RHINOPLASTY

Dr Chia Hui Ling

Rhinoplasty reshapes the nose to improve its balance with the rest of the face, correct breathing difficulties, or both. It is one of the more technically demanding facial procedures, because the nose has to work as well as it looks, and even small changes in shape can noticeably shift the overall result.

•      Refines the nasal tip, bridge, or width to improve overall balance

•      Corrects a visible bump, asymmetry, or crookedness

•      Improves nasal breathing when combined with septal correction

•      Can improve facial harmony without necessarily changing your ethnic or family features

•      Can address deformities from previous injury or earlier surgery

•      Concerns about nasal shape that affect confidence or facial balance

•      Nasal breathing difficulty, often related to a deviated septum

•      Nasal growth that is complete, generally from the late teens onward

•      Good general health and non-smoking status

•      Realistic expectations of a refined, harmonious change rather than a completely different nose

Rhinoplasty results take time to mature — visible swelling settles over weeks, but the tip in particular can continue to refine for up to a year. Because the anatomy and healing are complex, revision rates are somewhat higher for this procedure than for many other facial surgeries, which is worth knowing going in.


TREATMENT

HRhinoplasty can be performed as an open technique, with a small incision across the columella (the strip of skin between the nostrils) giving full visibility for more complex reshaping, or as a closed technique, with all incisions hidden inside the nostrils and no external scar, suited to more limited changes. Cartilage is reshaped, and sometimes grafted from within the nose or elsewhere, and the septum is corrected if it is contributing to breathing problems. It is usually done under general anaesthesia.



•      Surgery typically takes 1.5 to 3 hours, depending on complexity

•      A splint or cast is worn on the nose for about a week

•      Bruising and swelling around the eyes are common for 1 to 2 weeks

•      Nasal congestion or packing is common in the first few days

•      Glasses should not rest on the nasal bridge for 4 to 6 weeks

•      Strenuous exercise and contact sports should be avoided for several weeks

•      Visible swelling reduces over months, with the tip continuing to refine for up to 12 months


  • Preparing for Surgery

    For nose surgeries, inform your surgeon of previous nasal surgeries, allergies and any airway obstruction. Avoid blood-thinning medications, anti-inflammatory drugs or herbal supplementations as they can increase the risk of excessive bleeding during surgery, unless indicated by your doctor.



  • Surgery

    There are 2 surgical approaches to a rhinoplasty – open and closed. In a closed rhinoplasty, the incisions are placed within the nostrils. In an open rhinoplasty, in addition to the nostril, the incision is also extended onto the collumella – the skin over the septum in between the nostrils. The factors affecting the choice between the two approaches may depend on the type of surgical correction required, surgeon’s expertise and patient’s preference. The open approach provides better visualisation of the surgery and may allow the surgeon to perform more complex manoeuvres. The closed approach has the benefit of no external scar and less downtime.


    During a rhinoplasty, tissues may be removed, for example, to reduce a nasal hump. To reshape the nose, build up height or open up the airway, the plastic surgeon often needs to add materials to your nose during a rhinoplasty. The materials used may be grafts from your own body (cartilage, skin or bone) or implants made of materials such as silicone and Goretex.   


  • Post-Surgery Care

    After surgery, you may have a splint over your nose and / or packs in your nostrils. Most of the swelling and bruises usually improves after a week or two. Your upper lip may not move naturally for a few weeks.  Residual swelling may last for a few months and the final result is seen usually after 3 to 6 months, or longer if it is a revision rhinoplasty.

FAQs

How painful is recovery?

Most people describe pressure and congestion as more bothersome than actual pain, particularly in the first few days when the splint and any packing are still in place.

When will my nose look 'final'?

Most visible swelling resolves within a few weeks, but subtle swelling, especially around the tip, can take up to a year to fully settle into its final shape.

Will this be covered by insurance?

That generally depends on whether there is a functional component, such as correcting a deviated septum for breathing. The purely cosmetic portion is typically not covered, so it is worth clarifying this with your insurer beforehand.

How likely is it that I'll need a revision?

Rhinoplasty has a somewhat higher revision rate than many other facial procedures, given the complexity of nasal healing. A small proportion of patients do choose to have a touch-up procedure later.

Can it fix my breathing and my appearance at the same time?

Yes, when a deviated septum or other structural issue is contributing to breathing difficulty, this can usually be addressed in the same operation as the cosmetic reshaping.

When can I wear glasses or exercise again?

Light activity is usually fine within about two weeks, but glasses on the bridge and any contact sports are generally avoided for four to six weeks to protect the healing nasal bones.


COMPLICATIONS AND MANAGEMENT

Because the nose is both a functional and aesthetic structure, the range of possible complications is broader than for many other facial procedures.



•      Bruising and swelling around the eyes and nose

•      Nasal congestion during the healing period

•      Bleeding or infection

•      Asymmetry or minor surface irregularities

•      An aesthetic result that does not fully meet expectations, sometimes requiring revision surgery

•      Breathing difficulty from internal scar tissue or structural collapse

•      Numbness of the nasal tip, usually temporary

•      A small external scar with the open technique, usually faint

•      Septal perforation (rare)

•      General anaesthesia risks