Frequent Questions:

The upper third of the nose consists of bony structures, while the lower two thirds are made up of cartilaginous structures. The immovable nasal bone forms the basic supporting framework in the upper third. The cartilaginous part of the nasal bridge, which consists of the upper edge of the nasal septum and two triangular cartilages on either side (Upper lateral cartilages), is attached to the nasal bones on the upper end.  The arch-shaped lower lateral cartilages shape and stabilize the tip of the nose. The nasal septum forms the central support element of the nose and consists of cartilage and bone.

Nasal surgery has undergone rapid advances in recent years. Technological improvements, such as the use of ultrasonic scalpels, and the ability to preserve the nasal bridge have led to refined surgical techniques that enable individualized and natural solutions. In the past, most surgeries aimed to achieve changes in nasal shape by removing tissue. These operations were usually performed using a closed approach. However, removing tissue can compromise the stability of the nose, leading to unsatisfactory functional and aesthetic results. Therefore, a paradigm-shift in modern nasal correction has taken place. The surgical goal now is to anticipate potential long-term problems and prevent unsightly results from developing during the surgery. Taking into account the individual appearance of the nose, the structures of the nose are reshaped to maintain the stability of the support-structure, which is essential for achieving stable and pleasing long-term results.

A functional-aesthetic septorhinoplasty is performed under general anesthesia and as an outpatient procedure. The operation is usually carried out through the nostrils and through an incision on the nasal columella (open technique).

The extent of correction of the external nose depends on the individual deformity. Therefore, we discuss the surgical procedure with you based on images before the operation. The surgical procedure always includes the correction of the deformity of the internal nose, which involves straightening of the septum and surgery of  the lower nasal turbinates. The septum also serves as a „tool box“ for reconstructive purposes as cartilage can be taken from the nasal septum as material for cartilage transplants in the area of the external nose. In case of re-operations, it may be necessary to obtain cartilage from the ear or rib because no cartilage is left in the septum. Dissection under the skin is always necessary for the correction of cartilage and bone in the area of the external nose. In the case of the open approach, the skin is opened at the thinnest point in the area of the nasal columella and minutely closed at the end of the operation. The advantage of open approach is the significantly better overview of the surgical field and the possibility of direct visualization and fixation of bony or cartilageonous parts, which increases the safety of the postoperative result. Nowadays, bone correction is performed using the ultrasonic scalpel (Piezo), allowing for gentle, minimally invasive correction that can be tailored to the individual needs of the patient.

At the end of the operation, thin silicone splints are sutured to the nasal septum to prevent the formation of a hematoma and keep the septum straight. A soft plastic splint is applied to the nasal bridge. These structures remain in place for 7-10 days and are then removed in the clinic.

Unfortunately, there is no guarantee that the nose will look exactly as the patient imagines. Many factors can influence the final result, especially asymmetric scarring during the healing process, which cannot be controlled. The nose, even when optimally operated, will show swelling at during the first days and this may move newly positioned structures. Therefore, there can be no two identical noses, even if operated on by the same surgeon. It is similar to the process of baking: there are no two identical muffins or loaves of bread, even though they are made from the same dough and come from the same oven. This means that there can be no complete match between the photos brought by the patient and the final result. Additionally, anatomical prerequisites are different for each patient.

Packing is only needed in exceptional cases, typically only thin silicone sheets are used, and a splint is placed on the outer nose for about 7-10 days.

Patients report a “feeling like I am coming down with a cold” similar to having a stuffy nose in the first week after the surgery, and severe pain is rarely described.

Light physical activities can be resumed after about 3 weeks, and contact sports can be resumed after about 8 weeks. Sun exposure can lead to increased pigmentation or redness of the skin, and higher temperatures can lead to additional swelling, which can slow down the healing process. Therefore, after the operation, care should be taken to avoid strong exposure to the sun.

Healing is individual for each patient and depends on the thickness of the skin and any previous surgeries that may slow down the healing process. Normally, the final result is achieved after about 1-2 years.

If you decide to have a rhinoplasty, we will call you to arrange an appointment. During this call, we will also arrange an appointment for a detailed consultation with Prof. Gößler and a date for an anesthesia consultation. We will call you again shortly before the operation to give you the exact time of the operation.

A brief conversation with Prof. Gößler is usually possible immediately before the operation. After the operation, you will spend 1-2 hours in the recovery room until you are fully awake. Then you can be discharged home. The day after the operation, there will be a brief follow-up appointment where the nose is checked upon to ensure that the postoperative findings are normal. The splints in the nose and on the outer nose are removed after about a week. All stitches are resorbable, so there is no need for removal.

After the surgery, there can be swelling and bruising of the face. The intensity of these effects varies depending on individual predisposition and the extent and duration of the operation, especially when there is significant alteration of the nose. Typically, they reach their peak after 2-3 days and gradually subside afterward. Around 2 weeks later, the swelling and bruising have usually receded to the point where they are no longer visible to outsiders, and you can resume social activities with the help of makeup. It should be noted, however, that, albeit rarely, swelling or bruising may persist for a longer period, especially around the eyes.

