What is a septorhinoplasty?

A septorhinoplasty (or ‘nose job’) is an procedure to improve the appearance of your nose (rhinoplasty) and to improve how you breathe through your nose (septoplasty).

It involves operating on the bones and cartilage that give your nose its shape and structure and making your septum straight. The septum is the cartilage and bone inside your nose that separates your nostrils.

What are the benefits?

Your nose should be the size and shape you want, and you should be able to breathe through both nostrils.

Most people who have a successful septorhinoplasty are more comfortable with their appearance.

Are there any alternatives?

If you have a blocked nose caused by a bent septum, you may be able to have only a septoplasty.

A septorhinoplasty is the only way to permanently change the appearance of your nose. If you have a blocked nose because your nasal bones are crooked or damaged, a rhinoplasty (usually along with a septoplasty) is the only option to improve the way you breathe.

What will happen if I decide not to have the procedure?

If you are having problems breathing because of an allergy, your surgeon may be able to recommend nasal sprays.

What does the procedure involve?

The procedure is almost always performed under a general anaesthetic. The procedure usually takes 1 to 2 hours.

Your surgeon will make a cut on the mucosa (the skin-like lining of the inside of your nose) and lift it off the cartilage and bone. They will remove the parts of the cartilage and bone that are bent and they will put the rest back in a straight position.

Your surgeon can refine the tip of your nose by removing some of the cartilage. If you have a hump on your nose, they will shave it down. Your surgeon can also straighten and narrow the nasal bones by breaking and then setting them (infracture).

Your surgeon may need to support or rebuild part of your nose using a cartilage graft, a bone graft or an artificial implant.

Your surgeon may pack the inside of your nose to prevent bleeding, and place a splint and strapping on the outside of your nose for support.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Smoking stops your nose clearing mucus properly and this can increase the feeling of a blocked nose.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you may need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

General complications of any procedure

• Bleeding during or after the procedure. You may need to have your nose repacked with a firmer pack or have a pack in the back of your nose. If the bleeding is heavy, you may need a blood transfusion.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Adhesions, where scar tissue forms deep inside your nose and can obstruct airflow.
• Bleeding caused by infection in the first 2 weeks, if the lining of your nose gets infected.
• Unsightly scarring of your skin.
• Developing a collection of blood (haematoma) or an abscess between the layers of your septum.
• Damage to nerves that supply the skin at the tip of your nose, leading to a numb patch.
• Nasal obstruction, if the nasal valve area is reduced when cartilage is removed during surgery.
• Making a hole in your septum.
• Toxic shock syndrome, which is an infection of your bloodstream.
• Cosmetic problems. It is important to have realistic expectations about the size and shape of nose you can have. The healing process can take up to 6 months before everything settles completely.
• Problems at the donor site. If you need a cartilage graft from your ear you may develop a collection of blood (haematoma) or unsightly scarring. If the cartilage is taken from one of your ribs, this may be painful at first and will leave a small scar.
• Graft rejection.
• Reduced sense of smell.
• Watery eye. This usually improves on its own but rarely another procedure may be needed.

Consequences of this procedure

• Pain.
• Redness caused by tiny burst blood vessels near the surface of your skin.
• Bruising and swelling of your nose and under your eyes. Sometimes the swelling can make it difficult for you to breathe through your nose.

What happens after the procedure?

You should be able to go home the same day.

If you had some packing in your nose, it will usually be removed the next morning.

You will need to stay off work and away from groups of people for 2 weeks. This is to avoid catching a cold, which could lead to an infection.

Your surgeon will remove the splint and strapping after a week.

Do not exercise, have a hot bath or bend down for 2 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

It can take many months for your nose to settle and for the final appearance to develop.

Summary

A septorhinoplasty is a procedure to improve the appearance of your nose and how you breathe.

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