Thorough assessment before rhinoplasty is crucial to ensuring a good rhinoplasty outcome. The suitability for surgery, patient expectations and concerns are assessed and a surgical plan is formulated – getting this right comes with experience and it is an area of continuing learning for any rhinoplasty surgeon.
Patients are often seen on two separate occasions before a cosmetic rhinoplasty – the reasons for this are:
- To ensure there is consistency with the expected result for both the rhinoplasty surgeon and patient
- To give the chance to check that expectations are realistic and that patients understand the surgery fully
- To give patients the chance to ask questions on the second occasion that they may have forgotten to ask
Types of rhinoplasty
There are various ways that rhinoplasty surgery can be performed – open and closed rhinoplasty
A closed approach is when incisions are inside the nose entirely.
Open structure rhinoplasty
An open approach is when there is an incision across the skin of the columella (between the nostrils at the base of the nose) and then the incision becomes internalised.
- The open approach allows the structures of the nose to be seen in more detail
- With the open approach, there is a scar but this is, in the vast majority of cases, this is almost invisible and is very rarely the source of any concern.
An open approach is used when:
- There are issues to address with the intrinsic features of the nasal tip (using sutures, removing cartridge and/or grafting)
- If a graft to strengthen the nose is needed
- When the nose needs straightening
- For revision surgery (where there has been a previous rhinoplasty operation)
There tends to be more swelling in the first 2-3 post-operative weeks after open structure rhinoplasty compared to a closed approach – there is also more tip numbness and feeling of tip “rigidity” after an open approach – but these resolve with time.
Rhinoplasty / septorhinoplasty
A septorhinoplasty basically refers to a rhinoplasty that also involves straightening of the nasal septum (the cartilage and bone that separates the two sides of the inside of the nose- and which also forms the bridge of the nose in the mid-third of the nose). This may be necessary for treating a blocked nose and for aesthetic considerations (i.e. if the nose is twisted). If the nose is twisted, particularly in the mid-third, this can be quite difficult to get entirely straight and sometimes grafts (using cartilage from inside the nose usually) are necessary.
The two areas rhinoplasty can help address are to:
- Make the nose look natural and in keeping with the patient’s facial structure and general appearance (height/build)
- Correct blockage of the nasal airway passages
Rhinoplasty by an ENT specialist
ENT – head and neck surgeons can provide a complete evaluation and treatment options regarding rhinoplasty. An ENT specialist can receive up to 15 years of university and post-graduate training in surgery, concentrating on ear, nose and throat procedures. Because they study the complex anatomy, physiology, and pathology of the entire head and neck, ENT specialists are uniquely qualified to perform the procedures that affect the nose.