An expertly performed rhinoplasty can improve multiple cosmetic aspects of the nose. It can also fix problems with the septum and other nasal structures. A/Prof Damian Marucci, a Sydney rhinoplasty surgeon serving Miranda, Kogarah and the surrounding areas, has helped many people enjoy greater happiness, self-confidence and breathing function, thanks to cosmetic nose surgery.

Dr. Marucci answers the most commonly asked rhinoplasty questions here.

What are the signs and symptoms of a broken nose?

​The nasal bones occupy the upper third of the nose, and the lower two-thirds are cartilage. Nasal bone fractures are the most common facial bone fracture. The cause is most commonly direct force to the nose area. Although the cause of this direct trauma will vary in differing communities, among the patients Dr. Marucci sees the most common causes are falls, motor vehicle accidents, sports injuries and interpersonal violence.

Patients with nasal bone fractures present with a history of trauma. There is often significant swelling of the nose and sometimes a visible deformity or deviation of the nose. Bleeding from the nose (epistaxis) is common. The area is tender and nasal breathing may be difficult. It is important that your doctor looks inside the nose to assess for bleeding around the nasal septum (the cartilage sheet that separates the two nostrils from each other). A “septal haematoma” needs to be drained in order to prevent perforation and later nasal collapse.

Special investigations usually aren’t needed for someone with an obviously broken nose. A CT scan may be ordered in order to assess the extent of the injury and to exclude fractures of other facial bones.

Nasal bone fractures with deviation need to be treated with a “closed reduction.” Dr. Marucci performs this procedure under general anaesthesia in the operating theatre. The nasal bones are straightened, as is the septum if needs be. A splint is applied to the outside of the nose to protect it as it heals, and packing may be placed on the inside of the nose. This is day surgery and the splint is removed a week later.

Many patients don’t have their traumatic nasal bone deviation treated within the 10 day window and end up with a permanent nasal deformity. This may require a rhinoplasty, where the cartilage and bones of the nose are reshaped.

Does the nose change with age?

Every part of your body ages, including the nose. Although major changes in nasal shape are uncommon after puberty, it is not uncommon to see some drooping of the nasal tip and wrinkles in the skin.

Is “non-surgical rhinoplasty” a thing, and does it work?

Non-surgical rhinoplasty, or the practice of using dermal fillers and injectables to reshape the nose, has gained popularity in recent years, partly due to the increased number of health care professionals performing dermal filler and anti-wrinkle injections. Although it sounds very attractive — a rhinoplasty without surgery — in fact the potential applications are limited.

Dr. Marucci uses dermal fillers as an adjunct to normal surgical rhinoplasty, to augment any areas that require it and to smooth out any minor blemishes. For the majority of patients seeking rhinoplasty in Sydney, dermal fillers on their own are not an alternative to surgery.​

What is a tip rhinoplasty?

​There are different components to every rhinoplasty. Every nose is different and different noses need different procedures. A “tip rhinoplasty” refers to a surgical procedure which aims to modify the all-important lower third of the nose: the nasal tip. This is most commonly performed with the “open” technique through a small incision underneath the nose and several incisions on the inside of the nostrils. The cartilages that make up the tip of the nose are exposed and manipulated.

Although every tip rhinoplasty is different, the most common manoeuvres performed include the following:

• removal of the upper part of the ala cartilage (a “cephalic trim”)
• insertion of a graft of cartilage to support the tip of the nose (a “columellar strut”)
• placement of sutures to define the two domes of the nose where the cartilage bends near the midline (“tip defining sutures”)
• placement of sutures to reduce the nasal tip’s width

Swelling after a rhinoplasty takes a while to settle and tends to subside from the top down, meaning that tip swelling is the last thing to go. It won’t be possible to see the improvements to the nasal tip until the swelling has subsided.

Also, the tip of the nose will be numb after surgery and sensation can take a while to return.

Can cocaine-related nasal cartilage holes or nasal collapse be treated?

Cocaine causes the small blood vessels in the lining of the nose to constrict and go into spasm. This can lead to the death of the mucosa and, eventually, the underlying cartilage. This may lead to a hole in the septum, causing a communication between the two nostrils.

A hole in the nasal septum (septal perforation) following cocaine use is hard to treat.

Firstly, Sydney rhinoplasty patients must permanently stop using cocaine and cigarettes (which is a difficult undertaking for the addicted patient).

Cocaine-related nasal septal perforations commonly present with crusting, “whistling” during breathing and bleeding. If the hole gets large enough, the whistling disappears. If enough of the septum is destroyed by cocaine, the nose will collapse and there will be no cartilage left to support the lower two-thirds of the nose.

Reconstructive surgery for cocaine-related damage is difficult. Small holes can be “plugged,” either with synthetic materials or with local tissues (or flaps), which have been moved around. If the nose has collapsed, then a rhinoplasty usually involving cartilage harvested from the rib cage is performed to rebuild the nose. This is a significant surgical undertaking.

When I should cease alcohol before a rhinoplasty?

The answer, in part, depends on how much alcohol you are consuming on a daily basis. Assuming you drink 1 to 2 standard drinks a day, laying off the alcohol for a few days before surgery should be fine.

If your alcohol consumption is at a more dangerous level (more than 2 standard drinks a day)​, not only should you think about cutting down, you may also need to alert your surgeon. Excessive prolonged alcohol intake can affect your liver and ability for your blood to clot during surgery. This in turn may lead to excessive bleeding and bruising.

What is the recovery like after rhinoplasty?

Rhinoplasty is a is relatively low risk  and effective way to reshape your nose, although it will take some time for the swelling to go down and for the final result to be visible.

Dr. Marucci performs rhinoplasty as a “day surgery” procedure. When you go home, you will have a plastic splint over the outside of your nose and some dissolving sutures underneath and inside your nose. If a septoplasty has been performed, you will also have a plastic splint in each nostril. You go home with some painkillers, tablet antibiotics and some nasal spray to use a few times a day.

He asks patients to keep the nose clean and dry until all the dressings and splints are removed at the one-week mark. You should sleep on a few pillows, as this will help with the swelling. Cold packs on the forehead are good for headaches and to stop any oozing from the nose. Try not to bend over too much and take it easy. Do not exercise for a few weeks. Dr. Marucci asks his patients to clean the outside of the nostril with a cotton tip dipped in water.

Swelling and bruising is normal after a rhinoplasty. Although you will be able to see some changes in the shape of your nose when the splints come off at one week, Dr. Marucci advises patients to avoid important social situations for at least 2 weeks after the surgery. Much of this depends on how much “work” had to be done as part of your surgery — the more manipulation/ modifications required, the longer it takes for the swelling to settle. It will take a few months for all the swelling to go and the final result to be visible

Schedule a Rhinoplasty Consultation

To speak with Sydney rhinoplasty surgeon Damian Marucci about your options, please call or email our Miranda or Kogarah offices today.