What rhinoplasty can correct
Most aesthetic concerns and a good part of functional ones. The most frequent requests at consultation:
- Reducing a hump on the bridge of the nose.
- Refining a bulbous tip.
- Narrowing a wide nose.
- Lifting a drooping tip.
- Straightening a deviated septum that makes breathing difficult.
What surgery looks for is a nose that does not draw attention and fits in with the rest of the face.
How a nose is assessed
Before anything is recommended, the nose is studied in three views. From the front, to see deviations, width and its relation to the eyes. In profile, for size, tip projection and its angles. From below, for nostril symmetry and the length of the columella. Breathing is examined too.
The face is assessed as a whole. Often the problem is not just a large nose: a receding chin or flat cheekbones change how the nose is read. Simulation helps to talk about what is possible, and it is used as a conversation tool, never as a commitment about the result.
That analysis can end in a no, and that is as it should be.
Techniques: open, closed, ultrasonic and preservation
The technique is chosen according to what needs correcting and to the nose itself. These are the options discussed at consultation:
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Technique: Closed
- What it is
- Surgery is done from inside the nose, through small incisions inside the nostrils.
- What to bear in mind
- No external scar. The structures are less exposed.
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Technique: Open
- What it is
- A small incision on the columella exposes the nasal framework, so bone and cartilage can be reshaped in a stable way and the tip can be shaped.
- What to bear in mind
- Reserved mainly for the more complex cases. Usually linked to a little more early swelling at the tip.
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Technique: Ultrasonic
- What it is
- Bone work is done with a piezoelectric instrument that cuts bone without injuring the mucosa, vessels or cartilage. The rest of the surgery does not change.
- What to bear in mind
- Usually linked to less bruising in the first days. It takes longer in theatre and adds little when the work is mainly on the tip or cartilage.
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Technique: Preservation
- What it is
- Aims to keep the nose's own structures, such as the dorsum, ligaments and support, instead of removing and rebuilding them.
- What to bear in mind
- Complements the classic techniques. It has specific indications and is not used on every nose.
The indication for each technique is set at the in-person assessment.
Ultrasonic rhinoplasty
The benefit of the ultrasonic instrument grows with the amount of bone work the case needs: a marked bony hump, a wide dorsum, small asymmetries of the dorsum, thin bones or revision rhinoplasty on bone that has already been operated on. It improves how the first days look more often than the conventional technique, and it leaves the time to the final result unchanged, which is still a matter of months. The details are in ultrasonic rhinoplasty.
Dorsal recycling
In suitable cases Dr. Verbauvede uses the dorsal recycling technique. The bone and cartilage removed when lowering the profile are kept and reused as grafts in the same nose, so the surgery works with the patient's own tissue without turning to other donor sites when that is not needed. The precision of the piezoelectric cut makes it easier to obtain usable fragments.
Revision rhinoplasty
Secondary or revision rhinoplasty corrects the result of a previous rhinoplasty, aesthetic or functional. It is done on scar tissue and often needs cartilage grafts to restore support: from the septum if any is left, or from the ear or rib when it has already been used. Its aim is to balance the nose.
It calls for more precision than a primary rhinoplasty, and waiting is advisable: unless there is a clear functional problem, the usual approach is to let at least twelve months pass after the first surgery before planning a revision. When it makes sense is explained in revision rhinoplasty.
When surgery is not needed: non-surgical rhinoplasty
Non-surgical rhinoplasty reshapes the nose with injections, without an operating theatre. It adds material at specific points and can camouflage a slight hump, lift the tip or correct small asymmetries.
It has clear limits: it does not reduce the size of the nose, does not correct a deviated septum, does not improve breathing and its effect is not permanent. The nose is also an area of vascular risk, so it should be done by a doctor who knows its anatomy from the inside. How far it can go is explained in non-surgical rhinoplasty.
Nose and chin: the profile is assessed as a whole
The profile depends on the relationship between forehead, nose and chin. A chin with little projection makes the nose look bigger than it is, and in some profiles chin surgery or a profileplasty plan gives a more natural balance than reducing a nose that, on its own, is normal.
When not to have nose surgery
A correct indication includes the possibility of not operating. It is wiser to wait, treat something else or not operate when:
- Facial growth has not finished.
- Expectations do not match what surgery can offer, such as perfect symmetry or someone else's nose.
- The motivation comes from outside: a partner, family or the work environment.
- Body dysmorphic disorder is suspected. In that case surgery does not solve the problem and often makes it worse.
