Nose surgery procedure: how a rhinoplasty works step by step

Every rhinoplasty begins with a thorough personal consultation. The specialist in charge takes the time to get to know the individual wishes and expectations and to discuss the treatment options together with those interested. Alongside aesthetic ideas, functional complaints are also taken into account. These include, for example, restricted nasal breathing, previous injuries or nose operations already carried out. Pre-existing conditions, allergies and general health also feed into the planning. Another important part of the consultation is a realistic assessment of the result that can be achieved. The aim is a rhinoplasty that suits the face harmoniously and takes both aesthetic and functional aspects into account.

The next step is a thorough examination of the nose. Shape, size and proportions are assessed, as well as the condition of the skin and the stability of the bone and cartilage structures. In addition, the specialist examines the nasal septum, nasal breathing, the nasal dorsum, the nose tip and the nasal wings. If there are functional complaints, these are included in the treatment planning. Since the nose has a major influence on the overall appearance of the face, the facial proportions are also carefully analysed. The aim is a result that looks natural and blends harmoniously into the individual appearance.

After the examination, the concrete planning of the rhinoplasty begins. Photographs of the nose from different perspectives and a detailed analysis of the facial proportions help with this. Depending on the starting situation, digital planning or a simulation can also be used. This serves to illustrate possible changes and to bring the ideas of the doctor and the patient into better alignment. It is important to note, however, that a simulation only offers orientation. The actual result always depends on the individual anatomical conditions and the healing process and can therefore not be guaranteed.

Before every rhinoplasty, patients receive comprehensive information about the planned procedure. Possible risks, complications, limitations of the treatment and alternative methods are explained in detail. Typical side effects such as swelling, bruising or temporarily restricted nasal breathing are also discussed. At the same time, patients are told what the healing process usually looks like and which aftercare measures are required.

An open and honest consultation creates the basis for realistic expectations. It is an important part of individual surgical planning and contributes significantly to an informed decision.

Before a rhinoplasty, various preliminary examinations are carried out, depending on age, state of health and the extent of the operation. These often include blood tests, an anaesthesia consultation and, where appropriate, further medical findings. In the case of certain pre-existing conditions or functional complaints, an examination by an ear, nose and throat specialist may also be advisable. This allows any particularities of nasal breathing or the nasal septum to be taken into account in advance. All examination results feed into the individual surgical planning and help to prepare the procedure as safely as possible.

Certain medications can increase the risk of bleeding or affect wound healing. These include, among others, blood-thinning preparations as well as some painkillers or dietary supplements. Smoking and alcohol consumption can also have a negative effect on blood circulation and the healing process. Patients therefore receive precise instructions before the operation on what to look out for in the days before the procedure. It is important never to stop taking medication on your own. Any changes should only be made after consulting the doctor in charge.

Besides the medical preparations, it is advisable to plan your everyday life in good time. The following points can help:

• Arrange for someone to accompany you home
• Plan for time off work and recovery time
• Prepare ways of cooling for the first few days
• Choose loose clothing that does not have to be pulled over the head
• Book aftercare appointments early
• Plan a break from sport
• Avoid scheduling important social events directly after the operation if possible

Good preparation ensures that the first few days after the rhinoplasty are as relaxed as possible and that patients can concentrate fully on their healing.

On the day of the nose operation, you are first admitted to the clinic. After registration, your personal details are checked and any last organisational questions are clarified. The preparation for the procedure then follows. Before the operation, there is often a final conversation with the surgeon in charge. Any last questions can be answered and the planned changes discussed once more together. Depending on the surgical plan, markings are also made on the nose, which serve as orientation during the procedure. The medical team accompanies patients throughout the entire process and informs them about the next steps. The aim is to create a calm and trusting atmosphere before the operation begins.

In most cases, a rhinoplasty is performed under general anaesthesia. This means patients sleep throughout the procedure and feel no pain. A thorough conversation with the anaesthesia team takes place even before the day of surgery. General health, possible pre-existing conditions, allergies and previous experiences with anaesthesia are discussed. On this basis, the individually suitable anaesthesia is planned. Throughout the entire operation, all vital body functions are continuously monitored. Modern anaesthetic methods are considered very safe today and allow close monitoring throughout the entire procedure.

