NOSE RESHAPING SURGERY

Rhinoplasty

PROCEDURE

What is Rhinoplasty?

The nose is the central feature of the face and an essential component in our perception of self-image. A nose that is out of balance with other facial features can have a significant impact on the appearance of the face.

A rhinoplasty, commonly known as a nose job or nose reshaping surgery, is a surgical procedure to reshape, correct or reconstruct the nose to produce a more harmonious appearance and is one of the most popular plastic surgery procedures performed worldwide. In the UK, rhinoplasty ranks among the top five most common cosmetic surgery procedures, comprising about 10% of all such procedures in 2019.

Rhinoplasty is a complex surgical procedure, involving several techniques to correct a wide range of issues. It is possible to improve a bulbous tip, smooth a hump on the bridge, straighten a crooked nose, or address nostril asymmetry. It is possible to reduce or increase the overall size of the nose or change its projection.

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Individuals seeking rhinoplasty may include those who have experienced a sports-related injury, trauma or illness. Often, though, they have been unhappy with the appearance of their nose for many years.

Regardless of motivation, Mr Annakan Navaratnam’s surgical approach emphasises enhancing natural features, achieving a balanced and natural appearance by considering size, shape, contours, and definition.

While often performed for cosmetic reasons, rhinoplasties can also address functional concerns, such as breathing difficulties, sleep apnoea, and snoring, in the form of a septorhinoplasty procedure. A septoplasty is a procedure to correct a deviated septum which is usually responsible for airway obstruction.

A skilled and experienced rhinoplasty surgeon with expertise in nasal reconstruction is vital to achieve both a functional and aesthetic improvement.

Types of procedure

Open rhinoplasty

An open rhinoplasty involves an incision across the columella, at the base of the nostrils. The incision typically extends up and around the rim of the nostrils, allowing the surgeon to draw back the skin and fully access the nasal cartilage. It also allows access to the nasal septum which may need to be corrected to address airway obstruction. This procedure is required for more complex procedures such as significant nasal abnormalities, often the result of trauma or congenital conditions.

Closed rhinoplasty

During a closed rhinoplasty, the incisions are made within the nasal cavity and may be employed to address issues with just the tip of the nose. Although there is the benefit of no external scars, this approach is only appropriate for some procedures. Furthermore, Annakan has expertise in performing tip delivery techniques as part of a closed septorhinoplasty, which can be used to augment and reposition the nasal tip without the need for external incisions or scars.

Septorhinoplasty

Septorhinoplasty is a procedure that addresses both functional and aesthetic concerns. The septum is the wall of cartilage and bone in the nose that separates the nostrils. If it is misaligned, it can cause significant breathing difficulties. During a septorhinoplasty, Annakan will straighten any bent portions to facilitate unobstructed breathing. By straightening a crooked nose, a more aesthetically pleasing appearance is produced.

Tip rhinoplasty

A tip rhinoplasty specifically targets the nasal tip without altering the bony structure of the nose so is much less invasive than a conventional rhinoplasty. A tip rhinoplasty can address a bulbous, prominent, crooking or drooping nasal tip.

Revision rhinoplasty

Revision rhinoplasty is a specialised surgical procedure aimed at correcting or improving the results of previous nasal surgery. This operation is generally more complex than a primary rhinoplasty due to the presence of scar tissue, changes in nasal structure, and the need for precise corrections. Often, it involves the use of grafts from the patient’s own body, such as ear or rib cartilage, to rebuild or refine the nasal framework. Due to the intricate nature of revision procedures, patients can expect a longer recovery period compared to their initial surgery, as the nose needs more time to heal and settle into its final shape.

