Nose surgery, or primary rhinoplasty, is the initial surgical procedure performed on the nose, as opposed to any revision surgeries that may follow. Nose surgery is often referred to as a nose job.
If you are unhappy with the appearance of your nose, suffer from breathing problems that can be cured by surgery or have injured your nose in an accident, you are a candidate for primary rhinoplasty.
Rhinoplasty can reshape or rebuild your nose and improve your profile. It can change the length of your nose, the width of the bridge, the position of the nostrils and the position, size and shape of the nose tip.
It can also remove breathing obstructions and improve other functional issues. If you have injured your nose, or damaged your nasal structures with cocaine usage, primary rhinoplasty can rebuild your nose.
What rhinoplasty can do for you
Rhinoplasty is a surgical procedure to improve the shape and contours of the nose and/or its function. Nose surgery can be performed to correct birth deformities as well as irregularities caused by accidents and trauma.
Common complaints of people seeking to improve their noses include bumps, bulbous tips, noses that are too wide, or those that jut out too far from the face, unsightly nostrils, problems with the nose-lip angle and noses that droop with smiling.
Aesthetic nose surgery can improve all these dissatisfactions by changing the size and shape of the nose. It can lengthen or shorten a nose and change its contour or proportion. Nostrils can be made narrow or less flaring. The nasal tip can be lifted or contoured to give it better proportions or definition.
Corrective nose surgery can relieve breathing problems associated with nose structure, allergies and sinus blockage.
Long-term use of cocaine can weaken the structure of the nose by damaging the nasal bone and cartilage, including the nasal septum—the thin wall of cartilage separating the two sides of the nose. In the worst cases, this damage can result in nasal collapse.
Rhinoplasty is a complex surgery that combines both art and science, making it one of the most difficult surgeries to master. Even the slightest change in shape or structure can cause breathing problems and other functional issues. This is why rhinoplasty has very high revision rates compared to other types of cosmetic surgery. For more information on revision surgeries and why people want them, read our article on revision rhinoplasty.
Would you like more information?
Dr Marcells is a highly skilled and experienced rhinoplasty surgeon. He is adept at the detailed analysis of all aspects of the nose, both inside and out, essential for positive outcomes in nose surgeries.
You can view the before and after photos of his patients who have undergone rhinoplasty procedures in the Nose Gallery of this website. All the gallery photos are of actual patients of Dr Marcells.
- Female primary rhinoplasty gallery
- Male primary rhinoplasty gallery
- Check out the entire Nose gallery
Clicking on each gallery image will take you to a page with photos of each patient taken from multiple angles and details of the changes made during nose surgery.
What nose reshaping surgery can’t do
Don’t expect to see an entirely transformed person looking at you from the mirror after surgery. Nose surgery will not change your life or make you more popular or happy. It will only enhance your appearance somewhat and in many cases, help you feel better about yourself and your appearance. Nose surgery sometimes makes dramatic changes, but for most people the changes are subtle and often go unnoticed by others.
Are you a suitable candidate for rhinoplasty?
Rhinoplasty is performed on adult men and women with realistic goals and expectations for improving the function and/or appearance of their noses.
You should be in good physical health and psychologically stable to undergo rhinoplasty.
During your initial consultation with Dr Marcells you will be able to discuss and address any medical conditions that may require further investigation prior to your surgery. This includes conditions like an over or under active thyroid, anti-coagulants, circulatory disorders like heart disease or high blood pressure and of course, diabetes.
People who have Body Dysmorphic Disorder or certain other mental conditions are not good candidates for rhinoplasty or other cosmetic surgery.
How rhinoplasty is performed
Rhinoplasty can be performed using two approaches: open surgery and closed surgery.
In closed rhinoplasty all of the surgical incisions will be made inside the nostrils, and the scars will be out of sight. However, closed rhinoplasty limits surgical access and the level of precision that is possible with open rhinoplasty. It may also result in distortion of the nasal cartilages.
Open rhinoplasty is performed using incisions inside the nostrils and an incision across the bottom of the nose called the trans-collumellar incision. This allows the nasal skin to be folded up, giving full access to the nose and the underlying structures necessary for precision work.
Usually this incision heals well. The scar can only be seen if you raise your head to show the underside of the nose. Dr Marcells prefers open structure rhinoplasty as he is able to make changes to the nose much easier than trying to work inside the nose. He also understands that the modest risk of a visible scar more than compensates for the better access, precision and predictable outcomes this approach provides.
A rhinoplasty typically takes between one and three hours to complete, depending on the extent of work needed. It is an operation performed under general anaesthesia.
Preparing for your rhinoplasty
The preparation process for rhinoplasty surgery will involve a medical evaluation. It may be necessary to take certain medications or adjust the medications you are currently taking.
