Rhinoplasty

What is Involved in a Rhinoplasty?

There are two general surgical approaches to rhinoplasty:

• Closed rhinoplasty (endonasal approach)
  ‍Incisions are made entirely within the nostrils. This avoids any external scar but provides more limited exposure. It is generally suited to more minor refinements where extensive structural work is not required.
• Open rhinoplasty
  ‍A small incision is made across the columella, allowing the nasal skin to be elevated. This provides direct visualisation of the nasal framework and allows for precise modification, accurate graft placement, and improved control of symmetry.

For the majority of patients, particularly those requiring structural or tip work, an open approach is preferred by Dr Phua.

A key principle of modern rhinoplasty is preservation and support of the nasal framework, often using cartilage grafts. There are a number of options for cartilage grafts:

• Septal cartilage
  ‍The most commonly used source. It is located within the nasal septum and is ideal for many grafts due to its strength, straightness, and accessibility during surgery.
• Autologous rib cartilage
  ‍Cartilage harvested from the patient’s own rib. It provides a larger volume of strong structural material and is particularly useful in revision surgery or when significant augmentation or support is required.
• Cadaveric rib cartilage
  ‍Processed donor cartilage that avoids the need for a separate donor site. It provides reliable structural support and is often used when septal cartilage is insufficient and rib harvest is not preferred.

Cartilage grafts are carefully shaped and positioned to provide support for the external shape of the nose and improve the nasal airway. These may include columellar strut grafts to support the nasal tip, tip grafts to improve definition, alar rim grafts to support the nostril margins, spreader grafts to improve internal nasal valve function and dorsal contour, and dorsal onlay grafts to smooth or augment the bridge of the nose.

What to Expect

First Few Days

Swelling and bruising around the nose and eyes are expected and, in some patients, can be quite noticeable. You may feel a sense of pressure, congestion, and tightness rather than significant pain. An external splint is applied to maintain the new nasal shape. If septal surgery has been performed or septal cartilage grafts have been used, internal splints are often placed within the nose to support healing and maintain alignment. Breathing through the nose is usually limited during this period. Sleeping with the head elevated and using cold compresses can help reduce swelling.

First Week

By the end of the first week, much of the initial swelling and bruising begins to settle. The external splint is removed at around one week, along with any internal splints if used. In open rhinoplasty, fine sutures along the columella are also removed at this time. Although the nose will still appear swollen, particularly at the tip, many patients feel more comfortable being out socially.

Weeks Two to Four

Bruising largely resolves and swelling continues to improve. The nose may still feel firm, and there can be asymmetry related to uneven swelling. Most patients feel comfortable returning to work and light activities during this period. Subtle swelling, particularly at the tip, remains common.

After Four Weeks

Most of the visible swelling has settled, and the nasal contour becomes more refined. Residual swelling persists, especially in the tip, and continues to improve gradually. Exercise and more strenuous activities can typically be resumed, depending on individual recovery. Final results evolve over 6 to 12 months, and sometimes longer, as the tissues soften and the nose settles into its final shape.

Possible Risks

Rhinoplasty is generally safe when performed carefully, but as with any surgery, there are potential risks. These include bleeding, infection, and delayed wound healing. Swelling can persist for longer than expected, and there may be asymmetry or contour irregularities as healing progresses. Some patients notice changes in nasal breathing, which may improve or, less commonly, require further treatment. Scarring is usually minimal and well concealed, though in open rhinoplasty there is a small scar along the columella that typically heals very well. Altered sensation, including numbness around the nose, can occur and usually improves over time. In some cases, further refinement or revision surgery may be required.

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Medicare Coverage

In Australia, Medicare may provide partial coverage for rhinoplasty when it is performed for functional reasons rather than purely cosmetic ones. In general terms, this includes surgery to improve nasal obstruction (such as from a deviated septum), reconstruction following trauma, or a nasal deformity related to a congenital condition such as a cleft lip. Purely aesthetic procedures are not covered. Eligibility is determined according to specific criteria and is assessed on an individual basis during consultation.