Sydney plastic surgeon Dr Darryl Hodgkinson says a rhinoplasty procedure can improve both facial aesthetics and nasal function.

The goal of rhinoplasty surgery is to achieve a final result which complements the appearance, giving proportion to the profile so that the other more expressive features of the face – eyes, brow and mouth – are emphasised. I believe rhinoplasty, or a ‘nose job', is one of the most technically demanding of all aesthetic surgical procedures; the central position of the nose makes it easy for any irregularities to be spotted at once.

Selecting the 'right' nose

Each patient has a particular image of what they want their nose to look like, although they might not be able to verbalise this or show photographs to their surgeon. In most cases, digital imaging systems such as AlterImage can show patients around a 90 percent likelihood of the result they can achieve with rhinoplasty.

Before and after rhinoplasty by Dr Hodgkinson

The patient's input is essential and they are encouraged to bring in photographs of noses they like as well as those they think would not suit them. By communicating, and with the use of an imaging system, both the surgeon and patient can design a nose that not only looks natural but is the ‘right' nose for their individual face.

Too small a nose may not be the answer. Successful rhinoplasty is more to do with shape rather than size. A nicely shaped nose which balances the mid-third is not noticeable because it is so proportionate to the remainder of the face. Noses also need to be ethnically appropriate so the ‘ideal' nose for a patient of European heritage will be quite a different nose to the ‘ideal' Asian nose.

Before and after rhinoplasty by Dr Hodgkinson

Improvement to function

Breathing problems may be the result of previous trauma, a birth defect or exposure to noxious agents in the environment, especially smoke or irritants in the workplace whereby the internal nasal structures swell. During consultation, the patient's nasal function is investigated visually as well as radiographically to determine the cause of any nasal obstruction, if indeed it exists. In most cases, the nasal obstruction can be corrected at the same time the external appearance of the nose is improved.

In my experience, there are two general groups of rhinoplasty patients: Caucasians who often have a large bump to their nose or find their nose is too broad; and Asians who are concerned that their nose is too flat or broad. Operations for each group are essentially quite different. In the Caucasian patient, rhinoplasty often involves removing the bump, refining the nasal tip and narrowing the nose, whereas in the Asian patient, it usually involves augmenting or increasing the projection of the roof of the nose and refining the nasal tip, or the flare of the nostrils.

Before and after rhinoplasty by Dr Hodgkinson

Both procedures are typically performed under a light general anaesthetic, usually taking around one to 1.5 hours. A small nasal splint is then placed and worn for about a week following surgery, after which most patients can resume everyday activities.

A subgroup of patients are those who seek secondary rhinoplasty. In these cases, often too much tissue has been removed in a previous unsuccessful rhinoplasty and the nose needs to be reconstructed, often with bone and cartilage grafts. These revisionary surgeries are generally more complex procedures, taking more time to heal and also involving more swelling in the post-operative period. I advise patients to take at least seven to 10 days off work and to abstain from vigorous physical activity for four to six weeks, especially that which may involve the possibility of their nose being traumatised.