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Rhinoplasty

IMG_1205Rhinoplasty (nose job) is an operation that changes the shape and size of the nose. Rhinoplasty is frequently performed in combination with septoplasty and the procedure is then called septorhinoplasty.   You may wish to undergo a rhinoplasty because you have suffered a trauma to your nose which has left it mis-shapen, or you may naturally have a nose that you feel is too humped, too wide, too long or has a hanging or bulbous tip. Some people dislike the shape of their nostrils as they feel they are too flared or too big. Many people feel their confidence and self-image is undermined because the shape of their nose detracts from their overall appearance.

Rhinoplasty is one of the most frequently performed cosmetic procedures by Charles and Lydia and at consultation you can be assured of an honest opinion using morphed frontal and profile photographs to give you a clear idea of the results you can expect.  Simulation of your clinical photographs is a very useful way of communication between consultant and patient but it does not guarantee exact results.

Septorhinoplasty

The nasal septum, which divides the nose into a right and a left nostril, is the key supporting structure of the lower two thirds of the nose.  This principle should remain in all aspects of rhinoplasty and septorhinoplasty.   The nasal septum is involved in almost every rhinoplasty operation.  The majority of twisted noses are caused by twisted nasal septums. Knowledge of the septum and its peripheral attachments are key to understanding rhinoplasty and septorhinoplasty both for form and function.

Revision Rhinoplasty

Both Charles and Lydia are also experts at revision rhinoplasty procedures, which are generally much more difficult than a first time rhinoplasty, but which are requested when a patient has undergone previous unsatisfactory surgery elsewhere. If you have this problem please do get in touch for an appointment but be aware that generally twelve months must have elapsed before revision surgery can take place.  Charles also frequently receives tertiary referrals for the more complex procedures and large septal perforations, so if you are experiencing either of these nose conditions he will be happy to give you an opinion at consultation.

Non-surgical Rhinoplasty

Non surgical procedures to the nose are very popular as they are safe and quick. Changes to the nose can be achieved with injectables. Botulinum toxin makes subtle changes to the dynamic of the nose by weaking different muscles. Fillers of hyaluronic acid may alter the profile temporarily very satisfactorily

Charles and Lydia’s work is by reputation and we have decided to not show pre- and post-surgery photos on our website. During your consultation we are happy to show you pre- and post-operative pictures of those patients who have given their consent.

You will

  • Experience some ooze in the first 1- 2 days and congestion
  • Feel tired to a variable degree after anaesethesia
  • Need to rest and not over exert yourself in the first few days
You may
  • Sniff to clear nasal secretions immediately and blow your nose gently after 3 days.
  • See a difference in your nostril shape from day to day (swelling)
  • Have some throat discomfort, more than the nose
  • See bruising under the eyes
You must
  • Use the ointments and drops which were dispensed for you
  • Sleep slightly head up for 72 hours
  • Avoid putting tissues, buds and fingers into your nose to try and clear crusts

When to Contact the Hospital or Office

If you have
  • Persistent fresh bleeding
  • Fever, increasing throbbing pains in the nose, offensive smelly discharge
  • Abnormal reactions to any of the prescribed medication
  • The Clinic or Office will arrange for your follow up appointment between 5-7 days after surgery
You are now a week after being under the knife. Here are some of my top tips to help you through your journey.
Day 7, finally the plaster will be taken off and stitches removed (if any). If you feel you have a low pain thresh hold then take some pain relief an hour before your appointment.
Once the plaster is off you may instantly be very happy or feel shocked both reactions are normal at this point. It may take time to become acquainted with your new nose.
Start the second week: you are in the early stages of healing and these are the things you may experience:
1. Congestion/ difficult breathing
2. Dissolvable stitches that are visible or may drop out of the nose.
3. Feel Irregularities along the bridge of the nose
4. Tingling, woody sensation around the tip area of the nose.
You will experience:
  • Subtle Changes in the nose, one day it May be puffy one day you may notice asymmetries. This is all part of the healing process.
You must:
1. Use a SPF no lower than 30 all over the nose
2. Not go for any facials or beauty treatment for up to 4wks
3. Steam in the shower or in the sauna as much you can this will help clear any congestion.
4. Refrain from any contact sports for 4-6 wks
5. Not fly for up to 10 days.
6. Not put fingers or cotton buds or tissue inside the nose
At 6-8 wks you will need to return to the clinic to be reassessed but until then remember you are healing
It is important to remember this will be a 6-9 month journey. It will involve a lot of patience on your part so try to sit back and enjoy it.

We,your anesthetists are here to ensure that you have the safest possible experience before,during  and after your rhinoplasty surgery. Alongside your surgeon we work to facilitate the best possible outcome for you. We will  normally contact you prior to your hospital admission to discuss your health and your anaesthetic –your previous experiences with surgery, what to expect post operatively and to discuss any of your specific concerns. The consultation allows us to address any worries and to optimise your health before your surgery. It is important to let us know of any medicines or abnormal reactions that you may have experienced. As a general rule we do not recommend using aspirin containing compounds or anti-inflammatories e.g. Ibuprofen, arnica before your surgery. They increase the risk of bleeding or bruising, but can be taken after surgery.

on the day of your operation your anaesthetist will visit you preoperatively to confirm your history and ensure that you are fully prepared. Anaesthesia is induced in the anaesthetic room adjacent to the operating theatre. A fine needle in the back of the hand or the wrist is usually employed however we can adapt the technique if you have a fear of needles.A numbing cream can be applied if necessary. Painkillers, anti-sickness drugs and nasal medication are given routinely during your surgery. We want you to wake up in the recovery room calm and relaxed.

