Rhinoplasty in Zurich

Proportions

The relationship of the nose to the forehead, midface and chin determines how large or prominent it appears — not its absolute size.

Nasal dorsum

Humps, depressions and deviations of the dorsal line can be reduced, built up or straightened.

Nasal tip

Shape, rotation and definition depend on cartilage strength, cartilage shape and skin thickness. Thick skin limits the refinement that can be achieved.

Width

The bony base and nostrils can be adjusted; changing the width of the nostrils may leave small scars in the alar crease.

Projection

How far the nose projects from the face is changed via the supporting structures of the tip.

Asymmetry

Deviations can be reduced. Complete symmetry cannot be planned, as cartilage has its own dynamics during healing.

Breathing, septum and nasal valve

A deviated septum, enlarged turbinates or an unstable nasal valve can be treated functionally at the same time.

Skin quality and pore size, the face beyond the nose, and breathing problems without an anatomical cause — for example with allergies or chronic mucosal swelling — remain unaffected. A desired nasal shape that the existing supporting structures cannot carry is also not achievable.

In a first operation, the anatomy is unaltered. After previous surgery, scar tissue, an altered supporting framework and sometimes missing cartilage must be taken into account; additional cartilage material is often needed.

Secondary procedures are correspondingly more complex and their results harder to predict. There should be a sufficient interval since the previous operation.

With the closed approach, all incisions lie inside the nose. The open approach adds a small incision across the columella, which makes the structures directly visible and allows more precise reconstruction of the framework; the scar is usually inconspicuous once healed.

The choice depends on the findings: the extent of the planned change, work on the tip, asymmetries, functional aspects and previous surgery. Neither approach is fundamentally superior.

The assessment includes an external and internal examination, a check of nasal breathing, an assessment of skin thickness and cartilage stability, and standardised photographic documentation. An image simulation can aid communication; it is not a promise of a result.

Realistic expectations are particularly important here: the nose should suit the face and function — not match a template.

The procedure is usually performed under general anaesthesia. Afterwards an external splint protects the nose; internal splints are occasionally used. They are usually removed after about a week.

Bruising around the eyes and obstructed nasal breathing due to swelling are usual in the first few days. Physical exertion, wearing glasses and sport are gradually resumed as directed by your doctor.

After the splint is removed, the nose is still swollen. Much of the swelling subsides in the first weeks; the fine contour — particularly at the tip — develops over six to twelve months, sometimes longer with thick skin.

Nasal breathing also normalises gradually, not immediately after the procedure.

Nasal breathing

Deterioration is possible, for example if supporting structures are weakened; the structural stability is therefore planned with every shape-changing measure.

Asymmetry and irregularities

Palpable or visible edges, residual deviations and differences between the sides can occur and cannot be completely ruled out.

Further risks

Postoperative bleeding, infection, wound healing and scar problems, sensory disturbances at the tip and teeth, injury to the mucosa, and a result that differs from expectations.

Revision

Minor corrections are possible after healing is complete, generally no earlier than about a year.

The medical consultation for surgical procedures costs CHF 250. Following the examination, you will receive an individual cost breakdown for the recommended procedure. This should clearly state which services are included.

• Dr. med. Michael W. Payne

  Specialist in Plastic, Reconstructive and Aesthetic Surgery

• Facial surgery — overview
• Facelift
• Upper eyelid lift
• Articles on the face

The initial consultation is about clarification, not selling. It does not necessarily end with a surgery date — often it brings the realisation that a different approach, or no procedure at all, is the right choice.

The consultation process

1. 01

   Discussion

   We listen to your concerns, medical history, expectations and what you would like to change about your appearance.

2. 02

   Examination

   A careful clinical examination and assessment of your underlying anatomy.

3. 03

   Options

   Possible procedures, alternatives, limitations and risks — explained clearly and without time pressure.

4. 04

   Time to reflect

   You decide in your own time. Any outstanding questions can be addressed in a further consultation.