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Dr Ross D Farhadieh
BSc(Med)Hons, MBBS, MD, EBOPRASF, FRACS(Plast),FRCS(Plast)

So a patient is considering having a rhinoplasty, colloquially known as a nose job. What are the most important things that they need to know before proceeding with surgery?

The first thesis on rhinoplasty was written in the 19th century by Von Graffe called Rhinoplastik. The surgical technique has come a long way since then. In the first and early part of the second half of the 20th century closed rhinoplasty was the only surgical method available. Since the 1970s however, open rhinoplasty technique has replaced the closed rhinoplasty technique as the gold standard. It’s my opinion that you can never have done too much homework but these are the most important things that you need to know prior to proceeding with the surgery.

Let’s take a walk through history

The first thesis on rhinoplasty was written in the 19th century by Von Graffe called Rhinoplastik. The surgical technique has come a long way since then. In the first and early part of the second half of the 20th century closed rhinoplasty was the only surgical method available. Since the 1970s however, open rhinoplasty technique has replaced the closed rhinoplasty technique as the gold standard. It’s my opinion that you can never have done too much homework but these are the most important things that you need to know prior to proceeding with the surgery.

7 things you need to know:

1. Rhinoplasty can address functional as well as aesthetic concerns in relation to the nose. So in deciding on surgery it is vital that if there are any functional disturbances in your nasal passage that they are taken into consideration.
2. The choice of your surgeon. Both ENT and plastic surgeons perform rhinoseptoplasty surgery. What’s important is that you feel comfortable with the surgical options your surgeon discusses with you. That you are comfortable with the amount of information provided and the complication profile of the surgery.
3. Your nose will take some time to settle down and find its final shape. There is generally more swelling associated with an open rhinoplasty technique than a close technique. However, an open rhinoplasty technique offers more control and visibility of all the components of the nose allowing a more optimal and predictable outcome.
4. Your nose will feel numb during the post-operative period. By definition, especially in an open rhinoplasty the skin is disconnected from its main cutaneous nerve supply. Most people report sensation returning to almost normal within 12 months.
5. In the early post-operative period it is not at all unusual to find ongoing spotting from the nose or old blood discharging from the nasopharyngeal passages. This will take some time to settle down.
6. Breathing as well as sense of smell may be affected in the early post-operative period. These usually take some time to settle down. Usually, significant improvements will have been noted by eight weeks after surgery.
7. Oedema and swelling effects the shape of the nose. In the early post-operative period this is a constant and consistent theme. As this swelling and oedema settles down, this becomes intermittent with most people noticing the shape and swelling of their nose different at various times of the day. Generally, the vast majority of the swelling has settled down by three months. The final result however, remains a work in progress and is best judged at 12 months. Good luck on your journey!