The nose is perhaps the most defining characteristic of the face. With its central position it is often what the observing eye is first drawn to when looking at a face, particularly when prominent. Many patients are unhappy with the general look of the nose they were born with but for others trauma may have distorted the nasal appearance. The most common requests for cosmetic correction in our London clinic include:

• Hump on the bridge of the nose
• Deviated nose
• Wide appearance
• Large or unpleasant looking tip

Most patients request that the nose is made smaller and in female patients this is often the ideal; usually associated with making the nose look more feminine. In male patients (incidently approximately 30% of all our patients) such reduction in the size needs to be more limited and often refinement is what is required. In all patients it has to be remembered that the function of the nose is of extreme importance and that any surgical intervention does not compromise this. Indeed in many patients, cosmetic concerns are associated with breathing difficulties or sinus problems and these can be addressed concomitantly with related procedures.

First, incisions are made and the bone and cartilage support system of the nose is accessed. The majority of incisions are made inside the nose, where they are invisible. In more complex cases such as with difficult nasal tip or revision surgery, an incision is made in the area of skin separating the nostrils at the bottom of the nose. This ‘external approach’ may also be required in cases of traumatic rhinoplasty or where a nose is very deviated. Next, certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the cartilage can be sculpted in this area to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion. The width of the nose is addressed as a final step and reduced if required with small external incisions at the bases of the nostrils.

The skin and soft tissues are then redraped over the new frame and the incisions are closed. A plaster cast is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbent packing material may be used inside the nose to maintain stability along the nasal septum and to stop minor post operative bleeding although this is usually not required. Very occasionally, soft Silastic splints may be left within the nose for a week or two to help prevent scar tissue formation inside the nasal cavity.

All surgery carries risks complications. These complications are thankfully rare and usually only minor in surgery. Prolonged nasal bleeding is unusual. Whilst it is normal to get some minor bleeding from the nose in the first few days after the operation, heavier bleeding is possible. Rarely, if simple measures don’t settle the problem, medical treatment may be required.

Postoperative infection is rare but can be uncomfortable when it occurs. It will usually settle with antibiotic treatment which is sometimes given at the time of surgery and as part of the post op management as a prophylactic measure, particularly in more complex cases. After the swelling has settled, there is an unlikely risk of developing small irregularities in the supporting structures underlying the skin. These may only be felt but are sometimes visible and if conservative, simple measures don’t resolve matters with time, an additional procedure may be required. 

The skin itself may rarely become mildly reddened in certain areas, most commonly over the bridge of the nose. Once again this will improve with time but permanent discolouration may require treatment with a laser. Such complications are more common in patients with thinner skin. Whilst it is the aim of surgery to try and get the nose straight and symmetrical, the unpredictable nature of healing and scar tissue formation does not always allow this to occur. In markedly deviated noses and after severe trauma in particular, a residual deviation is possible but the likelihood of this will be discussed prior to the operation. Overall, approximately 6% of Mr Paun’s patients may need an additional procedure – most commonly a minor ‘touch up’.