At a glance

Surgery time

1.5 – 3 hours

Anaesthetic

General

Time off work

2 weeks

Hospital stay

Day Case

Shower

After 1 day

Reasonable mobility

After 2 days

Exercise

After 6 weeks

Sleeping on back

4 weeks

Full recovery

6 – 8 weeks

Driving

2 weeks

Rhinoplasty results

MORE BEFORE & AFTERS

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RHINOPLASTY SPECIALIST

Mr Annakan Navaratnam

Annakan Navaratnam is a Consultant Ear, Nose & Throat (ENT) Surgeon whose private practice is based at Harrow and Welbeck Hospital in Central London and The Clementine Churchill Hospital in Harrow. In his NHS practice, he works at the Royal National ENT Hospital and University College London Hospital (UCLH), and is an honorary consultant at Great Ormond Street Hospital.

He has a subspecialty interest in rhinology and facial plastic surgery, with particular expertise in septorhinoplasty and nose reshaping.

Annakan is excellently placed to manage general adult and paediatric ENT presentations and, in particular, is able to assess and treat complex problems related to the form and function of the nose. This includes endonasal (scarless) rhinoplasty, revision septorhinoplasty as well as advanced endoscopic sinus surgery.

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What to expect

Here you will find some essential information to help you prepare for surgery and the arrangements you should make to ensure you have the support you need and that everything runs smoothly on the day. However, we are on hand to answer any questions you may have.

01. The consultation

The first stage is always a comprehensive consultation and pre-operative assessment with your rhinoplasty surgeon Annakan Navaratnam.

During the consultation, he will listen carefully to your concerns and desired outcomes, and recommend whether surgery is appropriate at this time. The potential risks, post-surgery expectations, and recovery details of the specific procedure will also be discussed. A detailed medical history will be obtained to ensure your fitness for surgery.

Examination of the nose will be performed during the consultation to assess the nasal structures and to evaluate for any presence of nasal disease. This will often involve a procedure called nasoendoscopy to examine the deeper nasal anatomy.

Something investigations in the form of imaging such as a CT scan may be required as part of the assessment to help guide treatment. Pre-operative photographs are always necessary prior to rhinoplasty surgery and aid in the consultation process. These are taken during the consultation.

A two-week reflection period follows the initial consultation, during which you can return for additional consultations free of charge.

02. Preparing for surgery

If you decide to proceed, you’ll receive guidance on preparing for surgery. Pre-surgery tests may be required.

Mr Navaratnam will advise you on stopping smoking as far in advance of surgery as possible due to its impact on healing, infection risks, and complications during anaesthesia. Guidance on discontinuing blood-thinning medication and fasting before surgery will be provided.

03. Day of the procedure

Upon arrival at hospital, you’ll be escorted to a private room, and vital signs will be assessed. Your surgeon will finalise markings, and the anaesthetist will visit you. Clinical photography will document the pre-op and post-op phases.

The procedure is performed under general anaesthesia, followed by recovery in a specialist recovery room. Rhinoplasty surgery can be performed as a day case so once you have recovered sufficiently you will be discharged into the care of a friend or family member.

You will usually have an external nasal dressing over the nose and occasionally dressings inside the nostrils are required. These dressings are removed at your first post-operative follow-up appointment, which is usually 7-10 days after surgery.

04. Your recovery

Post-surgery pain varies for each individual, but most patients find it minimal and can be managed with over-the-counter painkillers. It typically subsides within the first week or so along with any bruising.

You will expect swelling and bruising around the eyes and cheeks following surgery which will subside in the days and weeks following surgery.

We advise that you do not undertake strenuous activity or exercise for 2 weeks after surgery. Also avoid hot drinks and hot showers for 2 weeks after surgery as this may increase the risk of bleeding.

A comprehensive recovery guide, including follow-up appointment dates, will be provided. Our team will be on hand if you have any concerns.

Frequently asked questions

Am I a suitable candidate for rhinoplasty?

Suitable candidates for rhinoplasty are those in good physical and psychological health, with concerns about nose size or shape, realistic expectations, damage or injuries, or issues like snoring, sleep apnoea, or breathing difficulties.

Why might rhinoplasty surgery not be right for me?

