The key to successful treatment of skin cancers over areas of the nose is complete excision of the tumour with a clear margin. This often leaves a defect that cannot be closed primarily. The skin overlying the nose can be quite tight and after excision of skin cancers of the nose, the resulting defect or deformity can often be reconstructed with local flaps such as bilobed flaps or mitre flaps or forehead flaps. Skin flaps are raised to mobilise skin from the adjacent areas of the cheek, lip or even forehead to provide durable skin cover after cancer excision.

The nasal bones are the commonly fractured bones in the face. This is often as a result of road traffic accidents, accidental falls or from altercations. The severity of the injuries to the nose can also vary from simple contusions to complex fractures. If the fracture is treated early (within 2 weeks), a simple manipulation and reduction of the nasal fracture can be done to correct the nasal fracture. If there is persistent deformity, an open rhinoplasty and/or septoplasty may be needed to correct the deviated nose and improve nasal function.

In the early period after a nasal fracture (less than 2 weeks), a minor procedure called a manipulation and reduction (M&R) of nasal fracture can be done to re-align the nasal bones and central nasal septum. This is a closed procedure where there will be no incisions made and the bones and septum are manipulated back to their original location and held in place by nasal packing and splints. There is a chance of persistent deformity despite manipulation and reduction. If the deformity persists, then a definitive rhinoplasty may be required.

With the aid of sophisticated 3D imaging computer software, we are able to simulate the surgery to allow patients a preview of how the surgery may change their nose and appearance. 

Reconstructive rhinoplasty is usually covered by most health insurance plans, although coverage varies according to the policy. When rhinoplasty is performed to improve breathing function, it is considered reconstructive and may be covered by insurance. This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

Immediately after the surgery, a splint may be placed on the outside to support and protect the new structures during initial healing. If required, nasal packing may be placed inside your nose and you will be unable to breathe through your nose during this period. 

Sutures on the nose will be removed after 5 to 7 days. For the sutures over other areas, such as the scalp or back of the ear, these may be removed after 10 to 14 days.

While the initial swelling may subside within 1 to 2 months, 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 nose as it refines to a more permanent shape. It is common for swelling to come and go and worsen in the morning during the first year following your rhinoplasty surgery.

The results of rhinoplasty surgery are permanent and the best results can be noted after 1-2 years when the swelling has subsided completely. As we age, it is natural to have some gradual changes to our faces, including our noses. A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Our plastic surgeon will explain in detail the risks associated with surgery. Rhinoplasty surgery risks include:

• Infection
• Bleeding, haematoma and swelling
• Surgical scars. Whilst the surgical scars are usually well concealed and heal well, there are occasions when it may scar.
• Nasal septal perforation (a hole in the nasal septum) is rare.
• Difficulty breathing
• Unsatisfactory nasal appearance
• Change in skin sensation (numbness or pain)
• Skin discoloration and swelling
• Possibility of revisional surgery
• In the event when there is rib harvest, there is a possibility of pneumothorax.
• Anaesthesia risks

Rhinoplasty surgery involves many choices and there are also many different techniques. The first and most crucial step is to select a certified surgeon you can trust. 

During the consultation with your surgeon, be prepared to discuss:

• The goals of your surgery, with regard to both appearance and breathing
• Medical conditions or previous nasal trauma, drug allergies and previous surgeries
• Current medications, vitamins, herbal supplements, alcohol, tobacco. The use of certain health supplements may increase the risk of bleeding and prolong healing. Please check with your surgeons on the impact of these medications. 

It's very important to understand all aspects of your rhinoplasty procedure. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon.