What to expect with a septorhinoplasty

What to expect with septorhinoplasty

Written by: Mr Florian Bast
Published: | Updated: 14/08/2018
Edited by: Laura Burgess

Functional septorhinoplasty, or functional rhinoplasty, is a term often used to reference several different types of reconstructive nose surgery intended to improve the function and aesthetic of the nose, as it's very often not possible to separate form and function. There is a wide variety of techniques that may need to be employed when trying to make the nose function and aesthetic better. Your surgeon should be highly trained in all aspects of functional and aesthetic nasal surgery.
 

Why have a septorhinoplasty?

If you have a blocked nose caused by a deviated septum, you may only be able to have a septoplasty or reduction of turbinates. But if you have a blocked nose because your nasal bones are crooked or damaged, your septum has severely deviated, or you have functional problems due to nasal valve pathology, a functional septorhinoplasty is the only option to improve the way you breathe.
 

What are the steps of a septorhinoplasty procedure?

A septorhinoplasty is almost always performed under a general anaesthetic. The operation usually takes between two and three hours. I perform about 95% of my functional septorhinoplasties with an open approach technique. The scar on the skin between the upper lip and tip is almost invisible when healed completely. The open approach gives me the opportunity to assess the bony and cartilaginous framework in the best possible way and I can address and deal with the pathology in a perfect way.

During the surgery, the septum, the upper lateral and lower lateral cartilages are brought into a central, symmetric and stable position. The nasal bones are straightened either by a controlled fracture or, if possible, by less traumatic shaving techniques. During the procedure, I can also refine the shape and position of the tip of your nose and remove a nasal hump. Sometimes cartilage is necessary to support or rebuild part of your nose. This is taken from your septum. If, for example, due to previous surgeries, not enough cartilage can be harvested from your septum, I use ear or rib cartilage.

At the end of the operation, a splint will be applied on the nose to maintain its new shape and reduces swelling and oedema. The splint (cast) stays on for one week. In more than 95% nasal packs are not necessary and all the sutures used inside the nose and to close the incision are dissolvable.
 

How long does it take to recover?

In the first 72h after the surgery swelling will increase and you will feel pressure around and inside your nose. The breathing won’t be perfect. Every patient gets a combination of antibiotic ointments, saline nasal douche and decongestive nasal spray to reduce the discomfort after surgery and to create a clean and moist wound environment for better healing.

You will need to stay off work for 1-2 weeks. You should also not do any exercise, have hot baths, bend down and avoid sun exposure. After removing the cast, a high SPF is recommended. Most swelling and bruising will usually have settled after the third week. It can take many months for your nose to settle down and for the final appearance to develop

 

What are common postoperative problems?

  • The face is puffy, you have a dull headache and your nose aches and is tender. Take the pain medication as prescribed and you feel better after the first 72h.
  • There may be a bloodstained or pinkish discharge for a few days. Serious nasal bleeding is rare.
  • Swelling and bruising around the eyes will increase at first, reaching a peak after about 3 days. Most of the swelling and bruising should disappear within 3 weeks.
  • Hot baths and showers may lead to nasal haemorrhage and also increase bruising around the eyes.
  •  Aspirin can potentially increase the risk of nasal bleeding.
  • Avoid smoky, dusty and dry atmospheres if possible, as this may irritate the nasal lining.
  • The splint over your nose will be removed a week after surgery.
  • Two weeks will need to be taken off from work or school with a sick-note provided. 
  • It is normal for your nose to be quite blocked for several days (even a couple of weeks) after the surgery, while all the internal swelling settles.
  • Avoid heavy nasal blow for 10+ days after your operation.
  • Do not drive for 48 hours (because of the effect of the general anaesthetic)
  • Avoid strenuous activity (jogging, swimming, bending, sexual relations…) for 3 weeks, as they may increase your blood pressure and risk of bleeding.
  • Avoid contact sports, hitting, rubbing your nose and direct sun exposure for 2-3 weeks.
  • Avoid wearing glasses for 2-3 months once the splint is off. Contact lenses can be used as and when you wish.

By Mr Florian Bast
Otolaryngology / ENT

Mr Florian Bast is a consultant ENT surgeon based at the Harley Street Nose Clinic and at Guy's and St Thomas' Hospitals in London. Prior to this Mr Bast was appointed as an ENT consultant at the University of Berlin, Germany. Mr Bast completed his higher surgical training at the University of Heidelberg and the University of Berlin, Germany and became a specialist in otorhinolaryngology, head and neck surgery in 2011. In 2014, Mr Bast completed the prestigious craniofacial and facial-plastic fellowship at Chelsea and Westminster Hospital, London.

Mr Bast specialises in aspects of rhinology and facial plastic surgery, including the treatment of chronic rhinosinusitis, functional and aesthetic septo-rhinoplasties, and treating patients with snoring problems and obstructive sleep apnoea. He is also trained in the use of Botox and dermal fillers. Mr Bast is a frequent lecturer at national and international conferences and is also widely published in his areas of expertise.

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