Rhinoplasty is an operation that reshapes the bone and cartilage framework of the nose. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, plans it by assessing appearance and the airway together; if there is a deviated septum or turbinate hypertrophy, it is treated in the same session when indicated. The open or closed technique and the use of piezo are decided after the examination. The final shape is usually assessed at month 12.
What is rhinoplasty?
Rhinoplasty is the surgical reshaping of the bone and cartilage framework that gives the nose its outward appearance. In this operation a hump can be removed, the tip can be lifted or refined, the nostrils can be narrowed and a crooked nose can be straightened.
The nose is also a breathing organ. Any change on the outside affects the airway inside; that is why rhinoplasty and surgery inside the nose (septoplasty, turbinate reduction) should be planned together. This combined approach is called functional rhinoplasty or septorhinoplasty. The difference between the two is explained in detail in the article rhinoplasty vs septorhinoplasty.
Who is it suitable for?
Rhinoplasty is considered for people whose nose has finished developing and whose general health allows surgery:
- People whose nose has finished developing and who are 18 or older. In younger patients it is only considered when there is a significant breathing problem and growth has finished.
- People bothered by the appearance of the nose, such as a hump, a wide or drooping tip, asymmetry or a crooked nose.
- People with functional complaints such as a blocked nose, mouth breathing or snoring who also want the appearance corrected in the same operation.
- People who have had nose surgery before and still have problems with appearance or breathing (see revision rhinoplasty).
Smoking, uncontrolled chronic illness and unrealistic expectations are the main reasons for postponing a decision to operate; they are discussed openly at the first consultation.
How does Op. Dr. Kumbasar plan the operation?
Planning starts at the consultation. The inside of the nose is examined with an endoscope, and the septum, turbinates and nasal valve area are checked. Skin thickness, cartilage strength and facial proportions are assessed. The steps of this examination are described in the article what is assessed at a rhinoplasty consultation. The technique is chosen according to these findings:
Open or closed technique
In the closed technique all incisions are inside the nose; it is suitable for removing a hump and for limited tip corrections. The open technique adds an incision of a few millimetres on the columella; it is preferred for detailed reconstruction of the tip, for marked asymmetry and for revisions. Op. Dr. Kumbasar uses both techniques and chooses according to the structure of the nose.
Piezo (ultrasonic) surgery
The piezo device reshapes bone using ultrasonic vibration. Some studies describe less damage to the surrounding soft tissue, with more limited bruising and swelling than with classic osteotomy. It is used where the bony framework needs marked reshaping; it is not needed for every nose. Details are on the ultrasonic rhinoplasty page.
A conservative approach
The aim is not to rebuild the nose, but to correct the part that does not suit the face. Cartilage supports are preserved as far as possible; this matters both for the nose keeping its shape over the long term and for the airway not narrowing. Skin type also affects the result: with thick skin the tip takes longer to become defined. This is explained in the article the nasal tip in thick skin.
How do you prepare for the operation?
Preparation starts about two weeks before surgery and ends with the anaesthetic assessment:
- Blood tests and the anaesthetic consultation are carried out; chronic conditions and regular medicines should be reported.
- Blood thinners, some painkillers and herbal products can increase the risk of bleeding; whether to stop them is decided together with the prescribing doctor.
- Smoking slows healing; stopping before and after the operation is recommended.
- Plan your work and social life for the day of the operation and the first week afterwards.
Risks and precautions
As with any surgery, there are risks of bleeding, infection and risks related to anaesthesia. Specific to rhinoplasty are temporary numbness, prolonged swelling, minor asymmetry and, rarely, breathing problems. If the result does not meet expectations, a revision is usually considered no earlier than month 12; the reason for this wait is explained in the article why wait 12 months for a revision. At the consultation before surgery the risks are explained one by one and written informed consent is obtained.
The surgical process
General anaesthesia. An anaesthetic assessment and blood tests are carried out before the operation.
2 to 3 hours on average; if septum and turbinate surgery is added, it takes correspondingly longer.
Depending on the extent of the operation, discharge on the same day or after one night in hospital; this is decided at the planning stage and given to the patient in writing.
Whether packing is used, and for how long, depends on the surgical plan. The external nasal splint is usually removed at the end of the first week.
Recovery timeline
Bruising and swelling around the eyes are most visible during this period. Keeping the head raised and applying cold compresses is recommended. Pain is usually mild to moderate and is controlled with oral painkillers.
The splint is removed and the stitches are checked. Bruising has largely faded; light office work can be resumed.
Recovery is enough for social life. Glasses are worn without resting weight on the nose; you continue to sleep on your back with your head raised.
Usually the right time for light exercise, swimming and controlled sun exposure. Contact sports should wait at least 3 months.
Most of the swelling goes down; the tip becomes defined sooner in thin skin and later in thick skin.
Final shape. The check-up at this point is the reference for assessing the result.
Frequently asked questions
Is rhinoplasty painful?
The operation is carried out under general anaesthesia, so you feel no pain during surgery. In the first two days there may be a feeling of pressure at the root of the nose and around the eyes, with mild to moderate pain that is controlled with oral painkillers. If packing is used, the feeling of fullness lasts until it is removed.
Is there an age limit for rhinoplasty?
The lower limit is the end of nasal development, usually around 16–17 for girls and 17–18 for boys. For cosmetic surgery we wait until the age of 18. There is no upper limit: if general health allows, it can also be done later in life.
If there is also a breathing problem, can it be treated in the same operation?
When indicated, yes. If the examination shows a deviated septum or turbinate hypertrophy, these can be treated in the same session as the rhinoplasty, so there is one anaesthetic and one recovery period. The procedures needed are determined by endoscopic examination.
Is piezo (ultrasonic) rhinoplasty suitable for everyone?
Piezo is an instrument used to reshape the bony framework; it may be preferred when a hump needs removing or the bone needs narrowing. If only the tip is corrected, the bone is not touched and piezo is not needed. The decision is made at the consultation.
Does the nose go back to its old shape after surgery?
Because the bone and cartilage are reshaped, the nose does not return to its previous state. In the first months it seems to become finer as the swelling goes down; this change is the swelling settling. Keeping the cartilage supports and following the aftercare instructions are what determine the long-term shape.
When can I fly or swim in the sea after surgery?
Flying is usually possible once the splint has been removed, from day 7–10; patients coming from abroad are advised to spend this period in Istanbul. For the sea and swimming pools, wait until healing is complete, usually from the fourth week and with the doctor’s approval. Sun protection is needed for the first 3 months.
When can I wear glasses?
Glasses can rest on the splint. After it is removed, they should not put weight on the nasal bones for 4–6 weeks: during this time they are taped to the forehead or worn with a support that rests on the cheeks. Contact lenses are an alternative.
How is the cost of rhinoplasty determined?
It depends on the extent of the operation (cosmetic only, or with septum and turbinate surgery), the technique, the anaesthesia and the hospital stay. That is why it is not quoted without an assessment; after the consultation, the scope and the quote are given in writing.
Related treatments
Articles on this topic
Sources
- Ishii LE et al. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology–Head and Neck Surgery, 2017.
- Han JK et al. Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 2015.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.