- It is not the right moment in life: bereavement, a break-up, pregnancy or breastfeeding, weight changes or a commitment that cannot be put off.
- There are health conditions against it, such as active smoking, uncontrolled illness or clotting disorders.
- It is too early to revise a previous rhinoplasty.
- The real problem lies elsewhere: rhinitis causing obstruction, the chin or the bite.
Anaesthesia, duration and first days
A full rhinoplasty is done under general anaesthesia. In some cases local anaesthesia can be combined with sedation. The operation usually takes between one and two hours, a little longer if a functional problem is corrected as well, and it is always done in an operating theatre. Under general anaesthesia, the operation involves one night in hospital.
For the first 24 hours the face is swollen, especially around the eyes, and there is bruising. The nasal packs are removed the next day or after two days, and the splint stays on for about a week. Pain relief is prescribed. Noticeable bruising and swelling usually go in about two weeks.
How the nose changes after surgery
The nose settles from top to bottom. The bridge clears early and the tip, with thicker skin, is the last to take shape. That is why the result is judged at one year.
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When: Days 1-3
- What happens
- Splint in place, swelling increasing, possible nasal congestion
- What you see
- Swelling and bruising around the eyes
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When: Days 4-7
- What happens
- Swelling starts to go down and bruising turns yellow
- What you see
- Face still swollen, better every day
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When: Days 7-10
- What happens
- Splint and external stitches removed
- What you see
- Swollen, upturned nose, still far from its final shape
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When: Weeks 2-4
- What happens
- The most visible swelling is reabsorbed
- What you see
- Presentable appearance, the bridge hints at the new line
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When: Months 2-3
- What happens
- Residual swelling, mainly at the tip
- What you see
- A normal-looking nose to others, gradual return to exercise
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When: Month 6
- What happens
- More defined tip
- What you see
- Much of the result visible
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When: Month 12
- What happens
- Internal scars mature
- What you see
- Result can be properly judged
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When: Months 18-24
- What happens
- Final refinement in thick skin and in revision cases
- What you see
- Last details of the tip
Approximate ranges. Every nose and every skin has its own pace.
Risks
As with any surgery, there is a risk of infection, nosebleed or reactions to anaesthesia. Specific to the nose are irregularities of the bridge, asymmetries and breathing problems.
Around 1 in 10 cases need a surgical revision to correct minor defects, and these cases cannot be predicted in advance. Some are solved with non-surgical rhinoplasty, without going back to theatre. No technique, the ultrasonic one included, removes these risks.
What should happen at the consultation
- Being asked what bothers you, in your own words, before anything is proposed.
- A complete examination, breathing included.
- An explanation of what can be achieved and what cannot.
- Clear information on risks, the postoperative period and the possibility of a touch-up.
- Time to think it over, without pressure, and a surgeon willing to say no or to suggest waiting.
Pressure to decide on the same day, promises about the result or simulations presented as a certain outcome are warning signs.
The planning references are not the same in a man.
Frequently asked questions
From what age can the nose be operated on?
The advisable age is from 18, when facial growth and development are complete. Besides age, maturity matters: being clear about what you want to change and why.
What anaesthesia is used?
General anaesthesia for a full rhinoplasty. In some cases local anaesthesia can be combined with sedation, which leaves the nose and the area around it numb while the patient is relaxed.
How long does the operation take?
It usually takes between one and two hours. If a functional problem also has to be corrected, it can take a little longer.
Is the postoperative period painful?
Pain relief is prescribed. The most uncomfortable part of the first days is usually the nasal packs, removed the next day or after two days, and the feeling of congestion. There may be a headache. Noticeable swelling and bruising settle in about two weeks.
When will I see the result?
By the third month the nose goes unnoticed by others, and between the sixth month and the first year the tip finishes taking shape. The result of a primary rhinoplasty is judged at one year, and in thick skin or revision cases it can keep refining up to 18 or 24 months.
Does ultrasonic rhinoplasty shorten recovery?
It usually means less bruising around the eyes in the first days. Swelling and the timetable for the result to mature follow their own pace, and the tip needs the same time.
If my problem is breathing, do I need a rhinoplasty?
Not always. Many obstructions are caused by rhinitis, allergy or swollen turbinates and improve with medical treatment. Surgery makes sense when the cause is structural, such as a deviated septum or a collapsed nasal valve.
How long should I wait before revising a rhinoplasty?
In general, at least twelve months, and longer with thick skin. During that time the nose keeps settling, and operating again earlier usually means working on a result that is not yet final.