Cosmetic nasal reshaping
Rhinoplasty, also known as nasal surgery or a "nose job", is one of the most popular of all plastic surgery procedures. Rhinoplasty can straighten a crooked nose, reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils… It can also relieve some breathing problems. Whatever the motivation for seeking nasal reshaping most problems can be fixed.
Before and after photographs
The New Zealand Medical Council has banned New Zealand doctors from using "Before and After" photographs in any form of public communication, including websites. The only permissible use of such photographs under the New Zealand Medical Council rules is during a medical consultation.
Dr Masters will show you examples of previous patient's "Before and After" photographs during your consultation.
The Procedure
The term rhinoplasty is used to describe any reconstruction of the external nose, whether this is increasing, decreasing or simply changing the size and shape of the external nose. If the midline septum separating the two sides of the nose is also being worked upon the procedure is called a septorhinoplasty.
Indications
Cosmetic rhinoplastys are usually only performed on patients who have reached facial skeletal maturity (usually 16 years old for females and 18 years for males), however occasionally for functional reasons or congenital anomaly reasons rhinoplasty may be considered for younger patients. The primary indication for rhinoplasty is a desire to change one or more features of the external nasal shape.
Relevant Anatomy
Each side of the external nose is composed of a nasal bone from between the eyes to approximately one quarter of the way down the nose and then two pieces of cartilage. The first cartilage, like a flat plate, is attached to the nasal bone above and the second piece of cartilage below. The second cartilage has a complex curving and folding shape that forms the shape of the tip of the nose.
In addition to this there is a large plate of cartilage and bone that runs down the midline of the internal nose called the septum. The skin covering these structures changes from thin and mobile near the top of the nose to thick and relatively fixed over the lower portions of the nose. The columella is the externally visible piece of skin separating the two nostrils.
Pre Operative Preparation
During your pre operative consultations Mr Masters will establish exactly which features you feel need to be changed on your nosed. As part of your assessment Mr Masters will also evaluate the remainder of your facial structures to ensure that the final result is in harmony with the remainder of your face.
Mr Masters will provide you with precise instructions well in advance of your surgery to allow you a smooth and stress-free preparation for the procedure. Take the time to read your consent form thoroughly, along with any other written information Mr Masters has provided for you with regard to your surgery. This will allow you to have all of your questions answered prior to the procedure, and ensure there are no unexpected surprises during the post-operative period.
If you are the main domestic executive in your home, or you live alone, you should plan ahead with regard to housework and meal preparation. Do your grocery shopping, cleaning, etc the day before your surgery and plan to have meals that require minimal preparation and/or cooking time.
If you are a smoker, stop smoking at least one month pre-operatively (see the "Policies" page). Do not take any aspirin or aspirin-containing products for at least one week prior to the surgery. If you are on any other medications, ensure that Mr Masters is aware of the medications (including homoeopathic remedies) so that any other medications that require cessation during the pre-operative period can be discontinued.
Anaesthesia
This operation is performed under general anaesthetic (you are asleep) administered by a registered Specialist Anaesthetist, as a day case (you go home the same day) in a full operating suite.
The Surgery
There are two surgical approaches to the nose, open and closed. Cosmetic rhinoplasty has traditionally been performed via a closed approach, meaning that there is no external scarring. More recently the open approach has become popular. With an open approach there is a small, well-concealed surgical scar crossing the columella at its narrowest point. The open approach gives the surgeon excellent exposure to the underlying nasal structures, facilitating precise manipulation to achieve the patients surgical aims. The surgery itself, depending on its complexity, varies between half to three hours to perform. At the completion of the operation a nasal splint is usually fitted for a week.
Post Operative Period and Recovery
Most rhinoplasty patients go home on the day of surgery once they have fully recovered from their anaesthetic. Some patients nasal passages may have been packed to help control the position of the structures that have been operated on and to help prevent post operative bleeding. These packs are removed on day 2 post-operatively. The patient should recover at home quietly whilst avoiding activities associated with increasing the chance of bleeding, such as exercise and heavy lifting.
One week after the operation any external sutures and the splint are removed from the nose. At this time the nose will still be swollen and bruised. Complete resolution of post operative swelling can take several weeks to months, however the patient is usually able to resume social activities at about seven to 10 days. Initially the airway may be slightly reduced due to internal swelling but this also settles.
Complications (general)
Before deciding to proceed with surgery, every patient needs to thoroughly consider the risks, as well as the benefits, of the proposed procedure. During your pre-operative consultation(s), Mr Masters will openly discuss the risks with you so that you can consider them. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website.
There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being performed.
Generalised surgical risks include:
- Bleeding - usually occurs within the first 24-48 hours of the procedure and may require a return to the operating room. A quiet, restful post-operative period will help to avoid this problem.
- Bruising - whenever possible, Mr Masters uses medications and techniques that help to avoid post-operative bruising. The appropriate use of Arnica may help to speed the resolution of bruising.
- Infection - surgical incisions, even though created in ideal circumstances, can become infected. When appropriate, antibiotics will be prescribed to lower this risk.
- Unfavourable scarring - every surgical incision results in a scar. It is Mr Masters' role to maximise the quality of your scars and, whenever possible, to hide them in natural skin creases.
Complications specific to rhinoplasty
Although uncommon, potential complications of rhinoplasty are possible. Mr Masters will thoroughly discuss these and other risks with you pre-operatively:
- Loss of smell (very rare).
- Reduced airflow through the nose.
- Dissatisfaction with the final result.
- Nasal asymmetry.
Approximate Costs
A written quote will be provided after your consultation. Including the theatre charges, consumable items used, routine follow up, anaesthetist and surgeon's fees, rhinoplasty surgery starts from $14,000. This price will change depending on your medical history, the complexity of the case and whether additional procedures (such as cartilage grafts, nasal implants, etc) are required.
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