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RHINOPLASTY (THE NOSE JOB)
The nose occupies the centre of the face and is one of the most commonly noticed parts of the face. It also has important functions related to breathing. The nose is made up of bones and cartilages that are joined together to form the shape of a roof. This is supported by a midline wall called the nasal septum that separates the nose into right and left nostrils. The shape of the nose depends on all these structures and the skin covering it, as well as hereditary factors. Nasal deformities are readily noticeable.
Your nose ... is it too large, too small, too flat, too pointed? Is it crooked? Do you have trouble breathing from one or both sides of your nose? Or does it simply not fit your face?
Surgery can change the shape of the whole nose or just a small part, making it fit more harmoniously with the rest of the face and improve the function of the nose. Mr D'Souza is skilled in making these changes while preserving, or if need be enhancing, the function of the nose. The operation is called Rhinoplasty. When rhinoplasty is combined with an operation on the septum, it is called a Septorhinoplasty.
WHAT RESULTS CAN I EXPECT?
Rhinoplasty is by far the most complicated of the facial plastic surgical operations. The thickness and texture of your skin, the strength, shape, and symmetry of the nasal bones and cartilages, healing power of your body following surgery, and, of course, the skill of the surgeon, all have an impact on the outcome. Please note that the end result is not apparent for 9-12 months following surgery and continued changes in the shape of the nose occurs with time.
A rhinoplasty is successful if the patient is happy after surgery. Therefore, if you are considering cosmetic rhinoplasty, you should look at your nose in the mirror carefully and try to determine the areas you find unsatisfactory and what you would like to have changed. If you need your nose to be perfect and if you are expecting surgery to correct all imperfections instead of merely making them better, do not have the surgery, as your expectations of the final outcome may exceed what the surgery can deliver. Some requested changes are more accomplishable than others. In general, however, the majority of the patients are happy with the end result.
SURGICAL PROCEDURE
A full assessment of your nose and facial features is carried out with the aid of photographs during the consultation. A computer programme is often used to assist this process and an operative plan is outlined. The surgery is usually performed whilst you are asleep. Cuts are made inside and occasionally outside the nose and the skin is lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the change in the shape of the nose. Small pieces of bone and cartilage may be removed from or even added to the nose to smooth out any bumps or dips. At the end of the procedure all incisions are stitched in place. In some cases, extra cartilage is required to obtain the desired shape of the nose. This cartilage is taken from your ear or ribs. Mr D'Souza will discuss this with you when planning the operation. A small dressing is inserted inside the nose, which is removed the next day and a temporary splint on the outside of the nose is used for 10 days.
AFTER CARE
After the operation you will have some discomfort but any pain tends to be minimal and controlled with simple pain killers. You may have some bruising and swelling around your nose and eyes for 1-2 weeks. Your nose will feel blocked and crusty in the first two weeks after surgery. We advise you to only blow your nose very gently in the first week following surgery and sneeze with your mouth open to protect your nose and minimise the chances of bleeding. You may get some blood stained watery discharge from your nose for the first 2 weeks or so and this is normal. We will give you some drops or a spray to help this. It may take up to 3 months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty and smoky places for that time. The stitches inside your nose will dissolve and will fall out by themselves.
The skin of the nose is very sensitive to the sun following surgery and it is important that you wear sunscreen (factor 30 or more) and a hat for at least 6 months. The nose may feel a little stiff and numb for up to 3 months, particularly around the tip.
Most people need 1-2 weeks off work, especially if the work involves heavy lifting or strenuous activity. You should not play any sports where there is a risk of your nose being knocked, for at least 6 weeks.
POSSIBLE COMPLICATIONS
Occasionally, your nose can bleed after the operation and we may have to put packs back into your nose if bleeding is excessive.
Infection inside the nose is rare but if this occurs it can be serious. The nose gets more and more blocked and sore and you may feel unwell. If this happens, please contact us immediately.
Rarely the operation may leave a hole in the septum inside the nose and very rarely you may experience some numbness of your teeth, which often settles with time. Loss of sense of smell may also occur but again is rare.
About 5-10% of patients need further operations in the future to further adjust the shape of the nose.
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REVISION RHINOPLASTY
AIM
To reduce the stigmata of previous surgery and to improve the appearance of the nose and to re-establish both function and natural, harmonizing, well-proportioned look to suit the face.
PROCEDURE
Revision surgery is complicated compared to primary rhinoplasty and requires in depth knowledge and expertise to understand the underlying causes and complications related to previous surgery. Surgical approach varies with complexity of individual case. Often comprehensive reconstruction is essential for severe problems.
It is prudent to find a surgeon who has knowledge and skills of both cosmetic and reconstructive procedures and specialises in this procedure to ensure optimal outcome. It is also important patients truly understand the limitations of revision surgery and have realistic expectations.
When properly performed this procedure can restore a more natural look to a nose that has been over-operated and now looks too small, short, long, narrow, wide or twisted.
It can overcome the stigmata of previous surgery including improving the functional airway of the nose.
Sometimes a nose may be severely damaged by previous surgery and virtually beyond repair, but this is not common. The biggest obstacle in revision rhinoplasty is trying to correct a nose that may have undergone several revisions or in which there is limited tissue to work with. The amount of scarring and the state of the tissues may significantly limit the degree of improvement possible.
In some cases it may be best to leave well alone, as the risks of further revision may outweigh the benefits. It is important that the surgeon understands your concerns and expectorations and gives the best advice which sometimes may be disappointing.
