Written by Dr. Julian De Silva
Rhinoplasty, more commonly known as a nose reshaping or a nose job, is one of the most commonly performed cosmetic operations that Dr De Silva completes for patients. The most common reasons people seek rhinoplasty is for reshaping of the nose, a high dorsal hump, lack of tip definition, a large or wide size of their nose. Patients may also describe the difficulty of breathing, commonly caused by blockage, deviation of the nasal septum and allergies. The nose is intricate and successful natural looking rhinoplasty requires a combination of meticulous surgical technique and artistry to tailor to each individual person’s facial characteristics.
As the nose forms the very centre of your face it is also is key to facial harmony and balance. Having a nose that is out of place catches our attention when we look at ourselves and people’s faces. This can result in patients feeling self-conscious and over time can affect how we feel about ourselves. Our thoughts about our own appearance can have an important influence over all aspects of our lives. Dr De Silva has helped many thousands of patients by improving their facial balance. After rhinoplasty, your nose can blend with the rest of your face, reducing those feelings of being self-conscious and enabling you to just get on with life. The detail around the nose are of great importance, as subtle changes of even less than half a millimetre can be discernible.
Rhinoplasty is considered technically the most challenging cosmetic surgery of the entire body, a great looking rhinoplasty requires a balance of respect to patient’s genetic make-up, surgical technical excellence and the surgeon’s artistic talent. Dr De Silva has developed a signature rhinoplasty that incorporate his artistry and experience from working in the cosmetic centres of Los Angeles and New York. Dr De Silva customises every rhinoplasty to the patient’s facial characteristics and often combines rhinoplasty with other technology to give the most natural-looking results. For some patients he will use complementary treatments to improve his patients results and enhance their recovery.
Approximately 20% of patients may have facial imbalance with a small chin. This is of important significant to rhinoplasty, as with natural facial balance a smaller chin may give the appearance of a larger nose. Dr De Silva may advise the use of a chin implant to restore balance to make a good result into a fantastic result. At the same time Dr De Silva advises patients only to complete surgery to what they notice and important to themselves.
Nasal hump reduction reduces the size of a nasal hump on the bridge of the nose to make a nose both straighter, smaller and in better proportion to your face.
Nasal tip refinement reduces a large box shape or irregular nasal tip, sometimes referred to as bulbous tip, the nasal tip cartilages are refined and sculpted to give an improved shape and definition.
Asymmetry is a common reason for undergoing rhinoplasty, depending on the degree of asymmetry, graft material may be required to enhance the shape of the nose.
Breathing The septum often requires straightening to ensure good breathing and for some patients graft material to support the airway.
Droopy nasal tip improvement involves lifting the tip of the nose, this is often combined with nasal tip refinement to improve the definition of the nasal tip. The optimal position of the nasal tip is specific to an individual and based upon individual characteristics such as height, ethnicity and gender.
Nasal augmentation to give a more defined nasal bridge and tip, with better balance to the overall nose, often this is in patients who have a small nose or have had a scooped bridge to the nose sometimes called a ski-slope.
Nasal width reduction reduces the width of the nose in relation to your face. A wide nose results from a combination of genetics and ethnic characteristics.
Ethnic rhinoplasty refers to surgery that is tailored towards improving nasal shape and refinement with consideration to a patient’s genetics and ethnicity. The nose is made up of skin, cartilages, soft tissues and bone, all of which have different characteristics based upon your ethnicity.
Revision rhinoplasty aims to correct previous surgery, patients travel long distances to have revision rhinoplasty with Dr De Silva
Combination of factors most rhinoplasty surgery requires a number of modifications of different aspects of your nose to give a well-proportioned and attractive result. For example, although the nasal tip of a patient may be large and predominantly bulbous, once the tip is sculpted and refined, other parts of the nose including the bridge of the nose, the width of the nose all need adjustment to give a shaped and proportioned result.
Refinement rhinoplasty refers to a person who has a relatively good nose, however they would like to make it the best they possibly can. More patients come to see Dr De Silva for refinement particularly in professions with HD photography and filming.
The nose has a central position in the face and is key to both facial balance and harmony. A nose that is out of balance to the face with a nasal hump or large undefined nasal tip or just too large or too small can become the focus attention on a person’s face and detract away from their other attractive facial features such as the eyes. Rhinoplasty surgery is nose-reshaping that involves sculpting and refinement of the nasal cartilages, soft tissues and bone to give better facial balance.
This is a common concern for many patients. Dr De Silva’s philosophy is a natural rejuvenation, where patients look like themselves only better. For most patient’s Dr De Silva completes imaging to give patients an indication of their appearance after surgery. Any change can seem more apparent initially as all of us become used to our appearance and even small changes can take some time to get used to.
