Rhinoplasty Surgery commonly known as a nose job or nose surgery, is a procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose by resolving nasal trauma (blunt, penetrating, blast), congenital defect, respiratory impediment, or a failed primary rhinoplasty.

These aims are achieved by techniques which reshape the underlying nasal bone and cartilages as well as correcting any congenital or post-traumatic abnormalities. Rhinoplasty techniques were carried out in ancient India by the first surgeon in ancient India, Sushruta.

What all can a surgical rhinoplasty can treat?

  • Nose size in relation to facial balance.
  • Nose width at the bridge or in the size and position of the nostrils.
  • Nose profile with visible humps or depressions on the bridge.
  • A nasal tip that is enlarged or bulbous, drooping, upturned or hooked.
  • Nostrils that are large, wide or upturned.
  • Nasal asymmetry.

A rhinoplastic correction can be performed on a person who is under sedation, under general anesthesia.

For the benefit of the patient and the physician–surgeon, a photographic history of the entire rhinoplastic procedure is established; beginning at the pre-operative consultation, continuing during the surgical operation procedures, and concluding with the postoperative outcome. To record the ‘before-and-after’ physiologies of the nose and the face of the patient, the specific visual perspectives required are photographs of the nose viewed from the anteroposterior (front-to-back) perspective; the lateral view (profiles), the worm’s-eye view (from below), the bird’s-eye view (overhead) and three-quarter-profile views.

Open or closed Rhinoplasty

In open rhinoplasty, the surgeon makes a small, irregular incision to the columella, the fleshy, exterior-end of the nasal septum. This columellar incision is additional to the usual set of incisions for a nasal correction. In closed rhinoplasty, the surgeon performs every procedural incision endonasally (exclusively within the nose), and does not cut the columella. The advantage is that it allows for greater exposure for performing a rhinoplasty. It is almost always required if there is a significant amount of tip work required, especially if it is a revisional procedure, or in the more extensive form of rhinoplasty.

In contrast, in closed rhinoplasty, the surgeon performs every procedural incision endonasally (exclusively within the nose) and does not cut the columella. This is a useful technique for the more simple form of rhinoplasty such as removing a dorsal hump or narrowing the width of the nose. This technique is generally not used if there is significant tip work to be performed or if it is a revisional procedure.

Occasionally, the surgeon uses either an autologous cartilage graft or a bone graft, or both, in order to strengthen or to alter the nasal contour(s). The autologous grafts usually are harvested from the nasal septum, but, if it has insufficient cartilage (as can occur in a revision rhinoplasty), then either a costal cartilage graft (from the rib cage) or an auricular cartilage graft (concha from the ear) is harvested from the patient’s body.

Onlay Prosthesis

This technique is commonly used for patients who simply require an augmentation of the dorsum of the nose. This will increase the height of the nose when viewed in the profile (side) view.

A simple incision is made through the nostril and a soft silicone prosthesis is inserted to lie on the bone and cartilage of the nose underneath the and the subcutaneous tissues. This is a relatively simple procedure and is particularly useful in patients who are requiring an augmentation only. It is a common operation performed particularly in patients of Asian ethnicity who are seeking a more prominent dorsum to the nose. This has both aesthetic and functional benefits as patients generally find it easier to wear glasses after this procedure is performed.

Dr. Rajesh Gawai is renowned for his skills as a revision rhinoplasty specialist and uses advanced surgical tools to visualize the entire surgical zone and to minimize tissue damage.

What options are available?

Rhinoplasty can be performed as a ‘closed’ or an ‘open’ technique. The closed technique is performed without the need for any external scars on the nose. Not all cases are suitable for closed techniques. An open technique involves a small incision being made across the base of the nose (columella). The resultant scar is usually difficult to see. Open techniques are usually done when more extensive work is required, especially work on the nasal tip.

The doctors plan your specific operation taking into account your wishes for the cosmetic appearance and function of your nose. This surgery can be performed as a day case procedure and drains are not used. Packs are placed inside the nose and are removed the next day. A small amount of bleeding may be experienced during the first 24 hours. This is easily mopped up with a small pad placed under the nostrils. A splint will remain on the nose for one week. Stitches will be removed at the same time as the splint. The nose and upper face will be swollen and bruised for one to two weeks. Nose blowing should be avoided for six weeks and strenuous activity for four weeks.

The staff can answer any questions you may have and a personalized quote and information can be sent to you regarding your procedure. The risks will be discussed with you in detail before you consent to the operation. The risks can be broken down into general risks associated with any operation and those specific to rhinoplasty surgery. General operative risks include anesthetic complications, bruising, bleeding, infection wound breakdown and abnormal scarring. Specific complications include: appearance – healing problems, visible external scars, wound breakdown, unsatisfactory final shape; functional problems – septal perforation, septal loss leading to collapse of the nasal bridge and airflow obstruction. Approximately one in ten patients will require a small revisional surgery. This is a fairly consistent statistic for all rhinoplasty surgeons.

Correction of deviation of the septum and nasal bones produces greater symmetry of the internal airway. Furthermore, the use of spreader flaps and grafts will improve the cross-sectional area of the internal valve of the nose and as a consequence will lead to a much-improved airflow. The spreader flaps or grafts re-use the excessive cartilage (upper lateral cartilages) that are routinely removed when reducing the dorsal hump or bump in rhinoplasty.

According to the laws of physics (Poiseuille ’s law) where the laminar flow rate depends on the fourth power of the radius), a small difference in the internal diameter of the nasal airway makes a massive difference to airflow.

One of the other advantages of using spreader flaps is that it will also help create more defined dorsal aesthetic lines improving the appearance of the nose as well as augmenting the strength and improving the stability of any corrective septal deviations.