Rhinoplasty: what to discuss in your consultation

Rhinoplasty, often called nose reshaping, is an operation to change the shape or size of the nose. Some people consider it because of how their nose looks, others because of breathing problems or an old injury, and for some it is a mix of both. Whatever your reason, the consultation with a plastic surgeon is the most important step before any decision. It is where the surgeon learns what you hope for, examines your nose and explains what surgery could realistically achieve, what recovery involves and what the risks are. This guide explains what is usually covered, what is worth preparing and which questions to ask, including if you are thinking about a second, or revision, operation.

Why people consider rhinoplasty

UK plastic surgeons describe several common cosmetic concerns: a hump on the bridge of the nose, a tip that seems too wide, rounded or poorly defined, and the overall length or width of the nose. There are also medical reasons. A nose that has been broken or bent by an injury can be restructured, and surgery can be used to open the nasal airways when breathing through the nose is difficult. Surgery for breathing or injury is regarded as reconstructive, while most other nose surgery is cosmetic.

The distinction matters in practice. In the UK, the NHS does not usually fund nose reshaping for cosmetic reasons, but it may be provided when it is needed to help you breathe. More importantly, the purpose of the operation guides the plan. The American Society of Plastic Surgeons advises that the consultation should cover your goals for both the appearance and the breathing function of your nose, so mention any blockage or past injury even if your main concern is how your nose looks.

Thinking about your reasons first

Before a consultation, it helps to be clear in your own mind about what you want and why. The NHS suggests asking yourself questions such as:

• What exactly would I like to change, and why?
• How long have I been thinking about this, and what made me consider it now?
• Am I doing this for myself, or to please someone else?
• Am I expecting the operation to change my relationships, social life or job prospects?

The NHS points out that expecting a procedure to change your life more broadly may not be realistic. UK plastic surgeons make a similar point: nose surgery cannot resolve emotional or social difficulties linked to appearance. The American Society of Plastic Surgeons describes rhinoplasty as a highly individual decision that should not be made to satisfy someone else or to match an ideal image.

If you are being treated for a mental health condition, the NHS advises talking to the clinician treating you before having a cosmetic procedure, and telling the cosmetic surgeon about any past or current mental health problems. UK plastic surgeons note that, occasionally, a clinical psychologist may be involved to talk through how appearance affects you.

What the surgeon will ask and examine

According to the American Society of Plastic Surgeons, a rhinoplasty consultation usually includes a discussion of:

• your goals for the appearance and the breathing of your nose;
• medical conditions, drug allergies and past treatments;
• the medicines and supplements you take, and your alcohol, tobacco and drug use;
• any previous operations, including earlier nose surgery.

The surgeon will also assess your general health and risk factors, examine and measure your face, and take photographs for your medical record. They will then talk through the options for reshaping your nose, recommend a plan, and explain the likely outcome along with the risks and possible complications.

Some factors limit what can be achieved. UK plastic surgeons explain that the outcome depends on the size of the nose, the condition of the skin and your age. The American Society of Plastic Surgeons lists the signs of a good candidate as having finished facial growth, being physically healthy, not smoking, and having realistic expectations about how your appearance may change.

What to bring

• a short note of what bothers you most about your nose, and any breathing symptoms;
• details of any nose injury or earlier nose surgery, including operation notes if you have them;
• a list of your medicines, supplements and allergies;
• your written questions, so nothing is forgotten on the day.

Understanding the surgical plan

Rhinoplasty is usually carried out under general anaesthetic. Depending on the goal, the surgeon may remove some cartilage and bone to make the nose smaller, build it up with grafts, or reshape the bone and cartilage, including the nostrils. The NHS explains that grafts can come from cartilage in the ears or from bone, and UK plastic surgeons add that cartilage from the septum, the central wall inside the nose, is also used. The skin then adapts to the new shape.

