Being a central facial feature, the shape of the nose is an important element that contributes to facial appearance. A rhinoplasty, commonly referred to as a nose job, is a surgical procedure which can be done to reshape or resize the nose. The surgery can either be done for aesthetic or medical reasons, to address issues like breathing difficulties, irregular shape or size and injury repair.
Rhinoplasty changes the nose's shape or function: It may improve appearance, correct structural problems or address certain breathing difficulties.
There are different approaches: Open, closed, functional, secondary and filler rhinoplasty serve different purposes and involve different techniques.
The procedure needs individual planning: A surgeon considers your nasal structure, skin, medical history, breathing and desired outcome before surgery.
Recovery takes time: Swelling and stuffiness are common after surgery, and the final shape may take several months to settle.
Rhinoplasty has professional risks too: Doctors performing the procedure need to consider allegations of professional negligence and the protection available under their applicable Professional Indemnity Insurance.
What Is Rhinoplasty?
Rhinoplasty refers to a type of plastic surgery which is used to reshape the nose. The plastic surgery can be cosmetic to change the shape or size of the nose, or reconstructive to fix the structures of the nose. The surgery can involve the alteration of nasal bones, cartilage, and other supportive tissues. In some instances, rhinoplasty may involve the correction of the septum and is then referred to as septoplasty.
Why Do People Get Rhinoplasty?
Rhinoplasty can be performed for various reasons, depending on the patient’s desired outcome and the function of the nose.
Cosmetic Reasons: This type of rhinoplasty is performed to improve the aesthetic appearance of the nose. Patients often choose this procedure to address their concerns about the size, shape, or proportion of their nose.
Functional Reasons: Functional rhinoplasty is performed to address functional problems in the nose, such as breathing difficulties, or in conjunction with a reconstructive nose job.
Reconstructive Reasons: Patients choose reconstructive rhinoplasty to address deformities or abnormalities resulting from trauma or birth defects.
Types of Rhinoplasty
The type of rhinoplasty is determined by the patient’s condition, their desired outcome, and the shape of the nose.
Open Rhinoplasty
An open rhinoplasty is performed by making an incision in the bottom of the nose, called a columellar incision. This technique provides better access to the nasal cavity and offers a more comprehensive view of the nasal bones and cartilage.
Closed Rhinoplasty
A closed rhinoplasty is performed by making all the incisions inside the nostrils. The surgeon reshapes the nasal bone and cartilage through these internal openings, making this approach more suitable for certain less extensive corrections.
Functional Rhinoplasty
Functional rhinoplasty is performed when the patient’s nose has dysfunctional structural elements that need to be corrected. It addresses structural problems that interfere with breathing and may be considered when issues with the nasal framework affect normal airflow.
Secondary or Revision Rhinoplasty
A revision rhinoplasty is performed when the patient is not satisfied with their initial rhinoplasty surgery. Revision surgery is more complex than primary rhinoplasty due to the scarring and the altered anatomy of the nasal tissue. Scar tissue is less pliable and more challenging to work with than healthy tissue.
Filler Rhinoplasty
This technique is also called a non-surgical nose job because it utilises dermal fillers to make small adjustments to the nose. Dermal fillers are injected into the nose to refine its appearance by reducing imperfections. However, this technique is only a temporary solution, as the effects of the fillers are short-lived. In addition, filler rhinoplasty is not a surgical procedure; therefore, it cannot alter the underlying structure of the nose.
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What Happens Before Rhinoplasty?
A rhinoplasty surgery involves a number of preparations before the procedure. Your surgeon will first go through your medical history, symptoms, previous surgeries, medications, and concerns during a consultation. A physical examination of your nose will also be conducted to understand your external nasal appearance, internal structure, and any abnormalities. They might also take photographs of your nose from various angles to help you visualise the expected outcome of the surgery.
The doctor should also discuss what rhinoplasty can and cannot do to address your concerns. This is especially vital if they suspect you might have unrealistic expectations about the surgery, especially if it is primarily for aesthetic reasons.
How Is Rhinoplasty Performed?
Although the technique may vary depending on the patient’s needs, rhinoplasty generally uses a similar procedure to reshape the nasal bones and cartilage.
The doctors may cut or remove the undesired portion of the nasal bone and/or cartilage, alter the tip of the nose or the bridge, or utilise cartilage grafts from another body part to reshape and reconstruct the nose. Open and closed approaches can be used to access the nasal framework. It is a relatively quick procedure that usually lasts between one and two hours, with more complicated surgeries taking longer than anticipated.
What Are the Benefits of Rhinoplasty?
Rhinoplasty has different benefits depending on the reason for the surgery.
Alters shape and size: The procedure can change the contour of the nose - the bridge, the tip or the overall shape.
Improves appearance: Cosmetic rhinoplasty can make the nose more proportional to the face.
Corrects deformities: The surgery can fix various irregularities - for example, those occurring in the nasal septum.
Improves breathing: A functional rhinoplasty is performed to remedy issues with breathing caused by nasal deformities.