Use cold packs (from the refrigerator, NOT the freezer!) several times a day during the first 2-3 days and as needed from then on. Afterwards, start with lymphatic drainage.

You can begin facial lymphatic drainage after just a few days. It is done by gently applying pressure with your fingers in a diagonal direction away from the nose over the face. Only a few minutes twice a day can help reduce swelling by expediting the removal of excess tissue fluid.

For individuals with thin skin types, this is generally not necessary. However, people with medium or particularly thick skin types can benefit from temporary nasal taping, preferably at night, for up to 3 months. Taping accelerates the reduction of swelling and reduces the risk of scarring beneath the skin, diminishing the likelihood of permanent thickening or irregularities. The tape can be left in place for 3-4 days and should be removed gently using Q-tips and an alcohol solution. You can receive detailed taping instructions from Prof. Gößler.

The vast majority of patients report mild to moderate pain. Pain medication is taken regularly for 3 days, and these medications also have anti-inflammatory effects that help reduce swelling. Some patients experience minimal pain, while a few may have more intense pain. Most commonly reported sensations include a burning sensation in the nose, pressure in the head, pressure on the teeth and upper jaw, or forehead pain. Sore throat is a common occurrence and is typically caused by the breathing tube used during the surgery, but it usually subsides within a few days.

You can actually start breathing through your nose shortly after waking up from anesthesia because we do not use no nasal. However, during the first week after the surgery, nasal breathing may be temporarily restricted due to swelling and the formation of crusts inside the nose. Additionally, nasal breathing is influenced by the silicone splints that remain in place for about 7 days. After this period, the splints are removed, and this is nearly painless (really!). Following the removal of the splints, nasal breathing significantly improves. Nevertheless, in the subsequent days and weeks, it may be periodically restricted due to the production of mucus and crusts. In such cases, regular care with an ointment and nasal rinses can be helpful.

It is possible to sleep on your back or on your side immediately after the operation as the nose is sufficiently stable. Elevating the upper body slightly can help with tissue fluid drainage and reduce swelling (for approximately 1 week).

Right after the operation, you should gently “pull up” nasal secretions and blood and then spit them out. Gentle blowing, initially through each nostril separately, can begin after about 14 days, while vigorous blowing can resume after 4 weeks.

After a rhinoplasty, the nasal tip may feel noticeably “numb” for several weeks or even months, with reduced sensation. Gentle massages with a facial cream can expedite the recovery process. The sooner you start touching and massaging your nose, the faster it will start feeling normal again.

Temporary numbness of the upper incisor teeth and the soft palate may occur due to injury or irritation of the small sensory nerve called the “Nervus incisivus” at the soft palate. In most cases, this sensation will recover on its own within a few weeks.

It is advisable to care for the scar area on the nasal bridge and inside the nasal entrance with nasal ointment 1-2 times a day for up to 6 weeks after the operation, preferably using a Q-tip.

Yes, all the stitches used will dissolve on their own. The stitches inside the nose are left in place, while the visible stitches on the nasal bridge usually are removed after 1-2 weeks if the dissolving process takes too long. If small remnants remain, they typically either fall off by themselves or dissolve.

After the removal of the silicone splints from the nose, it is possible and advisable to perform gentle nasal irrigation. Alternatively, you can consider using moisturizing nasal spray, for example, with saline and dexpanthenol.

Smoking is discouraged because it can delay wound healing. Nicotine narrows blood vessels and can promote inflammation.

Alcohol consumption should be significantly limited or paused for several weeks after the operation. Alcohol has a vasodilating effect and can increase blood pressure, which may lead to postoperative bleeding.

The first follow-up appointment takes place on the day after the operation in the morning at our clinic in Pasing. Additional check-ups are scheduled on the 3rd day (cleaning the nose) and between the 7th and 10th day. The splints are removed during the third appointment. Further check-ups are scheduled at 3, 6, and 12 months.

The healing of wounds, reduction of swelling, and remodeling processes in the nose can take up to 12 months, especially with thicker skin and in the case of revision surgeries, it can take up to 24 months. Only at this point can the final result of the surgery be fully assessed. However, patients can often notice a significant difference a few weeks after the procedure, typically as a substantial improvement in the shape and function of the nose.

After surgery, the skin on the entire nose and at the scar from the incision is more sensitive to sunlight. Direct sun exposure should be avoided in the first few weeks after a rhinoplasty. After that, during the first year following the surgery, always use sunscreen with a high sun protection factor and wear a hat or cap. Direct sunbathing should also be avoided.

Small and light glasses can be worn after 6 weeks, while regular glasses can be worn after 8 weeks.

Light physical activities like stretching, light yoga, brisk walking, and gentle cycling can be resumed after 3 weeks. Jogging, low-intensitiy fitness programs, etc., can typically be resumed after about 4 weeks. Contact sports, ball sports, and strength training can usually be resumed after about 8 weeks. However, each individual’s recovery may vary, and these timeframes are provided as general guidelines.