Rhinoplasty

Rhinoplasty is the surgical procedure that changes the shape, size or function of the nose. It works on the nasal bones, cartilage and skin to correct aesthetic problems, breathing problems or both. It is one of the most commonly performed facial operations in the world and one of the most technically demanding, because small changes to the nose alter the balance of the whole face.

History of rhinoplasty

The earliest nasal reconstructions with skin flaps are described in ancient Indian medical texts. Modern aesthetic rhinoplasty was born in the late 19th century: the American surgeon John Orlando Roe published an internal (closed) technique in 1887, and the German surgeon Jacques Joseph, in Berlin, systematised nasal reduction surgery in the following decades, which is why he is considered the father of modern rhinoplasty. The open approach became popular in the second half of the 20th century, followed more recently by ultrasonic instruments and preservation techniques.

Indications for rhinoplasty

Rhinoplasty can have aesthetic indications, functional ones or both:

• Aesthetic: dorsal hump, drooping, wide or poorly defined tip, large or wide nose, asymmetry and disproportion with the rest of the face.
• Functional: nasal obstruction due to a deviated septum, a narrow nasal valve or the after-effects of trauma.
• Reconstructive: after fractures, congenital deformities or previous surgery (secondary rhinoplasty).

It is not recommended before facial growth is complete, around 16-18 years of age.

Rhinoplasty techniques

The main rhinoplasty techniques are:

• Open rhinoplasty: adds a small incision on the columella (the skin between the nostrils). It gives a full view of the cartilage and is preferred in complex or tip cases.
• Closed rhinoplasty: all incisions are inside the nose. Suited to more limited changes.
• Ultrasonic rhinoplasty: uses a piezoelectric instrument that cuts and shapes bone more precisely and with less damage to soft tissue than a rasp or chisel.
• Preservation rhinoplasty: instead of removing the hump, the whole bridge is lowered, keeping its natural surface. Useful in selected cases.
• Septorhinoplasty: combines aesthetic correction with straightening the septum to improve breathing.

Cartilage grafts (from the septum, ear or rib) are often used to provide support or definition.

Risks and complications of rhinoplasty

Like any surgery, rhinoplasty can involve bleeding, infection or reactions to anaesthesia. Procedure-specific complications include irregularities of the bridge, asymmetry, changes in tip sensation, breathing difficulties and a result that does not meet expectations. Some patients need a touch-up or secondary rhinoplasty, which is usually more complex than the first.

Recovery and results after rhinoplasty

After rhinoplasty, an external splint is worn for the first week. Swelling and bruising improve within two or three weeks, but the nose continues to settle for months, especially at the tip. The final result is assessed at six to twelve months and is permanent, although the nose, like the rest of the face, continues to age.