Nose surgery involves shaping the nose. It is one of the most technically challenging cosmetic surgery operations and should only be performed by very experienced consultant plastic surgeons.

The benefits of nose surgery include improved appearance and proportion of your nose, enhanced facial harmony and improved self-esteem.

When used for medical reasons rhinoplasty can facilitate improved breathing by correcting anatomical abnormalities in the structure of the nose due to hereditary reasons or caused by trauma.

The first thing to do is to talk to your GP who can refer you to Mr Meagher. By talking to your GP and Mr Meagher you are more likely to get the results you want from the surgery.

Nose surgery can change the:

• Proportional size, in relation to the other facial structures
• Width, at the bridge
• Profile, with visible humps or depressions on the bridge
• Tip, that is large or bulbous, drooping or too upturned
• Nostrils that are large, wide or upturned
• Asymmetry and deviation
• Obstruction of the nasal passages

The ideal candidate for nose surgery is one who has:

• Completed their facial growth and is over 18 years of age
• Good physical health
• Stopped smoking
• Specific but realistic goals in mind for the improvement of their appearance

Before the operation

The most important thing to do is to talk with Mr Meagher so that there is a clear understanding of your desires and expectations, in light of any biological prerequisites. We want you to be well informed and have realistic expectations of the results.You should produce a list of all the aspects of your nasal shape that bother you, a ‘wish list’ of sorts.

Mr Meagher will describe the type of technique they will use, the type of anaesthesia, the hospital, any additional surgery, the pros and cons, benefits, potential complications, possible risks and the costs of the procedure.

You will be asked to discuss your medical history, including information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries and medications that you currently take. Mr Meagher will also examine the structure of your nose, soft tissue structure and underlying bone framework. You will have to stop taking medication which alters blood viscosity, e.g. aspirin. As for all surgery, patients are requested to stop smoking at least 6 weeks prior to the operation.

Specific individual risks will also be explored especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, medications and any deficiency in blood clotting. As well as assessing your general health and the appearance of your ears, Mr Meagher will assess your mental and emotional attitudes toward the surgery.

Mr Meagher will examine the structure of your nose, taking measurements and photographs for your medical record.

If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed by signing a consent form.

During the operation

Your surgery will be performed in a major hospital under a local or general anaesthetic. It can take between 1 and 2 hours for the operation and, for your safety, the attending anaesthetist will use various monitors to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

Mr Meagher will start with incisions to access the bone and cartilage support system of the nose. Most of the incisions are made inside the nose where they will never be seen and in some cases an incision is made in the area of skin separating the nostrils. Next, some underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, Mr Meagher can sculpt the cartilage in this area to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.

The tissues are then re-draped over the new frame and the incisions are closed with stitches. A splint is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Alternatively, soft nasal supports that permit nasal breathing post-operatively can be used.

After the operation

After the operation you will need to stay in hospital overnight. You should refrain form excessive physical activity for the next 4 to 6 weeks and avoid contact sports for 2 to 3 months. You will return to have your splint removed and/or sutures removed a few days after going home from hospital.

It is very important that you follow the advice of Mr Meagher to help your recovery. Mr Meagher will be available for post-operative care should you require their assistance.

It may take several months for swelling to fully dissipate and up to a year – and sometimes longer – for the outcome of the surgery to fully refine. Although the results of nose surgery are usually permanent, cartilage may continue to reshape and move tissue that may change the outcome over time.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another minor surgical procedure may be necessary to reach your aesthetic goal.

Scars

Rhinoplasty surgery can be performed through a closed technique (scar inside the nose) or an open technique (scar on the skin at the base of the nose). Mr Meagher will guide you to the most appropriate technique for you and the effect you’re looking for.

Potential complications

Naturally, there are risks associated with any type of operation and this surgery is no exception. Mr Meagher will explain the possible risks, which are rare, but may include:

1. Infection: Infection does not happen very often and you will be given an antibiotic at the time of your surgery to prevent this. If you do develop an infection, see Mr Meagher as soon as possible. Most infections can be treated with an antibiotic but they can cause serious problems and increased scarring.

2. Anaesthetic allergy: In very rare cases anaesthetics can cause life-threatening allergic reaction (anaphylaxis). It happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose your anaesthetic, taking into account the type of operation, your physical condition and whether you are allergic to anything. Most people make a full recovery from anaphylaxis. One review article suggests that one in 20 serious reactions can lead to death. This would mean that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetics.

3. Nerve damage: It’s possible, but highly unlikely, that you could suffer nerve damage after a general anaesthetic. The area may vary from a very small patch of numbness, tingling, or pain, to most of a limb. The pain can be a continuous, aching pain or a sharp, shooting pain. You may also get warm or cold sensations. If motor nerves are damaged, there may be weakness or paralysis (loss of movement) of muscles in that area. The risk of a significant peripheral nerve injury lasting more than three months is estimated to be less than one in 2,000 patients having a general anaesthetic. Permanent damage, lasting more than a year, is estimated to occur in less than one case in 5,000.

4. Poor wound healing: Healing can take longer in cases of:

• Infection
• Bleeding
• Fluid accumulation
• Overly tight stitches
• Improper support during healing
• Pressure against the scar tissue

Wound healing may also take longer in patients who have diabetes, or other medical conditions, or who smoke.

5. Pain: As with any surgical procedure, pain of varying intensity may occur following your surgery. You will be prescribed some pain medicine to take in hospital and at home after your discharge, if you need it.

6. Haematomas: Haematomas are a solid swelling of clotted blood within the tissue and they can happen after any surgery. The risk of infection is higher if a large haematoma or seroma (a collection of watery fluid within the tissue) collects immediately after surgery. Mr Meagher may use a surgical drain to help prevent small haematomas but, in some cases, Mr Meagher may need to re-operate to remove a large haematoma.

Other potential issues

The risks associated specifically with a rhinoplasty operation include:

• Rupture of small surface vessels
• Nose asymmetry
• Cardiac and pulmonary complications can occur in longer surgical procedures and may be associated with the formation of, or increase in, blood clots in the venous system
• Change in skin sensation (numbness)
• Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose
• Nasal septal perforation (a hole in the nasal septum) may develop but is rare
• Unacceptable or significant scarring
• Skin contour irregularities
• Skin discoloration and swelling
• Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal

Because of the very nature of cosmetic surgery, sometimes patients can be dissatisfied with the results.