Rhinoplasty in Kuching

Overview

---

What rhinoplasty is

Rhinoplasty is surgery to alter the structure of the nose. It may be done to change appearance, to improve breathing, or both. Because the nose sits at the centre of the face and is built from a framework of bone and cartilage covered by skin of varying thickness, small structural changes have visible effects — which is what makes the operation both effective and unforgiving.

Requests we commonly see include raising a low dorsum, refining a bulbous or drooping tip, narrowing wide nostrils, straightening a crooked nose, and correcting a deviated septum that obstructs airflow.

Techniques

Closed rhinoplasty

All incisions are placed inside the nostrils, so there is no external scar. It suits more limited changes, particularly to the bridge. Access and direct visibility are more restricted than in the open approach.

Open rhinoplasty

A small additional incision is made across the columella, the strip of skin between the nostrils, allowing the skin to be lifted and the framework seen directly. This gives greater precision for tip work, grafting and correcting asymmetry. It leaves a small scar that usually becomes inconspicuous.

Alarplasty

A separate, smaller procedure that narrows wide nostrils by removing a wedge of tissue at the alar base. It is often requested by patients with a broader nasal base, and can be performed alone or as part of a fuller rhinoplasty.

Grafts and implants

Support or projection often requires grafting. Cartilage may be taken from your own septum, ear or rib; synthetic implants are an alternative for the dorsum. Autologous cartilage carries no risk of implant rejection or extrusion but requires a donor site. Implants avoid a donor site but carry a long-term risk of infection, displacement or extrusion. Dr Kueh will discuss which is appropriate for you and why.

Who it may suit

• Adults whose facial growth is complete — generally from around 17 to 18 years
• People with a specific, describable concern about nasal shape or breathing
• Non-smokers in good general health
• People who understand that the nose will be their own, refined, rather than someone else's

Who it may not suit

• Anyone still growing
• Smokers who are unwilling to stop — smoking materially impairs healing of nasal skin
• Anyone with active nasal infection or uncontrolled bleeding disorder
• Anyone whose expectations cannot be met by surgery, or where body dysmorphic concerns are present

What recovery involves

An external splint is usually worn for about a week. Bruising around the eyes is common and generally fades within two weeks. The nose feels blocked at first, and breathing through it may be worse than usual before it is better.

Most people return to desk work after one to two weeks. Strenuous exercise, contact sport and anything risking a knock to the nose are avoided for at least six weeks. Glasses may need to be kept off the bridge for several weeks.

Rhinoplasty has an unusually long settling period. The obvious swelling goes within a month or so, but subtle swelling — particularly at the tip, and especially in thicker skin — can take twelve months or longer to fully resolve. Judging the result before then is premature.

Risks and limitations

General surgical risks include bleeding, infection, and reaction to anaesthesia. Specific to rhinoplasty: persistent swelling, numbness of the nasal tip, difficulty breathing, internal scarring, asymmetry, an irregularity that can be felt or seen through the skin, and problems with grafts or implants including shifting, infection or extrusion.

It is important to know that revision rhinoplasty is relatively common across the field, and that a revision is harder than a first operation because the tissue planes are scarred. Skin thickness places a real limit on how much definition is achievable — thicker skin conceals fine structural detail. Dr Kueh will tell you honestly what your own skin and framework allow.