Fixes trauma-related defects: The procedure can be used to repair damage to the nose caused by an injury.
What Are the Risks of Rhinoplasty?
As with all forms of surgery, there are potential risks and possible complications involved with rhinoplasty. These can include things such as bleeding, infection and reactions to anaesthesia. Rhinoplasty-specific complications can include breathing difficulties, numbness, irregularities, swelling, scarring, altered sense of smell, septal perforation and the need for further surgery.
While there are some potential complications, they are not guaranteed to occur, and each patient will receive an overview of their individual risks and concerns from their surgeon prior to surgery.
What Is Rhinoplasty Recovery Like?
The recovery process doesn’t actually finish with the surgery itself. Common side effects post-surgery include swelling, stuffiness and bruising as the healing process begins. There may also be a splint on the nose for about a week, and possibly internal splints or supports for a few days.
Most people take about a week off work or regular duties to recover, with full healing taking more time. Swelling will reduce over the next few months, with most of it disappearing within a year. Surgery patients are generally recommended to avoid strenuous activity and take care not to bump or damage the nose during the healing process, and stick to the surgeon’s post-op guidelines.
What Professional Risks Do Doctors Face During Rhinoplasty?
Rhinoplasty surgery involves a complex series of medical procedures and considerations, including patient risk assessment, treatment planning, informed consent, surgical intervention and post-operative care. While a patient may be primarily concerned with their own safety and achieving the desired cosmetic improvement, a doctor can also put their professional reputation and livelihood on the line with every surgery they perform.
This is why medical professionals carry some form of doctor professional indemnity insurance, to protect them against any eligible legal liabilities stemming from their professional services. While a patient may be let down by the outcome of their cosmetic surgery, this by itself does not constitute professional negligence on the part of the doctor.
How Does Doctor Professional Indemnity Insurance Help?
Doctor professional indemnity insurance is specifically designed to provide legal and financial protection for doctors and other medical professionals against eligible legal liabilities involving their professional services, such as negligence, errors or omissions. In the case of an eligible claim, the Doctor Professional Indemnity Insurance Policy provides protection for your eligible legal defence costs and covered compensation, up to the limit of indemnity protection, as outlined in the policy wording.
For a doctor performing rhinoplasty, the relevance of this cover lies in claims alleging professional negligence, rather than complaints about the service provided or a patient's expectations about the final cosmetic result.
What Is Not Covered?
Doctor professional indemnity insurance is not a blanket protection policy covering all forms of disputes with patients.
Any claim that doesn’t allege professional negligence, such as a complaint regarding your patient service, or a disagreement about the outcome of their surgery, will not be covered simply because it involves a patient. The policy wording will specify what incidents or alleged incidents fall under your professional liability as a doctor.
Pro Tip:Keep the patient's assessment, treatment plan, informed consent, procedure notes and follow-up records properly documented. These records are important when responding to an allegation of professional negligence.
These two procedures are frequently confused with each other, although their primary objective is different.
Rhinoplasty
Septoplasty
Changes the shape, size or structure of the nose.
Corrects structural problems involving the nasal septum.
Often performed for cosmetic purposes.
Primarily performed to improve nasal function and breathing.
Can also have functional or reconstructive objectives.
Focuses mainly on the internal nasal structure.
Can be combined with septoplasty when both appearance and function need attention.
May be performed together with rhinoplasty as a combined procedure.
Conclusion
Rhinoplasty can accomplish a variety of goals depending on the patient’s requirements. Apart from fixing deformities and giving the nose a new shape, it can also tackle issues with breathing and restore the functionality of the nasal septum. Even when the main goal is to change the appearance of the nose, there are several other factors that have to be taken into account. Apart from carefully determining the required correction and the desired outcome, both the doctor and the patient have to understand the risks and the healing process. When it comes to medical professionals offering such services, they also have to think about the risks from a slightly different perspective, as the coverage for aesthetic and plastic surgery is usually limited and depends on the provider.
Frequently Asked Questions
Is rhinoplasty a cosmetic or a medical procedure?
It can be both, depending on the patient’s needs and goals. Cosmetic rhinoplasty is aimed at improving the aesthetics of the nose, while functional or reconstructive rhinoplasty is needed to address various issues, including a deviated septum, breathing difficulties, traumatic injuries, etc.
What is the difference between open and closed rhinoplasty?
During an open rhinoplasty, a surgeon makes an incision beneath the tip of the nose to gain better access to the nasal bones, while closed rhinoplasty requires only internal incisions. The choice between the two approaches depends on the volume and complexity of the required corrections.
How long does it take to recover from a rhinoplasty?
While most patients are fit enough to resume their daily activities right after the surgery, it takes weeks or even months for the swelling to completely disappear. As a result, the final outcome may not be apparent until several months after the procedure.
What are the common risks of rhinoplasty?
Rhinoplasty has one of the highest complication rates among all types of surgery. Some of the most common issues after a rhinoplasty include bleeding, infections, breathing difficulties, numbness, scarring, a change in the sense of smell, facial asymmetry, septal perforation and the need for revision surgery.
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