With good surgery friends and family members will not be able to tell you have undergone rhinoplasty. Dr De Silva customises his treatments based on your individual facial characteristics, often patients that have substantial rejuvenation are surprised how friends and family have not been able to tell.
Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the nose requires precision and care. Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news and medical conferences.
Most patients are able to return to social and professional activities after one to two weeks. The truth is that recovery after rhinoplasty does depend on several factors.
1-week after rhinoplasty 80% of the swelling will have resolved. When the cast over the bridge of your nose is removed after one week, although you will see a change in the shape of your nose there will some swelling. Although the swelling will continue to resolve, the fine detail can be hidden with swelling for some weeks. By about 3-months, the majority of the swelling will have resolved however it can take as long as a year for the final shape to become apparent.
Most patients have minimal bruising that resolves over 1-2 weeks. Occasionally, less than 20% of the time, there can be a marked bruise immediately below the eyes where the skin is very thin, this bruising can take 6-weeks to go, though it can be covered with make up after 1-week.
Immediately after rhinoplasty your nose may feel blocked as a result of swelling of the inner lining of the nose, this will improve at the end of the first week. In addition, swelling can alter your sense of smell and this returns over the first 4-6 weeks.
There is often numbness at the tip of the nose after rhinoplasty, so your nose will not feel like your own. This improves over the first 6 weeks. It is common for rhinoplasty patients to report that their upper lip feels stiff and that their smile feels different, and this improves over a period of weeks as the swelling subsides.
In terms of pain, there is surprisingly little, and usually for less than 24 hours. Oral analgesia is adequate for the first day after surgery, and many of our patients never take any analgesia.
Some patients are sensitive to dryness after rhinoplasty, and in addition to avoiding dry environments after surgery, using a saline spray (salt water) and ointment into your nose several times a day will help with symptoms of dryness.
The position and shape of the scar is hidden under the nose, they reach their final endpoint 6-12 months later. They are discrete and difficult to see after a few weeks, there are steps that can be taken to speed up their recovery and soften their appearance. One week after surgery they can be covered with concealer makeup so they cannot be seen.
Most can be restarted after 1-2 weeks, there may be some residual bruising and swelling, generally this can be covered up with concealer. On average, at 2-weeks after surgery, 80-90% of the appearance of the nose will have resolved. An important event such as your own wedding, you should allow 6-weeks as a minimum to allow the majority of the swelling to have resolved.
As a general rule three weeks. Contact sports or racket sports should be avoided for longer to allow the nasal bones to heal. Often the tip of the nose can temporarily swell during exercise for several months after rhinoplasty.
Reading, computer work and other low-level activities can be started after the surgery and will not affect healing. They are not the same as lifting or strenuous activities that increase blood pressure which have the potential to increase swelling and increase the risk of nose bleeds. Many patients are concerned that they will do something to harm their result. It is true that a major knock on the nose can cause prolong healing, otherwise there are not many things you can do to really harm the result.
If you have any medical conditions like diabetes or high blood pressure these should be well controlled before surgery. Smoking delays healing therefore avoiding smoking both before and after surgery will speed up your recovery and improve the results. Two people having identical surgery will not heal in the same time, we all heal differently. Another factor is your mental attitude, cosmetic surgery can be an emotional experience for some patients, and having a positive mental attitude goes a long way towards a faster recovery.
Rhinoplasty is commonly completed in a general hospital with other surgical procedures in a general private hospital. Patients often are concerned around issues with general hospitals such as MRSA and hospital acquired infection. Dr De Silva has built a custom state of the art facility including private operating theatre to enable complete specialisation for every patient.
Nose reshaping takes two and a half hours on average to complete depending on the complexity of the surgery and additional techniques such as chin augmentation. Dr De Silva spends additional time to complete surgery for his patients as the nose is intricate and all the surgery is millimetres. Although the surgery can be completed in just one hour, it is not possible to complete the same amount in lesser time, Dr De Silva believes that it is better to take additional time and make the result as good as possible that look to complete a further revision at a future date.
Rhinoplasty is commonly completed in a general hospital with other surgical procedures in a general private hospital. Patients often are concerned around issues with general hospitals such as MRSA and hospital acquired infection. Dr De Silva has built a custom state of the art facility including private operating theatre to enable complete specialisation for every patient.
Dr De Silva and his team have developed a specialised form of advanced sedation anaesthesia for our rhinoplasty patients. This technique is safer that general anaesthesia, with a faster recovery and avoids the side effects associated with general anaesthesia. The recovery after a nose job with this twilight sedation technique is usually thirty minutes and all patients are able to leave the facility within one hour after surgery. Approximately twenty percent of all our patients have undergone previous general anaesthesia and they overwhelmingly prefer the experience of twilight sedation anaesthesia.
