The e-booklet below is both the Rhinoplasty consent for surgery and the Terms and Conditions of Berkeley Square Medical. Though you will have received hard copies of the exact information below at the time of your first consultation, it is important you re-read this fully and sign at the bottom of the page.
A Rhinoplasty or nose job is a surgical procedure performed to reshape the nose. It is the most individual of all aesthetic surgery procedures requiring the most dexterity, skill and understanding of the patient’s wishes, the technical possibilities and the underlying anatomy. There are several different ways of performing Rhinoplasty surgery and the exact way is very dependent on how the surgeon best thinks it is possible to achieve the aims of the patient.
Of all the surgical procedures we perform as Plastic Surgeons, a Rhinoplasty is considered one of the most complex. A Rhinoplasty can be performed with all the surgical incisions on the inside of the nose, or with some on the skin; it can be performed with or without using cartilage or bone grafts; it can be performed for breathing difficulties and can also be performed completely non-surgically using injections of skin fillers to fill out some of the nose skin to hide minor imperfections in the nose.
If you are considering a Rhinoplasty, you will want to know the following information about nose reshaping surgery.
Before you have a Rhinoplasty, your surgeon will assess your nose. You will need to say what you would like to achieve, what you do not like about your nose and how it affects you personally. It is important to be very honest about this and being very specific is helpful to your surgeon.
Your surgeon will ask you about your general health and whether you have any previous relevant issues with your nose (operations, injuries, breathing difficulties, allergies etc). The examination involves looking and feeling the nose internally and externally along with a breathing assessment. Your surgeon will also have a look at the skin of the nose and will assess the size and shape of the rest of your face. Most patients are looking for a nose that is in proportion with their facial features. If, for example, the chin is too small, this may give the nose an apparently prominent appearance of the face. So, sometimes your surgeon may talk about other additional procedures.
To perform a Rhinoplasty, your surgeon needs to access the cartilages and bones that form the structural framework of the nose. Together, the cartilages and bones form the skeletal support of the nose, and a Rhinoplasty changes these structures. Your skin then re-drapes across the new framework.
A “Closed Rhinoplasty” is one in which the incisions are made on the inside of the nostril, and an “open Rhinoplasty” is one in which a small incision is made in the skin under the tip of the nose which separates the two nostrils. Some surgeons do more open Rhinoplasties, as they feel they can predict the final outcome more readily, but other surgeons do more closed Rhinoplasties as the final result is achieved with less swelling and a shorter recovery period in a procedure that is already associated with a long recovery period before the final results are seen.
Whichever method is used; the surgeon will reshape the bones and cartilages and expect the skin to re-drape over the new shape without too much swelling. If the skin is too thin, then any minor imperfections may be more noticeable, and if the skin is too thick, then the skin may not drape well across the new shape of the new skeletal framework.
As with all surgeries, both cosmetic and medical, surgery will always carry elements of risk that we hope not to see. In Rhinoplasty surgery, these risks include infection, abnormal bleeding and swelling, over and under-correction, cartilages and bones moving after they have been reset in a particular position, asymmetry and healing problems.
Some of the risks are related to the function of the nose and include breathing difficulties, nasal drips and nose bleeds.
Your nose also continues to grow throughout your life so it will slightly change shape in later years of your life.
Complications are most commonly seen in smokers and if you smoke, please stop smoking a few weeks before your surgery. If you take any nicotine alternatives, please stop using them a few weeks before your surgery.
As recovery progresses, we may see or feel slight dips and bumps in the nose, along the cartilages and the bones. These usually appear a few weeks after the Rhinoplasty and continue to settle over the recovery period. Sometimes they may remain and sometimes the minor dips and bumps reform and fully resolve. If these concern you, we can offer treatments such as fillers to smooth these out during your recovery while the contour of your nose settles.
The final results of a Rhinoplasty are not seen for about one year once all the internal swelling settles down. The final results take longer to achieve with some variations of a Rhinoplasty. For example, open Rhinoplasty and revision Rhinoplasty recovery times are generally longer. Though you may be pleased with your results a few days after your surgery, it is important to remember we expect a final result 12 months after full recovery, inclusive of internal healing, which may not be visible to you.
You will have nasal packs for a few hours and a blocked nose for several days after a Rhinoplasty. Bruised eyes last for around 5-7 days, but the tip and bony portion of the nose will stay swollen for several months after the operation, with the last of the swelling taking several months to resolve completely. In very rare cases, some people report permanent swelling or discoloration around the lower eyelids after a Rhinoplasty.
After your surgery, you may have a plaster (or nasal splint) and dressings placed on the nose, and may have stitches in the undermost part of the nose or on the sidewall of the nose, if you are having a particular type of Rhinoplasty. Stitches will usually stay in place for around 7-days. You may also have small incisions made on the side of your nose depending on whether the bones need to be reset and how this will be performed, and the scars associated with these usually settle to look like minor skin blemishes in the area.
Numbness, prominent veins developing on the nose, skin damage, impatience with the recovery process, dissatisfaction with the final result.
Cartilage and bone grafts are more common in secondary Rhinoplasty. Complications include the complications from taking cartilage or bone grafts from the rib, head or ear, such as scars, infections, bruising and swelling at the site of the graft. When grafts are inserted, we expect most, if not all, of the graft to survive but sometimes the graft is absorbed, and some or all the graft may not survive. Sometimes we see persistence of the abnormality in the nose and moving of grafts after they have been put into place. Secondary Rhinoplasty is associated with a longer recovery time, more swelling and less predictable results.
There is always a revision rate associated with Rhinoplasty and we aim for a revision rate for Rhinoplasty of less than 5%. The rate of revision in Rhinoplasty in the UK and USA ranges between 5% – 15%.
A recent 2023/24 audit of our last 900 Rhinoplasty Surgeries carried out at Berkeley Square Medical carried a revision rate of 3.0%.
