Septorhinoplasty

What is a Septorhinoplasty?

A septorhinoplasty (or ‘nose job’) is an operation 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.

Before Septorhinoplasty

What are the benefits to septorhinoplasty?

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.

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How can I prepare for it?

Before the surgery, you need to:

. Schedule a visit with the surgeon to talk about the procedure, what results you expect and to go through your medical history;

. Have an ECG, blood pressure measurement, blood test and urine test;

. If you smoke, quit smoking and stop taking anticoagulants and platelet aggregation inhibitors, to avoid any complications (such as epistaxis) during the procedure.

Risks and Complications

Some complications can be serious and can even cause death.

. General complications of any operation

. Pain

. Bleeding

. Infection of the surgical site (wound)

. Blood clot in your leg

. Blood clot in your lung

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. Specific complications of this operation

. Adhesions, where scar tissue forms deep inside your nose and can obstruct airflow

. Redness

. Bruising and swelling of your nose and under your eyes

. Bleeding caused by infection

. 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

. Nasal obstruction

. Making a hole in your septum

. Toxic shock syndrome, which is an infection of your bloodstream

. Cosmetic problems

. Problems at the donor site if you need a cartilage graft from your ear

. Graft rejection

. Reduced sense of smell

Are there any alternatives to septorhinoplasty?

If you have a blocked nose caused by a deviated septum, you may be able to have only a septoplasty. Although, a rhinoplasty is the only way to 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.

During Septorhinoplasty

What does the procedure involve?

The operation is almost always performed under a general anaesthetic. The operation usually takes 1 to 2 hours. To begin, 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.

Then, your surgeon can refine the tip of your nose by removing some of the cartilage. If you have a hump (dorsum) 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).

Moreover, 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.

After Septorhinoplasty

Recovery and Aftercare

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 two weeks. This is to avoid catching a cold, which could result in an infection. Your surgeon will remove the splint and strapping after a week. Do not exercise, have a hot bath or bend down for two 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.

Aftercare:

Your medicines are:

. Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.

. Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.

. Pain medicine: You may need medicine to take away or decrease pain.

  . Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.

  . Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.

  . Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

Self-care:

. Avoid activities that may injure your nose: Right after your surgery, your nose is just starting to heal and can be damaged in many ways. Doing the following will help prevent your nose from getting injured:

  . Do not allow anyone to accidently bump your nose. This includes children, pets, and your bed partner.

  . Do not blow your nose until you are told that it is safe to do so.

  . Do not do any strenuous activities. Do not go swimming for one month after your surgery.

  . Do not wear clothing that you have to pull on over your head.

. Bathing and washing:

  . Avoid touching or getting your nose dressing wet when washing your face.

  . Be gentle with brushing your teeth and use a soft toothbrush.

  . Have someone else wash your hair during the first week after your surgery.

  . Take tub baths only and do not shower. Keep your dressing dry when bathing.

. Limit your facial movements:

  . Avoid facial movements for one week. This includes grinning, laughing, and smiling.

  . Avoid eating foods that need to be chewed for a long time.

  . Avoid talking for a long time.

. Wearing your contact lens or glasses:

  . You can wear your contact lenses 2 to 3 days after your surgery.

  . Do not wear your glasses or sunglasses where they rest on the top of your nose. Ask your caregiver for information things you can do to keep your glasses from resting on your nose.

. Nasal drainage: You may be sent home with a dressing under your nose. Change it when it gets wet and avoid touching your nose when doing so.

. Nasal rinsing: Your caregiver will tell you if he wants you to do this procedure. It is done to clean your nose cavity (inside of your nose) and prevent infection. Flush your nose cavity with saline (salt solution) 3 to 5 times each day, as instructed. This may be done for at least 14 days after your surgery. Ask your caregiver for more information about this procedure.

. Plaster cast and splint care: You may have a plaster cast or a splint on the outside of your nose. If so, it will be left on your nose for about one week.

  . Do not touch or disturb the cast or splint

  . Keep the cast dry.

. Preventing swelling: Swelling of your nose and face is common right after your surgery. It can slow healing and increase your pain. The swelling may not go away for weeks or months after your surgery. Doing the following will help reduce your swelling:

  . Always use your ice pack as your caregiver tells you.

  . Avoid bending over.

  . Rest and sleep with your head raised above your feet and body.

  . Avoid letting your face get too warm. This includes sitting in the sun, and using sun lamps and hair dryers.

Contact a caregiver if:

. You are sick to your stomach or throw up.

. You have a fever or chills.

. You have increased eye discharge or eye redness, itchiness and swelling.

. You have questions or concerns about your condition, medicine, or care.

Seek care immediately if:

. You have trouble breathing all of a sudden.

. Your bandage becomes soaked with blood and the bleeding does not stop.

. Your incision is swollen, red, or has pus coming from it.

. Your stitches come apart.

Sources:

. https://www.healthdirect.gov.au/surgery/septorhinoplasty

. https://www.drugs.com/cg/septorhinoplasty-aftercare-instructions.html