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Rhinoplasty is an operation that changes the shape of the nose. It can reduce a hump, refine or lift the tip, straighten a crooked nose, narrow a wide bridge or nostrils, and correct the effects of an injury. When it also improves breathing by straightening the septum or supporting the airway, it is called a septorhinoplasty. It is among the most technically demanding operations in facial plastic surgery, because a small change of a millimetre or two is visible, and because the nose must work as well as it looks.
A good rhinoplasty does not follow a template. It takes the nose you have and adapts it to your face, your skin and your breathing. For that reason the most important part of the process is the planning, long before the operating theatre.
What rhinoplasty can correct
- a hump on the bridge of the nose
- a wide, bulbous, drooping or asymmetric tip
- a nose that is too long or too prominent for the face
- a crooked or twisted nose, often after an injury
- wide nostrils or a wide nasal base
- breathing problems from a deviated septum or collapsing nasal valves
It cannot change the thickness of your skin, and it cannot turn a strong nose into a very small one without affecting how it works. Thicker skin, for instance, limits how refined the tip can look, because the skin drapes over the new framework rather than shrinking tightly onto it. These limits are discussed openly at consultation.
Facial balance
A nose never exists on its own. Its size and angle are judged against the forehead, the eyes, the lips and especially the chin. A weak chin can make a normal nose look large, and in some patients a small chin augmentation is suggested alongside rhinoplasty. The angle between the nose and the upper lip differs for men and women: a slightly higher tip suits many women, while men usually look better with a straighter profile and less rotation. Changing the nose in isolation, without considering these relationships, is one of the main reasons results look “done”.
Open or closed rhinoplasty
| Open rhinoplasty | Closed rhinoplasty | |
|---|---|---|
| Incisions | Inside the nose, plus a small cut across the columella | Inside the nose only |
| Visibility | Full, direct view of cartilage and bone | More limited |
| Best for | Complex tip work, asymmetry, revisions, grafts | Hump reduction, simpler changes |
| Visible scar | Small, usually faint | None |
| Swelling | Often a little longer at the tip | Often slightly less |
Neither is superior in every case. The approach follows the plan. If the tip needs structural grafts or careful reshaping, the open approach usually gives more precise control. If the main change is a hump and the tip is already well formed, a closed approach may be enough.
Structural and preservation approaches
Traditional rhinoplasty often removed cartilage and bone to make the nose smaller. That can look good early on, but a nose that has lost too much support can later collapse, pinch or narrow the airway. Modern rhinoplasty puts more emphasis on support. Cartilage is reshaped and repositioned with sutures, and small grafts, usually taken from the septum, are used to strengthen weak areas.
In selected noses, preservation techniques lower a hump by moving the whole bridge down as a unit rather than removing it and rebuilding the roof. They can give a very natural bridge line but suit only certain anatomy. Which of these approaches fits you is decided after examining your nose inside and out.
Who is a good candidate?
You may be a good candidate if your nose has finished growing, you are in good health, you do not smoke or are willing to stop, and you have a clear, realistic idea of what bothers you. It helps to be able to describe the change in your own words, for example “the hump in profile” or “the tip looks heavy”, rather than bringing a photograph of someone else’s nose. Your nose has to fit your face.
Preparing for surgery
About two weeks before surgery, stop aspirin, anti-inflammatory painkillers and supplements that affect bleeding, after checking with your doctor. Stop smoking at least four weeks before and after surgery, as nicotine slows healing of the skin and cartilage. If you have allergies, sinus problems or have had a nasal injury, mention it at consultation. Plan to have someone with you on the first night, and prepare a few days of soft food and extra pillows to keep your head raised.
The operation
Rhinoplasty is performed under general anaesthesia and takes two to four hours. The septum is straightened if needed, the hump is reduced or the bridge lowered, the tip is reshaped with sutures and grafts, and if the bridge is wide the nasal bones are narrowed. The nostrils can be reduced with small incisions in the natural creases where they join the cheek. At the end, a splint is placed over the nose and soft supports inside may be used for a short time.
Recovery week by week
- Days 1–3: swelling and bruising around the eyes, a blocked nose and a dull ache; sleep with the head raised and use cold compresses around the eyes
- Days 5–7: bruising fading; the splint and stitches are removed around day seven
- Weeks 2–3: most people return to work and social life; the nose looks swollen but acceptable
- Weeks 4–6: light exercise; avoid contact sports and resting glasses on the bridge
- Months 3–6: the bridge defines; the tip is still swollen, especially in the mornings
- Months 12–18: final refinement, particularly of the tip
Patience is part of rhinoplasty. The nose you see at three weeks is not the final nose. Swelling, especially at the tip, takes many months to settle, and in thicker skin it can take longer than a year.
Risks
Possible risks include bleeding, infection, breathing difficulty, asymmetry, irregularities that can be felt or seen along the bridge, a change in the sense of smell, numbness of the tip, and, uncommonly, an unsatisfactory shape that needs further surgery. International studies suggest that a small percentage of rhinoplasty patients go on to have a revision rhinoplasty. Careful planning, a conservative approach to cartilage removal and good support reduce this risk.
Non-surgical options
Small irregularities or a slight dip above the tip can sometimes be improved with hyaluronic acid fillers. This is sometimes called a non-surgical rhinoplasty. It can camouflage a hump by filling around it, but it cannot make a nose smaller, straighten the septum or improve breathing. Filler in the nose also carries a real, though rare, risk of blocking a blood vessel, so it should be performed by someone who knows the anatomy well.
Rhinoplasty in Istanbul
If you are travelling for surgery, plan to stay in Istanbul for seven to eight days, until the splint has been removed and the nose has been checked. Flying is usually fine after the splint is off, although the nose may feel blocked during descent. Bring saline spray for the flight.
Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon holding the EBOPRAS qualification of the European Board of Plastic, Reconstructive and Aesthetic Surgery, and lists nose surgery among his main areas of focus. He trained in Germany, Poland and Brazil and practises in Bakırköy, Istanbul. At consultation he examines the inside of the nose as well as its shape, analyses your profile, and explains what can realistically be achieved with your skin and anatomy.