Here you will be monitored until you are fully awake and able to return to your room.  Relatives or friends are usually permitted to come to the anaesthetic room with you but are not permitted in the recovery area.

We want you to be as comfortable as possible and so sufficient pain medication will be given and dispensed for you to take home together with ointments and decongestant nose drops. Pain is usually not severe with rhinoplasty – there is some discomfort which will need medication for a few days and may people describe it ‘like feeling you have a cold.’ A common complaint is of a sore throat or swelling at the back of the throat. This is due to one of the anaesthetic tubes placed into your throat to maintain your breathing. The soreness should settle within a few days. In some patients the discomfort can linger longer in which case soluble paracetamol gargles 1gm in warm water gargled the swallowed every 4-6hrs or Difflam oral spray will relieve the problem. The team of

Anaesthetist, surgeon, clinical specialist, and nursing staff work together all will be able to give you advice regarding specific queries during and after your surgery.

You may need to contact us to discuss pain issues in which case this can be done via the Clinic where your surgery took place.

Day Zero.

Well it’s finally here- very early in the morning, I’m arriving at the clinic about to be admitted for my operation..feeling a little bit anxious but Isuppose most people are before surgery. Really friendly staff and a lovely nurse looking after, me goes through my  basic checks and getting ready for the op. the anaesthetist is here- she called me 2 days ago – she’s a cute lady and instantly makes me feel relaxed -its all going to be great!

Mr East arrives with the nurse. He checks everything,I sign the consent. Now I’m ready!

Amazing I am back in my room with no recollection of going to sleep- can’t believe how I feel – full of energy well I suppose that’s the drugs they gave me- snooze time now. They have sleeping head up. Late afternoon I get some drops in my nose and some ointment-there is a little bit of an ooze that this is to be expected. Could go home tonight Mr East says but I think I’ll stay over and go after breakfast tomorrow.

Day one.

Mr East’s fellow checks me,my nurse discharges me and I’m off! Feel  surprisingly good and there’s virtually no bruise. Must remember to relax and try breath  through the nose although it feels a little stuffy -the drops help

Day2.

Slight sore throat – that’s from the anaesthetist . Feel fatigued, slightly more  puffy under the eyes, bruising a little more but hey, really happy- keep a little head up he said  for 2 to 3 days!

Day three.

Is my nose a bit turned up? Are my nostrils slightly different? OMG I’m
worried…checking website… Nurse said the first week things may not not look right….  calm down, no need to panic, I won’t call his office. Speak to my mum!
I can blow my nose now-gently.

Day four.

Nose feels very itchy and perhaps haven’t had enough of the ointment on the
inside. Now really want to have the plaster off but three days to go!

Day five.

Have a funny sense of smell in my nose but generally okay. Went out for a walk  today. Get the feeling the plaster is becoming looser – that means the swelling is going down.

Day six.

Nearly there. Will probably wear a baseball hat and glasses as feel a bit self-
conscious of turning up with the plaster on.

Day7.

Right this is it, on my way to the office to see Mr East- his office is really cool, not your typical Harley street room-in fact the whole house is really cool. Feeling a mixture of  anxiety and excitement. The practice nurse tells me what to expect and starts to remove my plaster – feels really odd as she gently works under the tapes with a cotton bud..,it’s off what a relief! Now the cleaning, it’s a little tender and I feel sensitive. We have a discussion about the gentle massage needed and I must remember to use the sun cream every day – really important for the next three months. A little makeover and then
I look in the mirror…. Gosh is this me… Yes yes yes it is – after the initial shock I, I love it, I can see how it’s going to turn out and I am tickled pink! Whoha I feel a little faint, emotional surges through me but then yes I love it, amazing for one week after surgery I will walk out and no one will notice I have had an operation! Genius

Day eight:

Woke up and the nose looks a little puffy. also feels Odd-rather numb,not part of me- guess I am going to have to be patient – Mr East said in the next 4 to 6 weeks there will be lots of little changes I’ll notice but there’s not much I can do about it so I’d better just chill and go with the flow. remember the moisturiser!
Day 14:

Feel less self-conscious about my nose and ready to start some exercise. Will
start with gentle cycling and some floor stretches. back to work today – I wonder who will notice I have had something done!

Day 21:

It’s starting to look really good but I have still got a bump and its tender – thought that would have gone.
Four weeks after surgery – I’m really growing to like my nose but there’s still a little bump I can feel under the skin. The nurse tells me this is not unusual as it takes several weeks to a few months before the bone, cartilage and the skin over my nose finally settles. She tells me to carry on with the massage and Mr East will see me in six weeks time.

16 weeks after surgery – my next follow-up appointment. What a difference from before my operation,the bump has gone its starting to feel like a part of me again– I understand now the time it takes for everything to settle after rhinoplasty and there is still some refinement to come in the next few months. I really love the result – it’s fantastic and has really changed my life. One of the best things I have done for myself, it looks so natural.
I now have an open appointment: if I need to come back any time I just call.

Love to all,

–  One happy patient!

+44 (0) 20 3196 0130