Lola’s Rhinoplasty

(Excerpted from Dr. Peter Adamson’s book Fabulous Faces available on and edited for our blog. Names of individuals mentioned have been changed to protect their privacy.)

Lola, a public health worker, is a single woman in her twenties. She’s tall and slim, with the striking good looks of a fashion model. She’s a happy camper—except for her nose.


We meet at an initial consultation and get to know each other over about an hour. I already know something about the general state of her health because she’s filled out the standard health questionnaire, a requirement for every patient stepping into a doctor’s office for the first time. Physically, she appears to be a good candidate for elective surgery.

I learn about her concerns with her nose. Lola tells me that she can see it tilting slightly to the left. I see the same thing, seat Lola in front of a mirror, and show her how rhinoplasty can make an improvement. We take photographs for the next meeting.

A few days later, Lola decides to go ahead. She books a planning meeting where Dr. Litner, who’s doing a one-year fellowship, goes through the details of her surgery and recovery. He makes sure that she’s aware of the risks, however small, of going under a general anesthetic and having this kind of operation. They agree upon a surgery date.


“The getting ready” recommendations Lola received are straightforward. She stocks up on soft foods, liquids, and bendable drinking straws. She arranges for her mother to take her home after surgery and stay with her overnight. She also follows the hard-and-fast rules. She avoids pills containing aspirin (e.g., Aspirin, Advil, Bufferin, 222s, Triaminic tablets) for two weeks prior to surgery, as they’re blood thinners and may cause excess bleeding during surgery. She also avoids herbal remedies, including echinacea, garlic, ginseng, green tea, and chamomile tea, as they’re also blood thinners.


Lola’s rhinoplasty, done under general anesthetic, takes one hour and forty minutes. It begins with an incision beneath the tip of the nose and is carried along to the inside of each nostril. The skin of the nose is then freed up from the underlying tissue and elevated. Now the inside of the nose is exposed.

The first step is to remove some cartilage from the midline of the nose. Small cuts are made in the crura, a number of arch-shaped segments that form a dome-like structure and give the tip of the nose its shape. The crura are then sculpted into their new position and sewn back together. Some of the removed cartilage is reshaped and put back in beneath the tip and along the sides to support the “new” nose.

We move on to the bridge of the nose. It has to be lowered slightly. It’s shaved down slightly with an instrument similar to a file. Small cuts are made in the bone with a few taps on a chisel-like instrument called an osteotome. This breaks the nose, enabling me to reshape the bridge. The skin is re-draped on the new frame, and the incisions are closed.

A small cast is placed on the nose, and plastic splints are inserted in the nostrils. A small amount of gauze is placed at the nostril openings.


The next day, Lola looks puffy, swollen, and bruised. She also has two black eyes. Lola’s nose feels blocked up, as the tissues are swollen and the splints are still in place. It’s no walk-in-the-park day. Lola feels miserable. “The things I do for beauty,” she says.

The little bit of gauze comes out the day after surgery. Three days later, we snip and remove the external sutures that have been holding the nose together. Internal sutures remain, but they’ll dissolve on their own.

The cast comes off in eight days, and so do the splints that have been placed inside the nostrils. By then, Lola is feeling much better. Most of the swelling and bruising disappears. Lola is given a list of postoperative instructions to follow.

It’ll take about six weeks until Lola’s nose feels back to normal. It will continue to refine, and there can be residual numbness in the tip for up to a year. A month after surgery, she takes a holiday in Mexico.

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