For a comfortable and pain-free procedure, rhinoplasty is performed under anaesthesia. The type of anaesthesia used will depend on the complexity of the surgery. Options include:

• Local anaesthesia with sedation: This type is often used for less invasive procedures. You will be awake but relaxed, and your nose area will be numbed to block pain. You may also choose to have more heavy sedation if you would like. That will involve a discussion with your surgeon and anaesthesiologist about your preference.
• General anaesthesia: For more extensive surgeries, general anaesthesia may be recommended. You will be asleep throughout the procedure, and a breathing tube will be used to assist your breathing.

An anaesthesiologist will monitor your vital signs and comfort throughout the procedure, ensuring a safe and pain-free experience. The choice of anaesthesia will be discussed during your pre-operative consultations, taking into account your medical history, the specifics of the planned surgery and your personal comfort.

There are primarily two ways of making the incision: open and closed rhinoplasty, with ultrasonic rhinoplasty as a more recent innovation. The choice of technique depends on the complexity of the surgery and the specific changes desired.

• Open rhinoplasty: Involves an incision across the columella, the small strip of tissue separating the nostrils. This approach provides the surgeon with extensive visibility and access to the nasal structure, allowing for very precise modifications. It is often preferred for more complex procedures.
• Closed rhinoplasty: All incisions are made within the nostrils, leaving no visible external scars. While visibility may be more limited compared to the open technique, closed rhinoplasty can be advantageous for less extensive modifications, offering the benefit of reduced swelling and shorter recovery times.
• Ultrasonic rhinoplasty: This method is relatively new and uses ultrasonic energy to precisely sculpt the nasal bones, minimising trauma to the surrounding tissues. It allows for more precise adjustments with potentially less bruising and swelling.

The main step during the procedure is to reshape the nose structure. If the septum is deviated, this may also be able to be straightened at the same time. Throughout this process, the surgeon works meticulously to achieve a balance between the desired aesthetic outcome and the preservation of nasal function. This is usually done by performing one or several of these techniques:

• Modifying bone and cartilage: Excess bone and cartilage may be removed or repositioned to achieve the desired shape. In cases where more volume is needed, grafts from other parts of the body (often the septum, ear, or rib) may be used.
• Refining the tip: The nasal tip can be reshaped through suture techniques or cartilage grafting, allowing for increased precision in adjusting tip definition and rotation.
• Adjusting the nasal bridge: The surgeon may reduce a hump on the nasal bridge by carefully removing bone and cartilage. Alternatively, if augmentation is needed, grafts can be used to build up the bridge, giving it the underlying structure it needs for a permanent result.

The incisions are carefully closed with sutures. In the case of an open rhinoplasty, the external incision made on the columella is also sutured, with care taken to ensure that the resulting scar is as inconspicuous as possible. In closed rhinoplasty, there are no external visible scars, since all incisions are inside the nostrils.

The sutures used inside the nose are typically dissolvable and do not require removal. External sutures, if any, are usually removed within a week after surgery. Following the closure of the incisions, the nose is often stabilised with splints and packing to support the new structure during the initial healing phase.

Adherence to your surgeon's guidance can significantly impact the outcome and speed of your rhinoplasty recovery. Initially, you can expect some swelling and bruising around the eyes and nose, which typically improves within the first week. To support a smooth recovery, consider the following advice:

• Rest and keep your head elevated
• Apply cold compresses, avoiding direct pressure on the nose
• Avoid strenuous activities for at least 3-6 weeks
• Follow your surgeon's instructions for cleaning the nasal area
• Attend your follow-up appointments

Recovery timelines vary, with most individuals able to return to work and daily activities within two weeks, although full healing and final shaping of the nose may take up to a year or a year and a half. During this time, you need to take proper care of your nose.