Rhinoplasty
Rhinoplasty is probably the most demanding facial operation: the nose sits at the centre of the face, millimetre changes are visible, and its internal structure governs something as everyday as breathing. That is why I approach every case from both angles at once — aesthetic and functional — rather than as two separate operations.
When is it recommended?
- A dorsal hump or a bridge that unbalances the profile.
- A drooping, wide or poorly defined tip.
- Nasal deviation, either congenital or after trauma.
- Difficulty breathing due to a deviated septum or collapse of the nasal valves.
- An unsatisfactory result from previous rhinoplasty (secondary rhinoplasty).
My approach
I do not work with a single technique, because not every nose admits the same solution. Depending on the anatomy I choose between a preservation approach — lowering the dorsum while keeping its support structure — or a classic structural one, and between a closed or open approach. I always analyse the complete facial profile before operating: in a fair number of patients who come in about their nose, part of the imbalance comes from an under-projected chin, and treating only the nose does not resolve the whole. That skeletal perspective is what my maxillofacial training brings.
Open or closed rhinoplasty: what changes
In closed rhinoplasty all incisions stay inside the nose, with no external scar. In the open approach a small incision is added on the columella — the strip of skin between the nostrils — allowing the skin to be lifted and the structures seen directly. That extra visibility is decisive in complex or markedly deviated noses and in revision surgery, where working blind multiplies the risk of asymmetry. The open-approach scar, well executed, ends up practically imperceptible: it is an area that heals very well. The choice is not about one technique being better, but about how much precision each case demands.
Skin thickness shapes the result
This is probably the factor that frustrates the most expectations when it is not explained before surgery. The operation acts on the skeleton of the nose — bone and cartilage — but what you see is the skin covering it. Thin skin reveals every detail of the structural work, allowing very sharp definition but also exposing any irregularity. Thick skin, by contrast, acts like a blanket: it damps down contour, takes far longer to deswell and limits how much tip definition can be achieved, however well the work underneath was done. It is not a problem, it is a starting condition that must be known and stated clearly in consultation.
Real risks and how they are minimized
Rhinoplasty is a safe operation, but its risks are worth knowing before deciding. The most frequent are prolonged swelling, especially at the tip and in thick skin, and small dorsal irregularities that become palpable as the swelling subsides. Bleeding is usually mild and self-limiting. The complication patients fear most — ending up worse than before — is real, and it is why secondary rhinoplasty is a subspecialty in itself: an estimated 5 to 15% of primary rhinoplasties eventually raise the question of a revision. Reducing that risk means meticulous planning, not promising results the anatomy cannot deliver, and being conservative: more can always be removed at a second stage, but restoring structure that was taken away is far harder.
Recovery
The splint comes off around day seven, and that is when most patients can return to normal life, still visibly swollen. Periorbital bruising, if it appears, resolves in 10-14 days. From the first month the appearance is socially comfortable, but it is important to understand that the nose keeps changing for a long time: tip swelling is the last to go and the definitive result is not judged until 12 months, or up to 18-24 in thick skin and in secondary rhinoplasty. It is the facial operation that demands the most patience.
Frequently Asked Questions
Is nose surgery painful?
Less than most people fear. Pain as such is usually mild and controlled with standard analgesia. What really bothers patients in the first days is nasal obstruction: breathing only through the mouth is uncomfortable and disrupts sleep. Today’s packing is far less aggressive than years ago, and in many cases it is not needed at all, which has considerably changed the postoperative experience.
At what age can the nose be operated on?
It is best to wait until facial growth is complete, which happens at around 16 in girls and 17-18 in boys. Operating earlier can disturb development of the middle third of the face. There are exceptions: significant breathing obstruction or trauma with marked deformity may justify earlier surgery, prioritizing function. There is no upper age limit as long as general health allows it.
When is secondary rhinoplasty considered?
Never before 12 months from the first operation, and preferably after a full year: until then residual swelling may be showing an image that is not the final one, and reoperating on tissue still healing worsens the result. Secondary rhinoplasty is technically harder than the first — there is scar tissue, the anatomy is altered and cartilage is often missing and must be replaced with grafts — which is why it demands even more careful planning.