A rhinoplasty or nose job is an operation to change the appearance and improve the function of the nose. Patients undergo a rhinoplasty for various reasons, be it to correct a deviated septum or a broken nose (functional rhinoplasty), or simply to enhance the appearance of their nose (cosmetic rhinoplasty). Regardless of purpose, most rhinoplasties involve functional and aesthetic elements as form follows function; the function and appearance of the nose are always of concern to patients.
With that said, functional and cosmetic rhinoplasty are umbrella terms to represent the different types of rhinoplasty surgeries available. Let me briefly explain the different types of rhinoplasty surgeries and their purposes.
Types of rhinoplasty surgeries
As its name suggests, reduction rhinoplasty reduces the size of the nose. Patients who opt for this surgery can opt to reduce the overall size of their nose or focus on specific areas that they wish to be smaller, such as the tip or dorsal hump. During a reduction rhinoplasty, resizing is often done by removing cartilage or bone from the nose to achieve the desired size and shape.
During this procedure, the surgeon performs tissue or bone grafting to build up the nasal tip and bridge. In many cases, cartilage is obtained from parts of the nose like the nasal septum, or through synthetics and autologous implants if the patient does not have enough nose tissue.
The nasal structure is a delicate and necessary part of the human anatomy. When the nose sustains an injury, things like broken bones, damaged cartilage and internal deviations can affect this structure, leading to breathing problems. Post-traumatic rhinoplasty addresses these issues together with conditions like septal hematoma, where the nose bridge collapses due to death of the cartilage partition.
Following facial trauma or surgery to remove cancer, the nose may be left severely disfigured due to a large amount of tissue that has been lost or removed. Reconstructive rhinoplasty restores tissue that is absent or damaged beyond repair. This specialised procedure requires the use of flaps and grafts from various parts of the body to restore missing tissues in the nose.
Refinement rhinoplasty is a procedure specially individualised to a patient’s unique facial characteristics. For instance, many patients who undergo a nose job for cosmetic reasons often want to fix their nasal tip. The surgeon will use various tactics to perfect the tip’s shape and direction while ensuring it complements other facial features.
Revision rhinoplasty is for patients who experience difficulty breathing or are dissatisfied with how their nose looks after a prior nose surgery. As the nose has previously already been operated on, form and function must be carefully considered.
Who can perform rhinoplasty surgeries?
In Singapore, rhinoplasty surgeries are commonly performed by plastic surgeons and ENT specialists. An ENT specialist is a medical professional who specialises in the treatment and diagnosis of conditions of the ears, nose and throat. An ENT can perform medical procedures not just related to the ears, nose and throat but also of other related structures of the head and neck.
Many think that nose jobs are limited to just plastic surgeons, but ENT specialists are equally if not more qualified. Given the extensive training ENTs receive in nasal procedures, some ENT specialists have more experience in rhinoplasty under their belts compared to traditional plastic surgeons.
The decision between an ENT specialist and plastic surgeon comes down to a few considerations:
- Is the surgeon qualified to perform this procedure? Does he/she have the necessary credentials?
- Does the surgeon have experience and a good reputation for performing rhinoplasties?
- What are your goals with this rhinoplasty?
If aesthetic is your main concern, then a qualified plastic surgeon can do the job. However, if you are considering rhinoplasty for functional reasons, an ENT specialist is probably the better choice.
Are there any differences in technique?
How an ENT specialist or plastic surgeon performs a rhinoplasty ultimately depends on the patient’s condition and goals, and even the complexity of the surgery.
There are two main approaches to surgical rhinoplasty — endonasal and external. The main difference between these two simply lies on where surgical incisions are made. All incisions made for the endonasal approach are inside of the nostrils, while incisions made for the external approach are outside the nostrils.
An external approach may involve visible scarring, but this technique may be more versatile, accurate and effective as the surgeon has complete visibility while working on the nose.
However, do take note that not all ENT specialists perform rhinoplasties routinely. Some may prefer to focus on the treatment of conditions and diseases and thus may not have adequate experience to successfully perform a rhinoplasty. Thus, it’s important that patients seek a specialist with the right training, background and experience in rhinoplasty surgery.
Halepas, S., Lee, K. C., Castiglione, C., & Ferneini, E. M. (2021). Grafting in Modern Rhinoplasty. Oral and maxillofacial surgery clinics of North America, 33(1), 61–69. https://doi.org/10.1016/j.coms.2020.09.003
Lee, L. N., Quatela, O., & Bhattacharyya, N. (2019). The epidemiology of autologous tissue grafting in primary and revision rhinoplasty. The Laryngoscope, 129(7), 1549–1553. https://doi.org/10.1002/lary.27551