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PROMINENT EAR SURGERY (PINNAPLASTY OR OTOPLASTY)
THE PROBLEM
Most prominent ears lack a normal fold of cartilage. Sometimes other parts may be affected, and one ear may be worse than the other. Children with prominent ears are often teased at school.
WHAT CAN BE DONE?
Surgery is carried out to correct the deformities and set ears back closer to the head and create the most natural look. The result is a more attractive look that allows you to wear hair short or pulled and restores confidence.
LIMITATIONS
The operation is usually carried out after the age of 5 when cartilage has adequate strength to hold stitches. The goal of surgery is improvement and not perfection. Perfect symmetry is both unlikely and unnatural in ears. Some deformities are completely correctable. Most patients are very happy with the results of surgery.
SURGICAL PROCEDURE
In children surgery is usually carried out under general anaesthesia. For older children or adults it may be possible to carry out the surgery under local anaesthesia often in combination with intravenous sedation.
Skin incision is made behind the ear to expose the ear cartilage. The cartilage is then sculpted and permanent stitches are inserted to help maintain the new shape of the cartilage. Any redundant skin and tissue is removed. The wound is closed and a turban-like head bandage is secured in place to help the moulding and healing. The surgery leaves a feint scar in the back of the ear that fades with time.
AFTER THE OPERATION
Children are usually up and around within a few hours of surgery although they often stay in hospital overnight until all the effects of the general anaesthetic wear off. The ears may ache for a few days but this can be relieved with simple painkillers (eg Paracetamol, Ibuprofen). The turban bandages are removed after around 10 days. Any necessary stitches are also removed at this time. A lighter head dressing similar to an exercise headband is worn, particularly at night, for 6 weeks. Contact sports and strenuous activity should be avoided for about 3 weeks.
TIME OFF
Most children can go back to school after a week and adults may return to work with in 48 hours.
POTENTIAL COMPLICATIONS
The scar behind the ear usually fades well but on rare occasions it can become red and lumpy Unfavourable scars are more common in Black or Asian patients.
Infection is uncommon but if it does occur it usually settles down with antibiotics.
Bleeding can occur but is usually minor because of the head dressing that is used.
Loss correction may occur especially if the ears are traumatised before healing is complete.
The ears usually feel numb or tingly for several weeks or even months after surgery. This sensation exaggerated when exposed to cold.
Occasionally further surgical correction may be required
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EYE LID SURGERY (BLEPHEROPLASTY)
THE PROBLEM
With age the skin looses elasticity and muscles tend to become floppy. This change is most obvious in the face particularly around the eyes. This excess skin forms folds in the upper lids and deepening creases in the lower lids. Loss of muscle tension results in prolapse of fat from the eye socket producing bags. In some people there is an inherited tendency for eye bags to develop in early adult life. Rarely medical conditions such as thyroid disease may results in similar problems.
Most changes are worse in the morning and can be particularly bad during periods of stress or lack of sleep. Additionally if forehead skin loses its elasticity the eyebrows may also droop and make the excess skin in the upper eyelid appear worse.
SURGERY
Eyelid surgery (blepharoplasty) can correct droopy, puffy eyes, rejuvenate a tired appearance and create a more youthful look. Both upper and lower eyelid surgery can be carried out under local anaesthesia, intravenous sedation or general anaesthesia. The procedure takes up to two hours.
In upper eyelid surgery cuts are made along natural skin folds to remove excess fat, muscle and loose skin depending on what is required.
In lower eyelid surgery cuts are made either inside the lower eyelid or in the skin to remove or reposition excess fat causing puffiness. If the lower eyelids have bags without any skin excess then fat can be removed using a cut on the inside of the lower eyelid (transconjunctival blepharoplasty) that avoids an external scar.
Following surgery the incisions are put back together with fine stitches that are removed after around five days. As all incisions are made along natural folds scar visibility is minimal.
LIMITATIONS
It is important to understand that blepharoplasty will not eliminate dark circles, fine lines and wrinkles around the eyes, change sagging eyebrows or remove festoons - the puffiness that sometimes occurs in the upper cheeks.
AFTER SURGERY
A variable amount of swelling and bruising is to be expected around the eyelids. Occasionally the whites of the eyes may become bruised with a red appearance. Slight blurring may also be noticed. Contact lenses are best avoided in the first few days. All these changes are most noticeable in the first 24 hours after surgery and settle in 3-4 weeks. These effects can be minimised by using cold compresses and sleeping propped upright for the first 3-4 days after surgery.
TIME OFF
Depending on the nature of your work it may be necessary to take a fortnight or so off work and avoid strenuous exercise for this time. It is important to remember that you will not be able to drive or operate machinery for 48 hours after a general anaesthetic and 24 hours after intravenous sedation.
POTENTIAL COMPLICATIONS
Bleeding can occur but is usually slight and is likely to stop by applying pressure over the area for about 10 minutes with a rolled up handkerchief or swab.
Infection is uncommon and can be minimised by the use of antibiotic eye drops or ointments
Closure of the eyelids may occasionally appear tight after surgery because of the swelling
Any incisions made on the face will produce a scar but these fade with time.
The eyelids may feel itchy and numb for several weeks after surgery
Rarely the outside corner of the lower eyelid may pull down slightly (ectropion). This tends to settle on its own but may need further surgery
Changes in vision are very rare
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