The nose surgery procedure

As with most plastic surgery a nose job (rhinoplasty) can be divided into three steps in terms of what happens before, during and after a nose surgery. This page describes the two first of these three steps.

Planning prior to a nose surgery

Once you have decided to undergo a nose surgery (nose job) the first thing you need to do is book a time with a plastic surgeon. You will find tips about what to think about on the page choosing a plastic surgeon ».

Be clear with your surgeon

Good communication between the plastic surgeon and the patient is necessary prior to plastic surgery. During your introductory consultation your surgeon will ask you how you would like your nose to look (feel free to bring a photo), assess your nose and your faces shape and proportions and discuss the possibilities with you.

The different factors that can influence the procedure and how they originate will be described. These include the nasal bone structure, the nasal cartilages shape, your face shape, the skins character, your age and your expectations.

Which changes can be achieved, based on your unique prerequisites and desires, need to be discussed thoroughly with your plastic surgeon. You need to both be in complete agreement about the goal of the rhinoplasty. It is therefore not unusual that a plastic surgeon meets their patient several times prior to nose surgery.

It is also not uncommon for plastic surgeons to recommend a chin surgery as a complement or an alternative to nose surgery since the balance between the chin and nose plays a decisive factor in how the size of the nose is perceived.

Accurately describe your health background and your expectations

A nose job can affect the airways so if you before the surgery have such problems it is important that you describe these to your surgeon. It is not unusual that the plastic surgeon then consults an ear-nose-throat specialist before the procedure is performed.

Also tell your surgeon if you have previously undergone nose surgery or damaged your nose, even if it was years ago. You should also inform your surgeon about any allergies, if you smoke, take medication, nutritional supplements or other substances.

Be honest when describing your expectations to your surgeon and demand the same honesty from your surgeon when describing the limitations and risks involved with the procedure.

All about nose surgery (rhinoplasty/nose job)

Preparations prior to nose surgery

As with all plastic surgery, you will receive thorough instructions about how you are to prepare for your nose surgery. This includes information about how you are to eat and drink, smoking rules, taking vitamins, medication and other substances.

The preparations also include a preoperative wash/shower aimed at minimising the risk of infection. This implies taking a double shower and washing yourself with a particular soap (Hebiscrub alt. Decutan) twice the day before your nose surgery and on the morning of the surgery.

Follow all the instructions your surgeon provides you carefully and it will create the best conditions for a successful outcome of your rhinoplasty.

As part of your preparations you should also make sure someone collects you after surgery and that someone can be of assistance for a few days if it is needed.

You can read more about this subject on the page about preperations and restrictions before surgery ».

Surgical procedure for nose surgery

When you arrive to the clinic on the morning of surgery you are admitted and given a patient room. Once you are installed and changed into operating clothing you will normally meet your plastic surgeon. He/she will go over your surgery again, ask any questions and take photos of your nose from different angles, if none have been taken before. Once the meeting is over you are moved to the operating theatre.

Once inside the operating theatre you are connected to the monitoring equipment and given your sedation. Generally nose surgery is performed under local anaesthesia in combination with sedative medication or light narcosis.

A nose job alters a. nasal bone, b. nasal cartilage and c. soft tissue

Once the narcosis has set in the surgery begins. As previously mentioned the nose consists of the nasal bone and nasal cartilage which gives the nose its structural base. This structure is covered by a thin layer of skin. A nose job generally aims to lift the skin, change the shape of the underlying structure (bones, cartilage) and thereafter covering it with skin again.

Some clinics choose to divide nose jobs into two categories, full and partial rhinoplasty. With a partial rhinoplasty only the nasal cartilage and other soft parts are operated on whereas with a full rhinoplasty the surgery involves the entire nose, both cartilage and nasal bone. A partial nose surgery is generally performed under local anaesthesia with light narcosis while a full nose surgery, as the one mentioned here, demands narcosis.

Even if it sounds easy, nose surgery is a complicated surgery that puts great demands on the plastic surgeons skills but also his/her restraint in terms of how much of the noses soft parts are to be removed during surgery. For the surgeon it is better to remove less and perform additional surgery than having to perform reconstructive surgery with cartilage and bone transplants which from a medical perspective is substantially more complicated.

Depending on the extent of the surgery and what is to be done a nose surgery can take between 1-3 hours. The most common procedure is to minimise a chubby nose tip or round off a pointed one, remove a hump on the nasal bridge, reduce the entire nose, straighten general lopsidedness or improve a far too prominent nasal septum.

The area of incision for nose surgery is a. inside the nose and for the open method also b. between the nostrils

During nose surgery the surgeon first loosens the skin from the noses underlying support structure of cartilage and bone. Normally the incision is placed within the nose which means no visible scars occur. Some surgeons do however (especially with demanding operations) prefer a so called open nose surgery. An open nose surgery implies placing the incision in the skin between the nostrils, in the thinnest area.

Once the incision/incisions are placed the noses soft parts (skin, dermis and fatty tissue) are separated from the lying structure made of bone and cartilage. Thereafter they are sculpted to desired shape. In cases when the nose is to be built this is done either with artificial material or own bone/cartilage tissue harvested from other parts of the body. Once the shaping is finished the soft parts are once again draped over the underlying structure and sutured.

After rhinoplasty the nose is secured with plaster, secured with tape on the skin. The plaster is exchanged or removed after approximately a week in conjunction with suture removal. Sometimes a supporting plaster is used for a further 1-2 weeks. Most surgeons recommend thereafter continued taping of the nose to minimise swelling. Also support dressings inside the nose are sometimes used for varying lengths of time, from one day for up to a week.

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