What is a Rhinoplasty or
These terms are often used
interchangeably, although technically “Septo”
means that the nasal septum (the cartilage partition
in the nose) has to be corrected as part of the
procedure. In actual fact, in many cases, the
septum must be dealt with in order to achieve
a desirable result and so the two terms become
almost synonymous. In essence there are two goals
in any Septorhinoplasty:
1. To make the nose look better
2. To ensure proper function (i.e. improve or
maintain nasal breathing)
For the ideal result, a surgeon will therefore
bear both of these aims in mind and be trained
in treating not only cosmetic problems, but also
other nasal diseases. This is the task facing
a Rhinologist, who specialises in all of these
aspects of nasal surgery.
Why have a Septorhinoplasty?
Most people undergo this
operation do so for one of two reasons and often
both: namely they don’t like the way the
nose looks or they can’t breathe through
the nose properly. For many, only certain aspects
of their nasal appearance bothers them and obviously,
only these issues need to be addressed by the
surgery. Some patients have a history of nasal
trauma - such as a broken nose – and they
want their nose to look the way it did before
the injury. People from all walks of life, both
male and female undergo Septorhinoplasty.
What types of Septorhinoplasty
operations are there?
There are many different
techniques in Septorhinoplasty surgery but they
may be divided into groups by looking at various
aspects. For instance, the operation may be a
“closed” or “open” procedure
depending on how the overlying skin is lifted
up to provide access to the underlying cartilages
and bones. In an “open” Septorhinoplasty,
a small incision is made in the columella, (the
skin between the nostrils) but this is not needed
in the “closed” technique. The former
method tends to be used more frequently for repeat
operations and operations of a complex nature,
involving several abnormalities. The incision
usually heals so well that it is virtually impossible
to see the little scar a few months later. Many
different structural abnormalities may be corrected,
ranging from a simple “hump” on the
nose to a twisted or bent nose. The nose may be
too wide, too long or the tip may be misshapen.
Some of the abnormalities may occur as a result
of injury (e.g. broken nose) or may simply be
the way the nose has grown. Each of these require
differing techniques to correct, and this will
be explained this to you.
What will happen when I visit the
Whatever the abnormality
is, it will have to be analysed carefully to decide
on the best way to deal with it, to give you an
optimum result. Mr. Marais will have a chat with
you and as part of this will ask you what it is
that you wish to have improved. You should have
a clear idea of what aspects of your nasal appearance
and function you wish to have changed. This will
help in clarifying what needs to be done. The
nose will then be examined both internally (very
important) as well as externally. Pre-operative
photos will be required, and these will be arranged.
After the operation, post-operative pictures are
also taken for comparison. Mr. Marais will then
explain what he envisages can be achieved with
surgery and what the operation itself entails.
Generally, Insurance policies do not cover any
cosmetic surgery, and you should check with your
insurer what you are covered for. Lastly, Mr.
Marais will discuss admission arrangements for
What should the end result look
You should be aware that
whilst it is possible to cosmetically improve
a nose – even a badly injured or deformed
one - that the final result will be dependant
on how bad the deformity was in the first place.
A very distorted nose with lots of abnormalities
is more difficult to improve and the end result
will not be as good as a nose that has the same
operation, but was not so bad to start off with.
This may seem common sense, but many patients
have unrealistic expectations of what can be achieved,
and if this is the case, may find themselves disappointed
with the result. Mr. Marais will explain what
he thinks can be realistically achieved with your
particular nasal abnormality.
What does the operation itself
A general anaesthetic is
required for this procedure. It will take between
one and three hours to carry out the operation,
depending on the complexity. You should not have
anything to eat or drink for six hours prior to
the operation. There is not usually severe pain
afterwards, but the nose may have some packing
in it, to stop any bleeding. You will probably
be kept in overnight and go home the next day.
Although there is not usually much pain, you will
be given some pain-killers to take home, should
you require them. You will be fully awake a short
while after the operation (although perhaps a
bit groggy) and you will be able to eat and drink
What will I look like afterwards?
You will probably have a
Plaster-of-Paris splint covering the nose to protect
it and to keep the nose in the correct position
for healing. This will be worn for one week. In
many cases, you will have black eyes afterwards.
This is because the nasal bones are surgically
fractured and re-set, and this produces bruising.
The black eyes settle in about ten days to two
weeks. The nose itself will be a bit blocked due
to internal swelling after the operation. Again,
this takes a week or two to settle. You will notice
a little blood on your handkerchief for the first
few days, but this lessens as the days go by:
The external appearance of the nose settles down
over a period of months, with minor changes evident
as the tissues heal.
How long will I need off work?
Probably between two to three
weeks, not because of pain, but because it take
that long for the bruising and swelling to recede.
Are there any complications?
Every operation has potential
complications. In Septorhinoplasty, there are
two main risks. The first is common to all nose
operations – that is, bleeding. There is
always a small amount of bleeding post-operatively,
and it is nearly always self-limiting. However,
there is a very small risk of a bad nosebleed.
The second complication is failure to achieve
the desired result. This is obviously relative,
as it depends on what was expected in the first
place, hence the importance of having a clear
and realistic understanding of the possibilities.
Nonetheless, due to various factors, such as cartilage
collapse, poor healing etc. the nose may not look
pleasing to the eye after the surgery.
Are there any Do’s and Don’ts
1. Irrigate or douche
the inside of the nose afterwards. This helps
flush away the scabs and crusts that can accumulate
2. Once the plaster has been removed, you should
massage the area over the nose and cheeks with
a good skin cream to help dissipate swelling and
3. Continue to wear the plaster at night in bed
for a further week to protect the nose from being
squashed or pushed into an abnormal position when
1. Undertake any heavy
physical activity in the first week after surgery,
especially bending down and/or picking up heavy
weights. No contact sports for a month after surgery.
2. Avoid sunburn on the nose/face for at least
3. Don’t worry if you find small bits of
thread-like suture material when you blow your
nose. These are probably dissolving sutures and
are expected to fall away in due course. Blowing
the nose after surgery is fine, if done gently.
4. Avoid very hot baths and showers. This may
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