and bring in fresh supplies. Hospital nightwear is available if required.
Medication you are currently taking, including inhalers.
DO NOT BRING any unnecessary valuables with you, such as jewellery, large sums of money or bank cards. The hospital cannot take responsibility for your valuables. On your admission you will be asked to sign a disclaimer form which gives you responsibility for any valuables you bring with you. Valuables may be taken for temporary safe keeping by the ward staff while you have your operation and you will be given a receipt.
What will happen when I go to theatre?
Just before going to theatre a checklist is completed by the nurse. You will then be taken on your bed to the operating theatre, usually by a theatre technician and a nurse.
Dentures, glasses and hearing aids can be taken out in the anaesthetic room and taken back to the ward by the nurse, or you may like to put them in your locker before your operation.
The anaesthetist will insert a small needle into the back of your hand through which you will be given the anaesthetic. The nurse will stay with you until you are fully under the anaesthetic and fully asleep. You will not wake up until the operation is over. You will be taken, on your bed, to the recovery area where a nurse will look after you until you are awake.
You will then be taken back to the ward, on your bed, by an orderly and a nurse.
Driving for 24 hrs after the anaesthetic is prohibited, and a friend or relative should oblige. It is advisable to take 10 days off work to give bruising and swelling time to abate. Most people take around 2 weeks to recover sufficiently from the anaesthetic to be able to resume their usual employment.
A small plastic cast is worn for one week to protect and support the nose. There may be tiny sutures under the nose that are removed at one week. The first post opp review is done one week after surgery ( removal of splint and sutures, nasal cleaning). Subsequent checks are likely to be a month later and then 6 months.
Medications will include an antibiotic, decongestant spray and mild pain killers.
Discomfort is likely to be more noticeable during the fist 48 hrs. However, it is usually mild and relieved with analgesics/ anti-inflammatories. Strepsil throat spray can be used to relieve any throat irritation.
Pain which does not resolve with analgesics should be reported as soon as possible.
Nausea is a common reaction to anaesthesia and unlikely to last longer than 24 hrs. ( Anti- nausea medications are often administered during the general anaesthetic).
Vomiting is seldom a problem, but may occur when small amounts of blood from the nose irritate the stomach. To avoid, keep head elevated with extra pillows.
Minor bleeding may occur over the first few days. Heavier bleeding is unusual but will usually settle with cold pack placed over the nose. Bleeding which continues after 10 mins should be reported.
Congestion caused by swelling of nasal membranes is temporary and will ease as swelling subsides and splints/ crusts are removed after the post opp visit. To relieve congestion use Otrivine nasal spray as directed. Drink plenty of fluids to keep the membranes moist and to reduce inflammation.
As the healing process takes place, crusts of dried blood and mucus commonly adhere to the nasal linings and sutures. These should be gently removed with hydrogen peroxide solution.
Soframycin ointment will be provided which should be applied just inside the nostrils and to the sutures over the first week to reduce crusting, enhance healing and facilitate suture removal.
As internal sutures dissolve over the first few weeks, they may occasionally hang from the nostril. Simply trim with scissors.
Avoid blowing or sneezing through the nose for the first week so that air is not forced into the tissue spaces created by surgery. If sneezing in unavoidable try to sneeze through the mouth.
Following splint and suture removal, skin- colour tape is applied to the nose each night for 3 weeks to reduce swelling.
Bruising & Swelling
Bruising is usually maximal at 3 days and has largely gone within 10 days.
Swelling will regress in 2 stages:
Stage 1 is a generalised swelling that reduces uniformly over the first 2-3 weeks.
Stage 2 is a more gradual period of scar remodelling that follows a constant pattern : bony dorsum, three months; cartilaginous dorsum, six months; supratip area, nine months; tip, one year.
A cold compress applied to the face for 2o mins every 2 hours during the first 24 hrs will help alleviate discomfort and reduce swelling.
Keep the head elevated with extra pillows when in bed.
Avoid activities which increase nasal swelling or bleeding, eg: bending, lifting, strenuous activities or exercise.
Avoid applying pressure to the bridge of the nose over the first 3 weeks. If glasses must be worm apply them softly.
Protect the nose from bumps, injuries & sunlight during the first 6 weeks. Generally the nose will look good at 2 -3 weeks but will continue to improve over 3 - 6 months. Subtle changes may become evident even a year after surgery.
Light meals are recommended for the first 12 hours following surgery, otherwise there are no restrictions.
Although rare, possible complications following a rhinoplasty include heavy bleeding, pain, infection and poor healing.
Persistent obstruction after the surgery may require steroid sprays because of underlying nasal allergies.
Numbness of the upper front teeth and gum can occur occasionally and is nearly always temporary. It is usual for the nasal tip to have a degree of numbness for a few months.
Septal haematoma ( a clot within the septum) can occur rarely requiring needle aspiration or drainage with packing
Septal perforation is also rare but may need a further procedure to close it if troublesome,
Remember that swelling of the skin may mean the final result is not evident for months. Occasionally a second procedure is necessary at 12 months to correct any irregularity- This is usually a minor operation under local anaesthetic but general anaesthetic may be necessary for further dorsal or tip refinement.