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Septorhinoplasty (Combination of Septoplasty & Rhinoplasty)

 
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Rhinoplasty - before and after

Rhinoplasty is a surgery, which aims to improve the cosmetic appearance of your nose (Not usually performed in NHS). Frequently rhinoplasty is performed in combination with septoplasty and is called septorhinoplasty. Septorhinoplasty addresses the cosmetic problem as well as the obstruction to the airflow caused by deviated septum. It may also correct a birth defect or injury.

The skin of the nose is separated from its supporting framework of cartilage and bone, which is then sculpted to the desired shape.

Sometimes rhinoplasty is performed through an incision “cut” inside the nostrils with 4 small incisions, 2 at either side of the nasal bridge. Rhinoplasty can also performed as an “open” procedure in which a small incision is made across the columella, the vertical strip of tissue separating the nostrils.

The type of procedure undertaken depends upon the nature of cosmetic problem and surgeon’s preference. (The surgeon will discuss this procedure with you as it may be too technical to describe here.)

Rhinoplasty takes one to two hours but may take longer in complicated cases.

It is usually performed under general anaesthesia.

At the end of operation, a splint will be applied on the nose to maintain its new shape. The splint (Plaster of Paris cast) stays on for one week.

Nasal packs are sometimes inserted into the nose and if so they will usually be removed the following day.

Rhinoplasty is not usually performed on teenagers until after their growth spurt, about 14 or 15 for girls and 17 or 18 for boys.

Complications of rhinoplasty

Complications mentioned under septoplasty section also apply here, such as bleeding, infection, and probable need for nasal packing. The following are additional complication/ risks:

  • Bruising and swelling around the eyes. This can vary from mild puffiness around the eyes to swollen closed eyelids with marked bruising which settles within ten days

  • An ideal cosmetic result may not be achieved- In order to achieve the goals set prior to this surgery, communication is essential. The expectations of the patient should be the same as the goals set by the surgeon such that they are in agreement with each other. Your surgeon may thus decline to do the surgery if he/she feels your expectations are unachievable or unrealistic. {N/P} Some patients may require a revision surgery

  • Pain-this may be mild to moderate and may be felt as a dull headache.

 Expectations and advise following Septorhinoplasty surgery

  • You may feel your face is puffy, you have a dull headache and your nose aches. Take the pain medication as prescribed and you feel better within 24 hours or so

  • You may awake with some packing in your nose to stop any bleeding. If present, this should be left alone and will be removed by your nurse when appropriate. You will be nursed with the head of the bed slightly elevated. It is probable that you will have to breathe through your mouth and thus get dry mouth

  • You may get a blood stained/ pinkish discharge for a few days. Serious nasal bleeding is rare
  • Swelling and bruising around the eyes will increase at first, reaching a peak after about 2 to 3 days. Most of the swelling and bruising should disappear within 2 to 3 weeks

  • Avoid very hot baths and showers. Take these quite cool. It may lead to nasal haemorrhage and also increase bruising around the eyes

  • If you take aspirin you should discuss this with your doctor, as you may need to avoid taking aspirin for a few days prior and after the operation. Aspirin can potentially increase the risk of nasal bleeding

  • Avoid smoky, dusty and dry atmospheres if possible, as this may irritate the nasal lining

  • The splint over your nose will be removed a week after surgery

  • Two weeks off work/ school. A sick-note will be provided. Remain indoors at least during the first week

  • It is normal for your nose to be quite blocked for several days (even a couple of weeks) after the surgery, while all the internal swelling settles

  • Only gently blow your nose after nasal irrigation, avoid heavy nasal blow for 10+ days after your operation

  • You may have a few sutures “stitches” that need to be removed. If so, you will be advised accordingly

  • Do not drive for 48 hours (because of the effect of the general anaesthetic)

  • Avoid strenuous activity (jogging, swimming, bending, sexual relations…) for 2 to 3 weeks, as they may increase your blood pressure and risk of bleeding

  • Avoid contact sports, hitting, rubbing your nose and direct sun exposure for 8 weeks

  • Avoid wearing glasses without consulting your doctor once the splint is off. Contact lenses can be used as and when you wish.
Please note that the details in this section are for general information only. You should always discuss the risks, limitations and complications of your specific operation with your surgeon.