Rhinoplasty — Procedure Guide, Recovery & Risks | MyMedicPlus

Rhinoplasty — commonly called a 'nose job' — is a surgical procedure that reshapes the nasal bones, cartilage, and overlying soft tissue to improve the appearance of the nose (cosmetic rhinoplasty), restore normal breathing function (functional rhinoplasty), or both simultaneously (septorhinoplasty). It is consistently ranked among the top five cosmetic surgical procedures worldwide, with over 600,000 procedures performed annually.

Two fundamental surgical approaches are used: open rhinoplasty, which places a small transcolumellar incision across the skin bridge between the nostrils to allow full exposure of all nasal structures, and closed rhinoplasty, which uses only endonasal incisions with no external scar. The open approach provides superior visualisation and is preferred for complex cases, significant tip reshaping, and revision surgeries. The closed approach avoids visible scarring and may be appropriate for straightforward dorsal hump reductions or minor adjustments.

Rhinoplasty addresses structural components including the nasal dorsum (bridge), osseocartilaginous vault, alar cartilages (tip), alar base width, and the nasal septum. Cartilage grafts harvested from the septum, ear, or ribs are frequently used to provide structural support and refine the nasal tip. The procedure requires meticulous planning with photographic analysis and open dialogue about realistic expectations.

Cosmetic rhinoplasty is sought by patients who are bothered by specific nasal characteristics: a dorsal hump (a bump on the bridge); a drooping, bulbous, or asymmetric nasal tip; excessive width of the nasal dorsum or alar base; post-traumatic nasal deformity following fractures; congenital asymmetry; or dissatisfaction with a previous rhinoplasty (revision rhinoplasty). Psychological readiness and realistic expectations are essential prerequisites; patients should be motivated by personal desire, not external pressure, and must fully understand that final results are not apparent for 12–18 months.

Functional rhinoplasty is indicated for patients with chronic nasal obstruction due to a deviated nasal septum (septoplasty component), collapsed internal nasal valves (the narrowest point of the airway, often aggravated by prior rhinoplasty), collapsed external nasal valves (weak alar cartilage causing nostril collapse on inspiration), or enlarged inferior turbinates. Functional symptoms include difficulty breathing through one or both nostrils, snoring, exercise intolerance, and sleep disturbance. Insurance may cover functional components in many countries.

Preoperatively, standardised photographic documentation in five views (frontal, lateral, oblique bilateral, and basal) guides surgical planning. Three-dimensional imaging is increasingly used to demonstrate expected changes to patients.

Under general anaesthesia or deep intravenous sedation, the surgical field is infiltrated with vasoconstrictor solution (lignocaine with adrenaline) to minimise bleeding. In open rhinoplasty, a V-shaped or inverted V incision is made across the columella, extended with marginal incisions around the alar rims to fully expose the nasal framework. The nasal skin is elevated off the osseocartilaginous skeleton.

The dorsal hump (bone and cartilage) is reduced with an osteotome, rasp, or ultrasonic piezoelectric device to the desired profile. Lateral osteotomies (cuts through the nasal bones using a fine chisel) narrow the bony vault and close the 'open roof' deformity created by hump removal. The alar cartilages are refined by trimming, suturing (cephalic trim, interdomal sutures, transdomal sutures), or augmentation with cartilage grafts (tip grafts, shield grafts) to achieve the desired tip projection, rotation, and definition. The septum is straightened where deviated. The nasal skin is re-draped, incisions closed, and a thermoplastic external splint applied. Internal nasal splints may be placed if septoplasty was performed.

At closure, the nasal skin is carefully re-draped over the refined framework, ensuring no skin redundancy or dog-ears. The transcolumellar incision is closed with interrupted nylon 5/0 sutures, removed at 7 days; marginal incisions are closed with chromic catgut. An external aluminium or thermoplastic splint is applied over the nasal dorsum and taped to the skin. The total procedure time ranges from 2 to 4 hours for complex open rhinoplasty.

The external thermoplastic splint and any internal splints are removed at 7–10 days, at which point most patients can return to work in a non-physical role. Significant bruising (periorbital ecchymosis) and swelling peak at 48–72 hours and largely resolve within 2–3 weeks, though residual swelling, particularly over the tip, continues to improve for 6–12 months.

Activity restrictions are important for healing: strenuous exercise and contact sports are avoided for 4–6 weeks. Glasses must not rest on the nasal dorsum for 6–8 weeks to avoid displacing osteotomies — patients requiring corrective lenses should use contact lenses or tape their glasses to their forehead during this period. Sun exposure should be minimised to prevent prolonged discolouration of healing skin. No contact sports for a minimum of 6 weeks (12 weeks recommended). Nasal tip swelling is the slowest to resolve — patients with thick nasal skin may not see their final tip definition for 18–24 months. Follow-up appointments are scheduled at 1 week (splint removal), 6 weeks, 3 months, 6 months, and 12 months.

All patients experience temporary bruising, swelling, and numbness of the nasal skin in the early postoperative period; these are expected and resolve within weeks. More significant risks include:

Unsatisfactory aesthetic result requiring revision rhinoplasty: occurs in 5–15% of primary cases and up to 15–20% of revision cases; revision surgery is significantly more complex and is best deferred for at least 12 months until all swelling has resolved. Asymmetry can result from unequal swelling resolution or cartilage warping. Septal perforation (a hole in the septum) is rare at less than 1% with experienced surgeons but causes crusting, bleeding, and a whistling sound. Infection occurs in approximately 1% and usually responds to antibiotics. Saddling deformity (collapse of the dorsum) results from over-resection of cartilage support. Breathing may temporarily worsen due to mucosal swelling before improving. Permanent numbness of the nasal tip or columella can occur. Anaesthesia-related complications carry standard surgical risk.

Patient satisfaction rates consistently exceed 80–85% after primary rhinoplasty when performed by experienced surgeons following careful patient selection. The procedure produces permanent structural changes to the nasal skeleton that are stable after 12–18 months. Cosmetically, patients report significant improvements in facial self-confidence and body image, with psychological studies demonstrating sustained quality-of-life improvements at 5-year follow-up.

Functional rhinoplasty (septoplasty with nasal valve reconstruction) improves subjective nasal airflow in over 85% of patients with documented septal deviation or valve collapse, with improvement in snoring and sleep quality frequently reported. The NOSE (Nasal Obstruction Symptom Evaluation) score, a validated tool, typically shows 30–50% improvement post-operatively. Combined cosmetic and functional procedures are cost-effective — achieving both goals in a single anaesthetic — and may qualify for partial insurance reimbursement in healthcare systems where functional disease is documented.