You will be given a set of instructions by Dr Marcells on how to prepare for your rhinoplasty. You will be advised to start your preparation from two weeks before and continue up to two weeks after surgery. You will be asked to stop taking aspirin, anti-inflammatory drugs and certain other herbal supplements and medications. This will help minimise the risk of bruising and bleeding associated with surgery. Dr Marcells will also instruct you to begin nasal washes as this will help reduce the risk of post-surgery infections and make your recovery more comfortable.
Follow these instructions closely. If you have questions or need any clarification about the instructions given to you, we will be glad to help.
After the surgery
You will most likely have a splint or cast taped to the outside of your nose to hold it in place, protect it and help it heal correctly. Sometimes, depending on the type of rhinoplasty, you may find soft internal splints inside the nose as well. These should remain in place for at least a week, until your nose has stabilised. Dr Marcells will inform you at your initial consultation about any casts and splints he will use in your procedure.
Your nose will feel very congested as if you have a cold or flu.
You should rest as much as possible. It is okay to engage in housework, but keep it minimal. You should not go to work, exercise or engage in sports for two weeks. Gentle walking is a good way to exercise during this period.
Although you may shower, ensure that the water is not too hot. If you have an external splint, you must make sure to keep it dry.
Make sure your sunglasses and reading glasses do not rest on the bridge of the nose for up to six weeks if the nasal bones have been affected as part of your surgery. Try to keep your head up as much as possible. It is better to sit up than lie down. Do not stoop over. Sleeping will be more comfortable with a couple of pillows to help prop you up. This will also help to lessen the congestion. Please don’t lie flat.
It is normal to experience a little bleeding and drainage of old blood and mucus from your nose for a few days after the operation. The same applies to your nasal washes.
When blowing your nose you may find not much comes out if you have splints in place during the first week. It may be more comfortable to gently dab under the nose rather than blow. After the splints & cast are removed, you may blow your nose. Blow gently keeping the nose straight, don’t wiggle it from side to side. Sneeze with your mouth open, this allows air to escape from your mouth rather than let the pressure build up inside your nose. Eating softer foods may help a tender throat. Very spicy food may irritate the nose. Otherwise, there are no dietary restrictions,
Before surgery, make sure your clothes that fasten in the front. Avoid pulling shirts, tops and sweaters over your head, as it may damage your healing nose.
It is natural to experience some level of bruising around the eyes and eyelids after the surgery. You may also feel numbness in the area. Both typically subside within two weeks. Ice packs and cold compresses will reduce swelling and discolouration around the eyes. Beyond this, there may still be some subtle swelling that most people will not notice.
If you are like most people undergoing rhinoplasty, you will be able to enjoy your enhanced appearance within a few weeks after surgery. The healing process after rhinoplasty can be extremely slow in some people, and recovery times vary from person to person. Swelling, especially in the nose tip, may not subside for as long as six to 12 months. It is only after the swelling has disappeared that the final shape of your new nose will become apparent. For this reason, surgeons will not perform revision rhinoplasty for at least a year after the first surgery.
Most people are able to resume normal social activities within two to three weeks.
Rhinoplasty is usually performed as an outpatient day only procedure, so you will need someone to drive you home after the surgery. It is also a good idea to have someone stay with you the first night.
Obviously, recovery periods depend on the extent of changes that have been made.
During your recovery, follow the post-operative instructions given to you by Dr Marcells.
Your instructions will include contact numbers to use in an emergency. Do not hesitate to use them. Having your mind at rest is important for uneventful and speedy healing. If a call can put your mind at rest, go ahead and make the call.
Potential risks and complications
Every surgical procedure carries some level of risk, expectation and complication, including adverse events to medications and anaesthetics.
Potential risks and complications that can arise from a rhinoplasty include:
- Bleeding and bruising
- Nasal obstruction
- Numbness, discomfort and tenderness
- Loss of sense of smell and taste
Dr Marcells will discuss all of these with you and how these risks specifically apply to you.
Your choice of facial plastic surgeon (including a check on the accreditation of the facility used by the surgeon), and a thorough discussion of your medical records prior to surgery can avert a lot of unnecessary risk. It is, however, impossible to entirely eliminate risk in a surgical procedure.
Now it’s your call
Rhinoplasty is among the top five most sought after cosmetic surgeries in the world. Aussies love rhinoplasty. Although US statistics show that it continues to be the most popular procedure among those in the under 35 age group, we have many rhinoplasty patients who are over 35.
Cosmetic rhinoplasty is not covered by Medicare Australia or by private health insurance companies. However, some costs associated with the nose revision surgeries that correct breathing problems or help rebuild the nose after collapse or trauma are covered by Medicare. Just to be sure, check with your insurance company before surgery about coverage.
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Meet Dr Marcells
MBBS (Syd), FRACS (ORL-HNS)
Past President – Australasian Academy of Facial Plastic Surgeons
Dr George Marcells is known for excellence in facial plastic surgery and is considered a true master of rhinoplasty. He performs advanced surgical techniques to restore balance and harmony to the face and can also resolve functional issues such as breathing difficulties.