There are two main approaches. In open rhinoplasty, the surgeon makes a small cut across the strip of skin between the nostrils, which gives a better view of the tip cartilages. In closed rhinoplasty, the work is done through cuts inside the nostrils and there is no visible scar, but this approach is not always possible. UK plastic surgeons note that open surgery tends to cause more swelling and a longer recovery. Ask which approach is recommended for you and why.

The NHS describes an operation time of about 1.5 to 3 hours, with a hospital stay of 1 or 2 nights. Your surgeon will confirm the details for your plan.

Recovery: what to plan for

Knowing the usual course of recovery helps you plan time away from work and travel. Based on NHS information:

• a dressing and a splint taped over the nose usually stay on for about 7 days, and stitches are removed around this time unless they dissolve;
• breathing through your nose may be difficult for about a week, and light nosebleeds are common in the first few days;
• many people take up to 2 weeks off work;
• bruising, swelling and redness may have faded by around 3 weeks, when swimming may be possible;
• strenuous exercise and contact sports are usually avoided for 4 to 6 weeks.

The final shape takes much longer. The NHS notes that swelling can take up to 6 months to go down fully, and the American Society of Plastic Surgeons explains that swelling may come and go, often looking worse in the morning, and that the shape can continue to refine for up to a year. In the early days, the NHS advises propping your head up on pillows, keeping the splint dry, not blowing your nose until the splint is removed and sneezing through your mouth. Your surgeon will give you instructions for your own recovery.

If you are travelling for surgery, the NHS advises avoiding flying for 7 to 10 days after facial procedures, because surgery and air travel both increase the risk of blood clots. It also suggests not planning a holiday straight after surgery, and asking in advance where follow-up appointments will take place.

Risks to talk through

The NHS lists common, usually temporary effects such as a stiff and numb nose, and soreness, swelling and bruising around the eyes for up to 3 weeks. Less often, complications can include:

• lasting difficulty breathing through the nose;
• damage to the septum, and rarely a hole in it (septal perforation);
• a change in your sense of smell;
• heavy nosebleeds;
• slight irregularities of the bone or cartilage that can be felt or seen;
• changes in skin sensation, skin discolouration, or poor wound healing and scarring;
• an appearance you are not happy with, which may lead to further surgery.

Like all surgery, rhinoplasty also carries small general risks: heavy bleeding, a clot in a vein, infection and an allergic response to the anaesthetic. Ask the surgeon to put each of these into context for your own health.

For people treated in the UK, the NHS says to call the clinic quickly about severe pain or any symptom you were not expecting; NHS 111 is another option. Before you leave, make sure you know exactly who to contact if you have concerns.

If you are considering revision rhinoplasty

Revision rhinoplasty means a further operation after an earlier one. The American Society of Plastic Surgeons lists the possibility of revisional surgery among the recognised risks of rhinoplasty, so it is worth discussing at your first consultation, before any operation takes place.

If you are already unhappy with a previous result, timing is the first question. Because the nose can keep changing for up to a year, a result that looks wrong early on may still be settling. UK plastic surgeons advise that it is usually wiser to accept the improvement that has been achieved than to have another operation, although a small further adjustment is sometimes reasonable. They also caution that repeated surgery can weaken the framework of the nose, which may then collapse. Bring your previous operation notes and photographs to the consultation so the surgeon can understand what was done.

Questions worth asking

The American Society of Plastic Surgeons and the NHS suggest questions such as:

• Am I a good candidate, and what can realistically be achieved for me?
• Which technique do you recommend, and why?
• How long will recovery take, and what help will I need?
• What are the risks for me, and how are complications handled?
• How is my nose likely to look over time?
• What are my options if I am not satisfied with the result?
• What are your qualifications, how many of these operations have you performed, and what follow-up will I have?

The NHS also recommends having more than one consultation before surgery, which gives you time to reflect. In the UK, this cooling-off period is normally 2 weeks.

Next steps

Whether your main concern is the look of your nose, your breathing or an earlier operation, arrive at the consultation with your notes and written questions ready. Our plastic and aesthetic surgery page introduces the team, and Find my physician can help if you are unsure whom to see first.