Dr De Silva has a large number of patients that live overseas. Our specialist team can help you organise a virtual consultation and coordinate your trip to the UK. We are able to utilise the latest technology to enhance your recovery including oxygen therapy and regenerative medicine.
At our specialist facility on Harley Street we have a private entrance for VIP patients, please notify us in advance of your specific requirements.
For patients whose profession involves high definition cameras it is important to modify surgery to enhance recovery. A common concern is looking different, with Dr De Silva’s natural-looking techniques, most patients find that friends and family were not able to tell they had undergone surgery. Dr De Silva may recommend additional techniques and advancements to enhance your recovery after nose reshaping based on your specific requirements.
Many of our patients are very nervous and have not undergone previous surgery. We take a great deal of time to ensure we provide both emotional support before and after surgery. Our aim is to provide the best possible experience and to foster a long-term relationship with our patients to provide ongoing care for years to come. Please read about some of the glowing patient experiences with us.
Some of Dr De Silva’s patients recorded on video their recovery experience in the form of a video diary. Please watch one or more of these true patient experiences if you would like to understand more healing and recovery after rhinoplasty.
Most patient’s recovery after nose reshaping is rapid and patients return to normal activities after a couple of weeks. Everything in life including surgery is an emotional experience and for some patients the recovery may be longer. We have a supportive and empathetic team that will continue to guide every patient through their recovery.
Most patients who look to undergo nose reshaping have felt self-conscious about their nose for many years before attending consultation. A nose that is out of balance with your face often becomes apparent in teenage years, though many patients take years to look into changing their nose. Rhinoplasty is most commonly completed in patients aged twenty to forty-five, and Dr De Silva has completed surgery for some teenager sand patients in their 80s. Dr De Silva has had patients travel long distances and internationally for opinions on their nose, sometimes they have been refused surgery by local surgeons.
Often there may be additional factors to consider with increasing age, these can include breathing issues, drooping tip (termed ptosis) and increase irregularity, and these may require additional treatments at the same time to ensure a successful result.
Dr De Silva has an avid perception for detail and utilises additional surgical techniques to enhance natural looking and longer lasting results. Dr De Silva specialises in all facial treatments (surgical and non-surgical) and evaluates your = face as a whole. Key considerations include position of nose relative to your chin and jaw line. Dr De Silva utilizes additional techniques and advanced technology including:
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When you attend a consultation, the surgeon will take a detailed medical history and examination of your nose. As a specialist in all facial plastic procedures, Dr De Silva will look at your face as a whole as all parts of the face lie in relative balance. Dr De Silva requests patients bring photographs of noses they particularly like if they feel this is a useful point for discussion.
A detailed examination of the nose and your face is important. Other important factors are breathing and evaluation of the inside of your nose including a 3D scope to assess septum and allergies. For most patients Dr De Silva uses computer imaging to give a visual representation of the results of nose reshaping surgery. A discussion of your goals and expectations of any prospective surgery. For some patients, Dr De Silva may advise against surgery and non-surgical treatments if in a patient’s best interest. Dr De Silva and his nursing team sees all patients a second time before surgery to discuss your procedure in further detail, inform patients of measures you can take to enhance recovery and provide detail regarding the recovery period. We recommend that you write a list of questions to ensure that you have covered all of your concerns.
Rhinoplasty is regarded as the most complex of all cosmetic surgery procedures and requires in depth knowledge of the anatomy and attention to detail. One of the most important factors responsible for the success of surgery is the surgeon. In Dr De Silva’s hands complications are uncommon, swelling and bruising are the most common aspects of recovery. Pain or discomfort is uncommon and resolves within 24-hours. Infection is very rare, and the gold standard is prophylactic antibiotics to protect against infection. Dr De Silva avoids the side effects of general anaesthetic (deep vein thrombosis and allergies) by using safer sedation anaesthesia. Two rare and serious complications are requiring a revision surgery and reduction in breathing. Dr De Silva takes multiple levels of precautions to avoid these issues in the first place. The nose has an intricate anatomy of millimetres, a facial cosmetic surgeon specialising in this area of the face is best suited to ensure a smooth journey and successful result. Although there is no surgeon completing rhinoplasty that has no revision cases, measures can be taken to make these rare by using the most advanced techniques. Over thirty percent of Dr De Silva’s patients have had surgery elsewhere.
Although there are individual factors that influence duration, most rhinoplasty surgery will last lifelong. Dr De Silva often utilises additional techniques including graft material and filler techniques to enhance the duration of the result. There is a small subset of rhinoplasty patients that are looking for perfection in which case every ten years they have a surgery to further refine their nose.