Rhinoplasty is a surgical procedure that changes the shape of your nose to improve its appearance and function. However, it may not be suitable for everyone. The success of this surgery depends heavily on a strong surgeon-patient relationship, where open communication and trust are paramount. Annakan will take the time to understand your expectations and goals and, in turn, provide you with a realistic outlook on the possible outcomes.

It’s crucial to remember that while rhinoplasty can enhance your facial features and improve breathing issues, it has its limitations. The anatomy of your nose, your skin type, and overall facial structure play significant roles in what can be achieved. Unrealistic expectations can lead to dissatisfaction with the surgery results. Therefore, ensuring you have a clear and realistic understanding of what rhinoplasty can and cannot do is essential before deciding to proceed with the surgery. This mutual understanding and setting of realistic goals are key to achieving results that both you and your surgeon are satisfied with.

Is there a difference between male rhinoplasty and female rhinoplasty surgery?

Rhinoplasty for men and women involves distinct goals, considering anatomical differences and individual aspirations. While objectives for surgery are specific to each patient, male rhinoplasty often aims for a straighter angle and stronger definition, while female rhinoplasty often seeks a softer transformation.

What’s the difference between rhinoplasty and septorhinoplasty?

Rhinoplasty reshapes the external appearance of the nose. Septorhinoplasty combines this with correction of a deviated septum, addressing breathing problems alongside the aesthetic changes in a single procedure. If you have both cosmetic concerns and nasal obstruction, septorhinoplasty may be recommended instead of rhinoplasty alone.

Is a nose job painful?

Contrary to expectations, rhinoplasty is not usually painful in the post-operative period, with low discomfort levels and temporary symptoms like a blocked nose during early recovery.

Will my nose job look natural?

Mr Navaratnam’s approach favours subtle, balanced changes that suit your existing facial features rather than a single, one-size-fits-all look. A natural-looking result depends on realistic goals discussed openly during consultation, careful surgical planning, and respect for the underlying structure of your nose and skin.

What are the risks associated with rhinoplasty surgery?

Risks associated with rhinoplasty include anaesthesia-related concerns, infection, poor healing, numbness or pain, nasal septal perforation (rare), difficulty breathing, unsatisfactory appearance, and the possibility of revisional surgery. Annakan will provide you with comprehensive aftercare instructions to help minimise risks.

What is the downtime after nose surgery?

Downtime after rhinoplasty typically involves taking a week off from work, wearing a splint for up to ten days, and avoiding strenuous exercise for at least two weeks. Gentle activities like walking can aid in the healing process by boosting circulation.

When can I resume exercise after a rhinoplasty?

Resuming exercise after rhinoplasty requires caution, with a minimum of two to three weeks of avoiding vigorous activities. Following Mr Navaratnam’s aftercare instructions is essential for a smooth recovery process.

When can I wear glasses or sunglasses after rhinoplasty?

Glasses that rest on the bridge of the nose should be avoided for around six weeks after surgery to prevent pressure on the healing nasal bones. Contact lenses are usually fine once you feel comfortable, and Mr Navaratnam can advise on taping or alternative frames if you rely on glasses day to day.

How long does it take to see the final results of rhinoplasty?

Initial swelling and bruising usually settle within two to three weeks, and most patients feel comfortable in social situations by this point. However, subtle swelling can persist for several months, particularly at the tip, and it typically takes around 12 months for the nose to fully settle into its final shape. For patients with thick skin and in revision cases changes can occur up to 18 months after surgery.

How long do rhinoplasty results last?

The results of rhinoplasty are generally long-term, as the underlying bone and cartilage have been reshaped. The nose will continue to age gradually over time, as with the rest of the face, but the core structural changes made during surgery do not reverse.

Is rhinoplasty available on the NHS?

Rhinoplasty performed purely for cosmetic reasons is not funded on the NHS. If breathing difficulties are also present, for example due to a deviated septum, NHS funding may be available for the functional element in the form of a septoplasty or septorhinoplasty, though strict eligibility criteria and waiting times apply. Mr Navaratnam can advise which of your concerns are functional versus cosmetic during your consultation.