Rhinoplasty and nasal reconstruction

Rhinoplasty changes the framework of the nose — the external structure of bone and cartilage. It is done for breathing problems as well as for appearance, and the two goals are usually intertwined: rebuilding the structure of the nose is how weak sidewalls or a collapsing nasal valve are corrected. Septoplasty is narrower: it straightens the septum, the midline wall between the two sides of the nose. Both can be done ‘open’ or ‘closed’. Rhinoplasty is most often an open operation, through a small incision in the skin of the columella between the nostrils; septoplasty is traditionally done through an incision inside the nostril, but it is very commonly performed open when part of the septum has to be completely replaced. Conversely, some rhinoplasties can be done entirely through the nostrils.

When the surgery has a functional component, yes. Medicare item 45641 covers total rhinoplasty where the indication is either airway obstruction with a self-reported NOSE Scale score greater than 45, or a significant acquired, congenital or developmental deformity, with photographic and/or NOSE Scale evidence documented in the notes (MBS item 45641). With a Medicare item number, private health insurance covers the hospital costs, and Medicare and the fund contribute towards the surgeon’s and anaesthetist’s fees. Be aware that for most rhinoplasty patients there is still a substantial gap for the surgeon’s fee; your surgeon’s rooms will give you a written quote before you decide.

Yes — and rhinoplasty almost never has only one goal. For most patients it is a mix of the two, and even when the aim is purely aesthetic, a great deal of care goes into preserving or improving the nasal airway as part of the operation.

The short answer: a cast on the nose for about two weeks. When it comes off, the swelling has usually settled enough to return to social and professional life, and most people are back to exercise at around two weeks. The long answer: full recovery takes about twelve months. Early on the nose is swollen and lacks definition, and the skin needs time to shrink down over the new framework. By three months there is usually a dramatic improvement in shape, the nose begins to feel softer and sensation returns; subtle refinement continues out to a year or more. For that reason rhinoplasty patients are followed up for a year.

Nasal reconstruction — open nasal reconstruction, or open septorhinoplasty — is an operation to rebuild the framework of the nose, the approach known as structural rhinoplasty. Surgeons who practise this style of surgery can rebuild almost any nose: however badly the underlying bone and cartilage have been deformed by injury, previous surgery or disease, there is usually a way to recreate them, using cartilage from the septum, ear or rib. The real limiting factor is the lining, inside and out. If the inside of the nose has been heavily damaged by recreational drugs, trauma or disease, or the skin on the outside has been affected by previous surgery, radiotherapy or other conditions, reconstruction becomes much harder. The structure can almost always be rebuilt; missing lining — mucosa inside or skin outside — is the challenge.