Nose Reshaping (Rhinoplasty)
Nose surgery (Rhinoplasty) is a procedure to reshape the nose in order to create a more pleasing look and, in some instances, to correct severe breathing problems.
Rhinoplasty usually involves reducing the size of the nose by removing and sculpting the nasal tissues in order to enhance the facial appearance. The results are unique to each individual, and depend upon such factors as skin condition and thickness, nasal and facial structure, genetic contributions, and age.
In general, having nose surgery provides the patient with a better facial balance and overall appearance.
Reasons for Considering Nose Surgery:
Bring a better proportion to the nose and facial features.
Reduce the size of the nose that is too large or too wide.
Correct an overly arched or “Roman” nose.
Re-form a crooked or elongated nose tip.
Restore the nose if damaged from an accident or sports injury.
Help with breathing problems by rebuilding the nasal passage.
Treat nasal deformities caused at birth.
Pre-operative consultation is the most important part of the procedure. During this consultation Dr Gahankari will take detailed history and will establish your goals from this procedure. He will also examine the proportions of your nose in relation to the chin and the rest of your facial profile and perform an intra-nasal examination to look at the nasal septum and the turbinates. He may also use a special medical image morphing program to simulate the results following the procedure. It is important to note that this simulation is not a guarantee of the result but merely a tool to have a mutual understanding of the goals of the operation. He will then discuss the procedural details and make suggestions for achieving your goals.
Rhinoplasty may involve a relatively small procedure if only a small bump on the nose requires correction, to a ‘complete rhinoplasty’ procedure that involves complete reshaping of the nose. In complete rhinoplasty, the bony and cartilaginous structure of the nose is modified to address the aesthetic goals of the patient. 
Rhinoplasty may also involve measures to improve the functional problems of breathing. This part of the procedure generally corrects the nasal septal twists and distortions and occasionally may involve trimming of the prominent inferior turbinate. Rhinoplasty procedure can improve a nose that is that is too big, too flat, too humped, too wide or fat, too thin, too long, too short, pinched, bumpy, bulbous, crooked, or scooped. It can also narrow large nostrils or nostril sills.
It is very important to have clear goals of improvement in your nose shape to be helped by this procedure. It is not a procedure for patients who are vague about their desired results or who are seeking the procedure for relieving stress or finding a new job. Patients with Body Dysmorphic Disorder (BDD) or other self image disorders are also unsuitable.
Common surgical approaches for Rhinoplasty are ‘open’ or ‘closed’. The ‘Open’ Rhinoplasty approach means only a small part of the incision is visible at the base of the columella. In the ‘closed’ approach, the incisions are placed inside the nose and the entire procedure is performed through incisions inside the nostrils. Dr Gahankari will discuss the pros and cons of both the approaches with you and suggest the best approach suited for your Rhinoplasty. He does tend to favour the modern open approach, especially if complete rhinoplasty is needed. Rhinoplasty is usually performed either under General Anaesthetic or under Local Anaesthetic and sedation. A few mls of local anesthetic is injected into various areas of your nose to make it numb and also to reduce bleeding.
In his hands, Rhinoplasty procedure can take from one to two hrs. Sometimes a small bone or cartilage graft may be needed to add prominence to the tip or the nasal dorsum. It is most commonly obtained from your own septum. However occasionally it may need to be obtained from the ribs or ears. Of course, Dr Gahankari will discuss this with you in the pre-operative consultation.
Sometimes Rhinoplasty is combined with a chin augmentation or reduction procedure to balance the proportion of your nose and chin to the rest of your face. Every case is unique and consultation with Dr Gahankari can help you understand what may be needed to reach your expectations.
Most patients are operated as a Day surgical procedure if you could be driven home and looked after by an adult at home. Otherwise a night’s stay in the hospital may be preferred. The nasal packs, if used, are removed in 24 – 48 hrs and the external splint is worn continuously for at least 10 to 14 days. It is preferable not to blow your nose for at least a couple of weeks following the surgery. Dr Gahankari also advises conscious avoidance of direct injury or manipulation of the nose for at least 3 weeks. Contact sports are avoided up to at least 6 weeks following the procedure.
Most of the swelling of the nose and that around the eyes subside in 2-3 weeks but subtle bruising and swelling subsides gradually and may take up to 6 months to one year. If external sutures are used, they are removed between 5-7 days.
The documented risks of this operation include wound infection, bleeding or haematoma, bruising, asymmetry or un-evenness. Rarely scar may be visible. Another very rare documented complication is ‘septic shock’. It is important to disclose all the medications that you take – some – such as aspirin, arthritis medication and others may cause more bleeding. It is also essential to quit smoking at least 2 weeks before surgery to avoid reduce wound healing related complications.
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