While the shape of your child's nose is usually the result of heredity, the appearance may have been altered in an injury or during prior surgery. Also known as rhinoplasty, surgery of the nose improves the appearance and proportion of your nose, enhancing facial harmony and self-confidence. Surgery of the nose may also correct impaired breathing caused by structural abnormalities in the nose.

What can surgery of the nose accomplish?

Rhinoplasty can change:

• Nose size, in relation to the other facial structures
• Nose width, at the bridge
• Nose profile, with visible humps or depressions on the bridge
• Nasal tip, that is large or bulbous, drooping, or too upturned
• Nostrils that are large, wide or upturned
• Nasal asymmetry and deviation

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another minor surgery may be necessary to reach the intended aesthetic goal.

Preparing for surgery

Prior to surgery, your child may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust current medications
  
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

• What to do on the night before and the morning of surgery
• The use of anaesthesia during your nose surgery
• Post- operative care and follow up

Important facts about the safety and risks of nose surgery

Your surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure your child will undergo and any risks or potential complications.

The risks include:

• Rupture of small surface vessels of the nose
• Infection
• Poor wound healing
• Anaesthesia risks
• Bleeding (hematoma)
• Nose asymmetry
• Cardiac and pulmonary complications can occur in longer surgical procedures and may be associated with the formation of, or increase in, blood clots in the venous system
• Change in skin sensation (numbness)
• Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose
• Nasal septal perforation (a hole in the nasal septum) may develop but is rare; additional surgical treatment may be necessary to repair the nasal septum but in some cases, it may be impossible to correct this complication
• Pain, which may persist
• Unfavourable scarring
• Skin contour irregularities
• Skin discoloration and swelling
• Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
• Possibility of revisional surgery

Be sure to ask questions: It’s very important to ask your surgeon questions about your child's nose procedure. It’s natural to feel some anxiety, so don’t be shy about discussing these feelings with your surgeon.

When you go home

If your child experiences shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you child may require hospitalization and additional treatment.

Be careful

Following your surgeon’s instructions is key to the success of your child's surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your surgeon will give you specific instructions on how to care for your child.

Recovery

After the procedure is completed, a splint, internal tubes or packing will likely be placed inside your child's nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.

You will be given specific instructions that may include: How to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your child's general health, and when to follow up with your surgeon.

Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period.

• Where will my child be taken after my surgery is complete?
• What medication will my child be given or prescribed after surgery?
• Will my child have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can my child resume normal activity and exercise?
• When do we return for follow-up care?

The results will be long-lasting

It may take several months for swelling to fully dissipate and up to a year – and sometimes longer – for the outcome of the surgery to fully refine.

Although the results of nose surgery are usually permanent, cartilage may continue to reshape and move tissue that may change the outcome over time.

What happens during nose surgery

Step 1 – Anaesthesia

Medications are administered for your child's comfort during the surgical procedure. The procedure will be under a general anaesthestic.

Step 2 – The incision

Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

Step 3 – Reshaping the nose structure

Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body.

Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, is used for this purpose.

Occasionally a piece of cartilage from the ear and rarely a section of rib cartilage can be used.

Step 4 – Correcting a deviated septum

If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.

Step 5 – Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is re-draped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Step 6 – See the results

Splints and internal tubes will likely support the nose as it begins to heal for approximately one week.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine.

During this time you may notice gradual changes in the appearance of your child's nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following nose surgery.

Nose surgery to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.