Advice after your nerve block for surgery
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Introduction
Rhinoplasty surgery (nose re-shaping) is performed for one or both of the following reasons:
• Cosmetic
• Functional e.g. nasal blockage
During your pre-operative assessment with your surgeon, it is important to outline the major concern that you have with your nose. If correcting the shape of the nose is the major factor, you must have realistic expectations regarding what can be achieved with rhinoplasty surgery.
Your surgeon will discuss with you how the nose should look in relation to your other facial features. It is important for the patient to understand that the goal of the surgery is not to achieve perfection but rather to improve the appearance.
Photographs of the nose allow the surgeon to evaluate the appropriate procedure to achieve the desired results. Sometimes rhinoplasty is combined with a procedure called septoplasty, which involves straightening the partition or septum inside the nose.
This may be performed to help the nasal airways or the shape of the nose. Occasionally it is necessary to remove the cartilage part of the nasal septum and straighten it, prior to repositioning the septum back inside the nose. This is called an extra-corporeal septoplasty.
Typical cosmetic reasons for rhinoplasty surgery are to straighten the nose, remove a hump on the nose, Improve the angle of the nose with the upper lip, or reduce the size of the nasal tip. These conditions may be congenital or caused by external trauma to the face.
The Operation
You will attend the hospital about 1—2 weeks before the operation for a pre-operative assessment. You should not have suffered from a common cold for at least two weeks before the operation. If you have had a cold, please ring the Consultant’s secretary. You will be admitted to hospital on the morning of the surgery.
The operation requires a general anaesthetic (fast asleep) and usually takes 1—2 hours.
Rhinoplasty can be performed via two different approaches designed to gain access to the bones and cartilages of the nose.
- The ‘closed’ approach involves making all of the major incisions inside the nose, resulting in no visible scarring on the nose. This technique is used for the majority of cases.
- In more complicated cases, particularly if there are cosmetic issues with the nasal tip, an open approach is used. This involves an incision on the skin of the under-side of the nose in a region called the columella.
After the surgery, this incision is closed with fine stitches, which are removed a week after surgery. Usually the scar heals very well, and in view of its position on the nose, it is rarely noticeable in the long term.
On the day of the surgery prior to the operation, your surgeon will see you to confirm the operative plan and ensure your expectations from the surgery are realistic. In particular the surgical approach, whether open or closed will be confirmed.
During the surgery the nasal hump is often removed using a special file or chisel. The bones are straightened and sometimes narrowed via two tiny incisions made on each side of the nose through which a chisel is used to break the nasal bones. The small incisions generally heal without visible scarring.
In patients in which the size of the nasal tip is too large or the tip in not symmetrical, cartilage may be removed to reduce the volume and improve the shape of the tip. In addition sutures may be inserted into the cartilages of the tip. The angle between the nose and upper lip can be improved by judicious removal of cartilage from the tip and nasal septum. In some cases it is necessary to narrow the base of the nose, which involves removal of skin and soft tissues from both sides of the nostrils.
In some rhinoplasty surgery, material may be required to augment the shape of the nose. Usually a cartilage graft is taken from the ear. The ear incision creates a scar on the front of the ear, but this usually heals very well and there is no resulting deformity to the ear.
Various other materials may be used such as silastic and permacol, which are safe and well tolerated by the body. Any such graft will be discussed by your surgeon.
After the operation:
Patients undergoing rhinoplasty surgery usually stay in hospital for one night, although if the surgery is performed in the morning, occasionally it is possible to go home later the same day.
To stabilise the nasal bones, steristrips and a plaster cast are placed on the nose at the end of the operation. These are removed one week after the surgery. Makeup can be applied after the removal of the plaster.
There will be some swelling and bruising around the bridge of the nose and possibly the eyes. The bruising around the eyes begins to fade within a few days. The discolouration has usually disappeared completely in 2 –3 weeks in most cases.
Dressings or packs may be inserted into the nose at the time of surgery. These may be removed later the same day or the following day.
There will be some congestion of the nose, particularly when work has been done to the nasal septum. This may last for up to 4 weeks.
Pain after the operation is usually mild to moderate and is controlled with medication.
During the healing process, great care must be taken to protect the nose from injury. Eyeglasses should be adjusted in order to minimise pressure on the nose.
Although patients are usually up and around a day or two after the procedure, any exercises particularly those which might elevate blood pressure, must be avoided for several weeks.
After the plaster on the nose has been removed, you should avoid direct sun exposure to the face for 3 months.
You should remain off work for two weeks. If you need a medical certificate, please ask the ward staff before you are discharged home.
The Risks
- Swelling and bruising—around the nose and eyes this is to be expected.
- Bleeding—occasionally bleeding from the nose occurs, either shortly afterwards or up to 10 days following surgery. This may require re-admission to hospital.
- Infection—This is rare in rhinoplasty surgery, but if it occurs, antibiotics will be prescribed. When grafts are placed inside the nose, antibiotics are usually prescribed as a preventative measure. There is a small risk that infection could adversely affect the success of the operation. Were it to happen, it may be necessary to remove an implant or it may cause a cartilage graft to resorb. In either event it should be possible for you to have a further reconstructive operation once the infection has cleared. Sometimes manufactured implants will extrude through the skin or the nasal lining and need to be removed. This can happen months or years later.
- Scarring—For open rhinoplasty this is a rare complication of the columella incision on the nose.
- Unsatisfactory Result—often after rhinoplasty surgery, the dorsum (top surface) and side of the nose feel irregular. This is to be expected but the contour of the nose will look fine. In approximately 10 per cent of rhinoplasties, a small adjustment is required at a later stage and requires further surgery. Very occasionally the cosmetic appearance of the nose is unsatisfactory and formal revision surgery is required. Every patient must prepare themselves psychologically for this possible eventuality. Revision surgery is usually undertaken a minimum of 6—12 months following the original operation. Sometimes an unsatisfactory result manifests many months or even years after the original rhinoplasty surgery.
Please tell your surgeon about all medication you are taking especially warfarin, aspirin and/or the oral contraceptive pill.
Any Questions:
The team involved in your care have written this information booklet to make your admission and care as smooth as possible. However, it does not cover every aspect of your care and the staff will always be happy to answer any other questions or points of concern.
If any of these problems arise after you have gone home please contact the wards:
Frimley Park Hospital: Short Stay Surgery ward Direct No 0300 613 3216
F1 (children’s ward) 0300 613 4252
Sources of Additional Information:
British Association of Otorhinolaryngologists: www.
National Institute for Health and Clinical Excellence (NICE) www.
Contact us
If you have any queries relating to this information, please contact the Ear or nose and throat (ENT) service.
About this information
Service:
Ear, nose and throat (ENT)
Reference:
G/031
Approval date:
23 February 2026
Review date:
1 February 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.