Facial Surgery

Male Rhinoplasty

Balancing the Face

The nose takes pride of place in the middle of our faces, dominating the appearance from front and side views. It lies directly between our eyes and is often the focus of attention as our eyes flit from one side of a person’s face to the other during conversation. A coarse or prominent nose may overshadow a naturally handsome face. The nose enjoys a disproportionate degree of influence on our appearance and, whether we like it or not, we all subconsciously compare differing proportions of the nose to other facial reference points when deciding on the attractiveness of a person. Nasal surgery is most often requested for nasal refinement or reduction and only rarely for nasal augmentation.

The male nose has a higher radix, greater dorsal projection and a more acute columello-labial angle. The male rhinoplasty should respect these factors.

Reduction rhinoplasty is always performed under general anaesthetic and can be performed through a variety of techniques. Mr McDiarmid uses the open approach (with internal nostril scars and a small scar across the columella) almost every time as he feels that the degree of predictability of outcome is far greater. He also feels that the excellent exposure of the anatomy that this approach offers, combined with the ability to add subtle cartilage grafts and cartilage shaping manoeuvres, can provide a dramatic improvement in nasal tip definition and fine tune the ultimate result.

Rhinoplasty Options

Open or Closed Rhinoplasty

The patient is first ‘set-up’ for the surgery by infiltrating local anaesthetic and adrenaline into the soft tissues, positioning the operating table with a head-up tilt and hypotensive anaesthesia. The tip cartilages are first dissected from the overlying skin exposing their shape and configuration. Next the nasal dorsum is exposed and inspected. The hump is then removed and the nasal bones mobilized by osteotomy. The septum is exposed if necessary and straightened if deviated. Usually non-structural (non load bearing) septal cartilage is harvested and used as grafts (spreaders grafts, columellar strut and lateral crural strut grafts). These grafts are then delicately sutured in place with precise tolerance and the skin closed once the optimal cartilage configuration has been attained. Occasionally it is necessary to reduce the size of the nostrils and nostril reduction is performed through a small incision in the crease around the ala of the nose, which usually leaves an imperceptible incision. A vaseline-gauze pack is placed loosely in each nostril and a plaster of Paris splint is placed over the nasal bones to keep them in place.

Augmentation Rhinoplasty

Augmentation Rhinoplasty or building up of a flat, depressed nose, is a particularly challenging undertaking. Mr McDiarmid performs this procedure under general anaesthesia and prefers to use a combination of morsellised auricular cartilage and temporal fascia. In some cases, cantilevered iliac crest (hip) bone graft can be the ideal material of choice for this purpose. Nasal implants are occasionally useful for subtle improvements. Rhinoplasty is first performed to move the remaining nasal structures into a better position, then the tissue chosen for augmentation is harvested from its donor site and inserted into the nose in the ideal measure.

The Relationship Between the Nose and the Face

The nose does not live in isolation from the face and occasionally the main reference points by which we judge the size and shape of a nose may also need to be adjusted to achieve a harmonious appearance. These key subconscious reference points are the chin, the premaxilla (and anterior nasal spine) and the brow. 

Sometimes a weak chin can make a normally proportioned nose look bigger and in many cases the chin should be addressed at the same time as rhinoplasty. Different styles and sizes of Implantec implants can be used depending on the degree of retrusion, age and gender of the patient. These solid silicone implants can generally be left in place permanently.

First Steps?

Your Consultation

Your first step is to book a consultion with one of our experienced plastic surgeons. On your first visit, your surgeon will listen to what procedure you are interested in undertaking and will answer your questions. Your surgeon will explain the alternatives that are available to you in order to achieve the result you desire.

Should you decide to proceed, our Patient Coordinator will then be able to provide you with a price and date for surgery, with options to personalise your stay.

You will be provided will practical information about what you will need to know about before, during and after the operation. Your surgeon will be available to discuss any queries you have prior to surgery.

On the Day?

Your Surgery

On arrival, you will be greeted by one of our team and taken up to your ward room. This is where you will be based during your stay with us.

You will meet your surgeon and your anaesthetist on the morning of your operation. Your surgeon will mark up the surgery area and take photographs of this. Incisions are made within the nostrils and sometimes across the bridge of skin between the nostrils (open rhinoplasty). This provides access to the cartilages and nasal septum as well as the nasal bones. Under direct vision, these structures can be reshaped to reharmonises the nasal appearance and the skin de-fatted, re-draped and resected if there is an excess. Occasionally cartilage may need to be harvested from the ear or rib. A splint and a nasal pack are placed at the end of the procedure.

Depending on the extent of the procedure, your rhinoplasty will take between 1 to 2.5 hours and is always performed under general anaesthesia. 

And Afterwards?

Your Recovery

You will stay on the ward for one night and are discharged the following day, after the removal of the nasal pack. You will need to attend a follow-up consultation approximately a week after surgery for an intial check up and to remove stitches and cast.

Depending on the extent of the surgery, you will need to remain off work for between one to two weeks and to refrain from exercise for the first two weeks. The nose should look markedly better immediately after the cast is removed, but more subtle improvement will continue for 24 to 30 months.