Mr Mike Tyler, UK Specialist Surgeon in Rhinoplasty  for Aurora Clinics explains the Rhinoplasty Procedure in general, and who should consider this procedure. For more information please call us on 01844 214362.

Nose Surgery – Rhinoplasty

Hello. My name is Mike Tyler and I’m a plastic surgeon working here and one of our specialist interests is rhinoplasty. I’d like to spend a few minutes just talking about what a rhinoplasty is and the different types of rhinoplasty that you can have and also the main aims of having a rhinoplasty operation.

A rhinoplasty really is a nose job in common language, and it’s an operation that’s designed to change the size, the shape, and the different angles that the nose has. Broadly speaking, there are two types of rhinoplasties. One is a rhinoplasty that we term a closed rhinoplasty, and this is an operation where all the incisions are actually done inside the nose. So you don’t have any external scars. And the other type of rhinoplasty is called an open rhinoplasty. During an open rhinoplasty, as well as having some incisions inside the nostrils, you also have a little incision just running along the bottom of this central part of your nose called the columella.

I’m going to spend a little bit more time talking about an open rhinoplasty because I spend most of my time doing open rhinoplasties. The reason why I prefer doing rhinoplasties in an open fashion as opposed to a closed is because it gives me greater access and I can actually see that there are extra bits of cartilage and bone that I’m trying to move in order to shape the nose in a much better light than during a closed rhinoplasty when a little bit more of the operation is done by feel.

So, who’s a good patient for an open rhinoplasty? Well, the sorts of things that we do with open rhinoplasties is that we often have to remove a dorsal hump. Dorsal hump is when you have a large part of the nose sitting just here. And that’s a very common part of any rhinoplasty operation is to remove a little bit of dorsal. The other things that we often do with a rhinoplasty is to make the tip of the nose, this bit here, a little bit less bulbous, and we can do that by reducing the amount of cartilage we’ve got there. And the third common element to a lot of rhinoplasties is just to set the tip. Either if the tip’s a little bit too low, then we need to lift it up a little sometimes. Sometimes if the tip’s a little too high, we can bring it down again.

During rhinoplasties, most rhinoplasties that we do, we actually take away a little bit of tissue. We take away a little bit of tissue on the hump. We take away a little bit of tissue on the tip. Some rhinoplasty operations we do the opposite, we actually put tissue in. And the most common areas where we put tissue in are if you’ve got a saddle deformity, in other words, you’ve got too big a dip here or if you’ve got various defects or gaps in the cartilage that give rise to little hollows within the nose and sometimes we wish to fill those. We fill those using cartilage either from the nose. Sometimes we even pinch a little bit from the ear, and in very severe cases, we even sometimes pinch a bit of rib cartilage although that’s very rare.

So who’s the typical patient who would like to have a rhinoplasty? Well, often they’re adults, usually somewhere between 20 and 50 years of age, and most people have had a gripe about their nose ever since they were teenagers. So most of my patients have always wanted to have this done. The best candidates for rhinoplasty are those that have a very clear idea of what aspect of the nose they want to change. So I like patients who come along and say it’s the hump, doctor, I don’t like or it’s the tip I think is too big. If I have a definitive target, I can then usually surgically change that target. If you come along with an aim to be looking like Brad Pitt if you’re a male or Angelina Jolie if you’re female, then it’s much more difficult for me to ascertain how I’m going to change that nose. So, key thing when I think about rhinoplasty is to try and identify which parts of your nose you don’t like and articulate that to the surgeon when you come to the preoperative consultation.

During the preoperative consultation, I will be looking at what sort of techniques that I’ll be needing to employ during the course of your rhinoplasty, and as I said, the key elements I’ll be looking at what I have to change on this part of the nose, the dorsum, either if there’s a hump going this way or if it’s very thick in the top part of the nose. I then also have a look at this middle part of the nose and see whether it’s, again, it’s very pointed or very narrow or indeed whether there’s any hollows there, and then I start to look at the tip. When I look at the tip, I look to see how bulbous the tip is and also look to see the position of the tip. Once we’ve got the position of the tip, I’m then looking at the various angles. This angle here between the nose and the lips is called the nasolabial angle. The older we get, the more and more obtuse that angle becomes. That’s why, when we draw elderly patients, we usually draw them with a long overhanging tip on their nose, because as we get older, that nose starts to drop. If your nose has dropped a little bit too prematurely, then one of the things that I’ll be wanting to do is just to reset that tip back up a little bit.

So then after we’ve done the broad outlines of the major aspects of the rhinoplasty operation, I then looked at some of the finer points, whether I’ll be wanting to do any work around these parts of the nose, in other words the sides of the nostrils, whether there’s anything else that might be needed. We can then sit down and discuss the risks, what you have to go through with the course of the operation, what the alternatives are and also the risks. Obviously, these are very important parts of the preoperative consultation. If you’d like to know more about that, I’d asked you, obviously, to contact us. Thank you very much.