Facial bone structure differs among various human races, each having its own special beauty. Regardless of the racial origin, individuals desire nasal refinement by improving definition of the nasal tip and changing the projection and character of the nasal bridge. Fig. 8. Such alterations are possible but must be carried out by observing the principle that a natural look is always more attractive than features which show obvious signs of forced surgical intervention.

    Prior to surgery, appropriate laboratory tests and an evaluation of the patient’s general health are carried out.

    The operation is usually performed under general anaesthesia. The patient is put to sleep by the anaesthetist, who assumes constant care of the patient’s body functions until he or she has recovered from the anaesthetic. The remainder of the recovery period takes place in the recovery room. The surgery itself lasts between thirty minutes to one hour and forty-five minutes. In some instances, a rhinoplasty can be carried out with a local anaesthetic under heavy sedation.

    The incisions are usually made inside the nose so that there are no scars on the skin. In rare instances a small cut may have to be made under the nasal tip between the nostrils, as indicated in Fig. 9a. This produces a small scar which becomes virtually invisible six months after the operation. Fig. 9b. The details of the type of incision necessary in your case will be explained to you during the pre-operative assessment. The external incision only becomes necessary in badly traumatized noses or in those who have undergone previous surgery by another surgeon and require a revision. After surgery has been completed, a small cast is placed on the nose and a small amount of soft packing is inserted into each nostril. The packing (not the cast) is removed usually the next day.

    The length of stay in the hospital normally does not exceed one or two days after surgery. Following discharge, the patient is encouraged to remain out of bed most of the time as being in an upright position will decrease swelling and accelerate healing.

    The cast is removed in the surgeon’s office on the sixth or seventh day after surgery. The swelling and bruising under the skin, and occasionally in the whites of the eyes, distort the immediate post-operative appearance. You must be patient while normal healing takes place. The average patient is usually presentable in ten or twenty days, even though he or she may resume normal activities much earlier, provided it is not strenuous exercise or work.

    It is expected that the nasal passages will remain slightly obstructed for up to two weeks. During the same time blood stained discharge and crusting may appear in the nostrils. You may start blowing your nose gently, using both nostrils at the same time after one week. Smoking is not contra-indicated but IT IS NOT DESIRABLE particularly during the first two weeks as it may increase the risk of bleeding. You may gently cleanse the outside of your nose when the dressings are removed and you may use cosmetics.

    For a period of six weeks, it is essential that no pressure be exerted on the nose as this may displace the still unstable nasal bones. Eyeglasses of any kind must not be worn unless they are suspended from the forehead with adhesive tape. Contact lenses can be worn as soon as the eyelid swelling has subsided enough to permit comfortable insertion. You should protect your nose from prolonged exposure to direct sunlight or frost during the first year following the operation. You will find that some areas of the nose will remain numb for a few months and this may render you susceptible to frostbite and sunburn. Some temporary numbness or altered sensitivity in the front of the palate and upper front teeth may also occur.