How Nose Surgery is done

Nasal surgery is performed as an inpatient in the Beacon private hospital. It may be combined with other procedures such as facial or chin surgery.
In most nose surgeries general anaesthesia is used. However, in some cases, local anaesthesia with intravenous sedation may be sufficient.

Mr Golchin uses the computer imaging photographic references in the operating theatre to provide direct evaluation of the intended goal during the nose surgery.

Rhinoplasty can be accomplished using an internal or external surgical approach. The internal surgery approach allows all the incisions to be hidden inside the nostrils. Therefore there is no evidence of any cuts or scarring on the outside of the nose after surgery.

The external (Open) approach to nose surgery leaves a small scar under the nose. This provides the best exposure to the nose, and is recommended when treating the more difficult problems. The skin incision in this type of nose surgery can cause delayed healing, prolonged swelling of the tip and often prolonged numbness of the skin over the tip of the nose.

Mr Golchin uses the internal approach for most nose surgery cases whenever possible. This approach provides more delicate control of the final shape of the nose because the skin is not loosened up very much during the surgery. This permits more accurate assessment of the shape during surgery.

The external rhinoplasty incision is placed under the nostrils. In Mr Golchin's practice this generally applies to very complicated cases only with twisted nose or abnormalities of the tip.

After anaesthesia is given, small incisions are made inside the nose. Specialized instruments are used to separate the skin from the underlying supporting framework of bone and cartilage. The bone and cartilage are then sculpted to the desired shape.

The nature and extent of the sculpting are dependent on individual nasal anatomy and the desired contour with the aim of providing a good long-term outcome for both breathing and the shape. Accordingly a more conservative approach is sometimes suggested with grafts and/or sutures used to increase the strength of the nose.

Some patients require building up of the nasal bridge. This may be due to injury, previous overzealous surgery or just having a small nose. In such cases an “Augmentation rhinoplasty” is performed. Materials for building up the nose can be natural materials, such as the patient's own cartilage and bone, or else foreign material, such as high-density porous polyethylene. These materials are sculpted and placed in appropriate areas.

Natural materials have the advantage of being better tolerated and very safe. However sometimes natural materials are not the right shapes or there may be an inadequate supply for the extent of the augmentation that’s required. The main risk of foreign materials is that of infection and rejection. These materials have been modified over the years so that materials available now have a much lower risk of these complications. Mr Golchin will discuss these pros and cons with you very carefully.

When the nose surgery is completed, a plaster is applied to protect and maintain the new shape of your nose. It also limits the amount of postoperative swelling. If the nose surgery involves straightening your septum, soft nasal splints may be placed in your nostrils to stabilise the septum. You will then be awakened and taken to the recovery room. The rhinoplasty operation takes one to three hours depending on the complexity of the nose surgery.

Risks of nose surgery

As with any operation, nasal surgery has minimal risks and potential complications. However, with highly trained cosmetic plastic surgeons and nurses making up the surgical team, complications are extremely rare. Like all surgeries, the risk of bleeding, infection, scarring or an anaesthetic problem is present.

Healing affects the nose in different ways. With heavy skin the nose is likely to drop a little over time, and there is a higher risk of scar tissue under the skin. Consequently the experienced surgeon makes a shape during surgery that allows for these inevitable changes. Mr Golchin sometimes uses medicines in the postoperative period to reduce scar tissue and permit sculpting of the tip on the months after surgery.

Since all of the incisions are inside the nose, there are no visible scars. When the External (open) technique is employed, the small scar underneath the nose becomes inconspicuous after several months. Should the unusual situation occur that the incision is noticeable, revision and dermabrasion procedures are available.

In about five percent of rhinoplasties, a second procedure may be required to correct a minor deformity such as a small residual bump on the bridge. The corrective surgery is usually minor in nature.

Revision Rhinoplasty

Revision rhinoplasty is unfortunately fairly common. All patients undergoing nasal surgery must realise that there are no guarantees in any rhinoplasty and that a revision surgery may be required.

Every revision case needs very careful planning and an experienced rhinoplasty surgeon. The main principles are to do as little as possible in order to provide minimal disruption and reduce the risks. However at times revision rhinoplasty requires a larger operation, which must be carefully thought through by the operating surgeon.