Choosing the surgeon for your nose surgery is one of the most important decisions you will make.
Key considerations in this choice:
An important choice in selecting the right surgeon is to look for a specialist in facial cosmetic surgery. As our understanding of the human body has evolved, surgeons have become more specialised it is difficult for a general plastic surgery to have knowledge in all parts of the body. Dr De Silva is a World-renowned specialist oculo-facial plastic surgeon who focuses only on the face and has an extensive background of experience to give you a safe and successful outcome.
Cosmetic surgery is a different branch of medicine to reconstructive plastic surgery. Cosmetic surgery focuses on natural rejuvenation hiding scars and discretion. Although Dr De Silva trained at London hospitals, he went onto complete specialised cosmetic experience in Los Angeles and New York.
Rhinoplasty is a surgery of millimetres and most refinements are measured to the nearest half a millimetre. Seeing a surgeon who specialises in the entire face is important, as the nose exists in balance with face. A nose job can be completed with sixty minutes however the result will not be the same as a surgeon who completes the surgery in two and half hours
Unfortunately, nose reshaping surgery can be completed incorrectly and require revision surgeon. Select a surgeon specialising in this surgery. Dr De Silva treats revision rhinoplasty patients from all over the world.
No two people have the same nose. The best surgeons are also artists who are able to modify their technique to give every patient the best possible result. Dr De Silva is an artist and sculptor and uses his knowledge of the human face for each individual patient.
Chose to have surgery in a facility that does not treat the entire body or general surgery to avoid hospital acquired issues such as infections. Dr De Silva completes surgery in a World Class facility that was custom built for facial cosmetic surgery.
It is key that you feel comfortable with the surgeon and that they will be there for you after the procedure.
Key with rhinoplasty is minimizing scars. Dr De Silva hides scars inside the nose or at the lower aspect of the nose to ensure they are discrete and difficult to see. With modern techniques scars can largely camouflaged on the inside of the nose or natural creases. Dr De Silva uses advanced techniques to hide scars including multiple levels of stiches, material and number of stitches.
Dr De Silva frequently combines rhinoplasty with other facial procedures to give a natural looking result and avoid the use of scars associated with conventional techniques:
A non-surgical rhinoplasty utilises a filler material to alter the shape and position of the nose thereby avoiding surgery. The principal advantage of the technique is that it avoids a surgical procedure, however by definition the treatment is not permanent. A non-surgical nose job can be effectively used to correct specific nasal appearances: a nose with a small hump, nose that has a depression or irregularity along the bridge, very mild droopy. A non-surgical nose job can be used to improve certain features of a patient’s nose, who is not yet ready for a surgical rhinoplasty. Filler can also be sometimes used to smoothen a minor contour irregularity following previous rhinoplasty.
Caution is required in non-surgical rhinoplasty, as the nose is an intricate structure with important anatomy that can be damaged with filler techniques. There are important blood vessels in the nose that need to be avoided with non-surgical rhinoplasty as the implications for damage to these vessels include scarring of the skin (termed necrosis), damage to vision (even blindness) and scarring making surgical rhinoplasty more challenging. For these reasons it is important that non-surgical rhinoplasty should be performed by a clinician who is familiar with the underlying anatomy. Caution is also required to ensure a sterile environment is used to maximise rapid recovery and reduce the risk of infection. The most common filler used is a type of hyaluronic acid that naturally dissipates, most results typically last up for over one year.
Dr De Silva is able to offer patient’s non-surgical or surgical rhinoplasty based on their individual needs and expectations from surgery. Most practitioners are only able to offer one or the other.
Dr De Silva sees many younger patients for nose shaping in their teenage years. Many of these patients have disliked the appearance of their nose for many years before attending a consultation, and some have associated breathing issues and have been teased about their appearance. Of key importance before considering rhinoplasty is the patient understands the implications of surgery, recovery, and expectations. Utilising modern surgical techniques are important to ensure a long-lasting natural result. Dr De Silva completes nose reshaping on younger patients only when it is in their best interest and some patients travel long distances to London.
All these patients underwent rhinoplasty with Dr De Silva. We encourage patients to watch one or two videos of patient experiences to have a good understanding of healing and the recovery period. Dr De Silva and his team will provide support and reassurance during your recovery, we believe that being a well-informed patient is helpful to most patients undergoing rhinoplasty.
Dr De Silva has published over 30 journal and book chapters in peer reviewed journals and several randomised control research studies, regarded as the gold standard in medical research. Dr De Silva published a Complete Guide to Rhinoplasty and Nose Reshaping in 2017.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and pioneered use of regenerative medicine in Natural Looking Results
Copyright © 2020 Dr. Julian De Silva