There are basically two surgical methods available for a rhinoplasty: the closed and the open approach. Which method is used depends on the individual findings and the extent of the planned changes. In closed rhinoplasty, all incisions are made inside the nostrils. This means no externally visible scars are left. This technique is often suitable for corrections of smaller scope. In open rhinoplasty, a small additional incision is made on the columella between the nostrils. This gives the surgeon a better view of the anatomical structures and allows more complex changes to be carried out particularly precisely. Which technique is the better choice in the individual case is discussed in detail during the consultation and determined individually.

During the operation, the areas of the nose that were planned together beforehand are adjusted. Depending on the initial findings, different structures can be corrected. The nasal dorsum is often straightened, a nasal hump removed or the nose tip refined. Changes to the nasal wings or the base of the nose can also be part of a rhinoplasty. If there are also functional complaints, the nasal septum can be corrected at the same time. This not only improves the outer appearance but often also optimises nasal breathing. All changes are made with the aim of creating a harmonious nose shape that is convincing both aesthetically and functionally.

Once the actual correction is complete, the surgical incisions are carefully closed. Fine sutures are used to support the most inconspicuous healing possible. Depending on the extent of the operation, internal splints or nasal packing may then be inserted. These stabilise the inner structures of the nose and support healing in the first few days. In addition, the nose is usually protected by an external plastic splint or a plaster cast. This fixation helps to stabilise the newly shaped bone and cartilage structures during the first healing phase and to protect them from external influences.

Swelling and bruising occur particularly often after a rhinoplasty around the nose, the cheeks and the eyes. They arise as the body’s natural reaction to the surgical procedure. The most pronounced swelling usually develops within the first few days and then recedes step by step. How pronounced it is depends, among other things, on the surgical method and the individual healing conditions. Cooling, a slightly raised sleeping position and physical rest can – in line with the doctor’s recommendation – help to ease discomfort and support healing.

Many patients find the temporarily restricted nasal breathing one of the biggest adjustments after the operation. The cause is swelling of the mucous membranes and, where applicable, nasal packing or internal splints. During this phase, breathing is often mainly through the mouth. This can lead to a dry mouth or a slight feeling of pressure. As the mucous membranes subside, nasal breathing gradually improves in most cases. Patience is particularly important here, as the inner structures of the nose recover more slowly than externally visible swelling.

Depending on the surgical method, nasal packing is removed again after a short time. The external splint or cast usually stays on the nose for about one to two weeks in order to stabilise the newly shaped structures. Any stitches present are also often removed during a check-up appointment. The exact timing, however, always depends on the individual healing process and the chosen surgical method. After the splint is removed, the nose often still looks swollen. The final result therefore only develops over the further course of healing.

Many people fear severe pain after a nose operation. In fact, however, most patients report a feeling of pressure, tension or blockage rather than pronounced pain. Should pain occur, it can usually be treated well with the medication recommended by the doctor in charge. Taking additional painkillers on your own should be avoided unless this has been expressly agreed. As healing progresses, the feeling of pressure and tension usually eases continuously while the nose recovers step by step.

After the rhinoplasty, check-up appointments take place at regular intervals. The specialist in charge checks the healing process and assesses swelling, wound healing and the development of the nose shape. Depending on the healing phase, the external splint or cast is also removed and the inside of the nose is checked. If necessary, crusts can be carefully removed or the mucous membranes cleaned to support nasal breathing. The check-ups also offer the opportunity to clarify questions and to receive individual recommendations for the further healing phase.

Proper nose care at home also plays an important role. Depending on the surgical method, the doctor in charge recommends suitable ointments, nasal sprays, nasal rinses or other care measures that can support healing.

Gentle handling of the operated nose is particularly important. Crusts should not be removed on your own, as this can injure the delicate mucous membranes. Internal stitches or splints must not be tampered with either. Careful care helps to keep the mucous membranes moist and to support the natural healing process. Which products are suitable in the individual case is explained as part of the aftercare.

So that the nose can heal as undisturbed as possible, some rules of behaviour should be observed in the first weeks.

Important recommendations after a rhinoplasty:

• No sport and no intense physical exertion
• No heavy lifting
• Avoid pressure on the nose
• Open your mouth when sneezing if possible
• Do not blow your nose forcefully
• Avoid saunas and sunbeds for the time being
• Avoid direct sunlight
• Wear glasses only after consulting the doctor in charge

Following this advice helps to reduce swelling and to protect the newly shaped structures of the nose during the healing phase.