Male Rhinoplasty in London

Nose reshaping surgery planned around male anatomy and male proportions. The operation is the same one performed in women. The bone and cartilage framework is reshaped. What changes is the plan. Thicker skin over a heavier skeleton, and a different target profile, mean the technique is more structural and the reduction more conservative.

It is usually a day case at Weymouth Street Hospital under general anaesthetic, home the same evening with a splint. Weymouth Street schedules around two and a half hours for a primary male rhinoplasty, and around three and a half where septal work is done at the same time.

You will see the same operation called a nose job, nose reshaping (the NHS's own term), rhinoplasty for men, or simply male rhinoplasty. They all mean this.

Most men arrive with one of a small number of concerns. A hump on the bridge, a nose bent by an old injury, a tip that looks heavy in photographs, or a nose that has never breathed properly since a break at school. Many men put this off for years, and it is common for breathing, rather than appearance, to be the thing that finally forces the question. In my experience the hardest part of the conversation is not whether surgery will help, but how small the change should be.

The aesthetic target shifts, the anatomy is different, and the margin for reduction is narrower. A male nose taken too far reads as feminised, and putting structure back is harder than taking it away.

How does thicker male skin affect the result?

Male nasal skin is generally thicker and more sebaceous, particularly over the tip. Thick skin behaves like a blanket. It hides small changes made to the framework underneath, and holds swelling for longer.

So definition has to be built rather than carved. Cutting cartilage away to make a tip look smaller under thick skin tends to produce a soft, shapeless tip a year later, because nothing is left holding the skin up. The structural approach described by Toriumi, and by Gunter and Rohrich, uses suture techniques and, where the tip needs support, cartilage grafting. In practice I refine the tip with sutures and, where it needs support, small grafts of your own septal cartilage.

The tip settles slowest in thick skin, so twelve months is the point at which a result can fairly be judged. In very thick skin the tip can carry on refining beyond that, sometimes towards eighteen months.

What does a masculine nose look like?

The features that generally read as masculine are a bridge that runs straight in profile without dipping into a concave curve, a nasal tip that stays projected and sits less rotated than a typical female tip, and a bony base in proportion to the width of the face.

Two words come up constantly once we start planning, so here they are in plain English. Projection is how far the nasal tip stands out from the face. Rotation is how far it points up. Almost everything discussed about a tip comes back to one of those two, or to the balance between them. Textbook proportions are population averages, though. What I plan for is your face.

Why is over-reduction the main problem in male rhinoplasty?

It is the easiest mistake to make and the hardest to undo. An over-reduced male nose has a scooped bridge, a tip rotated too far up, and a bony base narrowed out of proportion to the face. Putting back what an over-reduction removed is a grafting problem rather than a reduction problem, and it is the work of revision rhinoplasty. Male rhinoplasty planned conservatively the first time is the best protection against ever needing it.

Not if the plan is built for a male face. Feminisation usually comes from over-reducing a hump into a concave curve, over-rotating the tip, or narrowing the bony base too far. Those are surgical choices, and they are the ones I plan against.

I use 3D VECTRA imaging at the planning stage, so we can look at a simulated profile together. It checks that the nose you are imagining and the nose I am planning are the same one. It is not a prediction of your result.

Almost any structural feature: the profile, width, tip, nostrils and the airway inside. What it cannot change is your skin quality or the proportions of the rest of your face.

• A dorsal hump. Reduced with ultrasonic piezo instrumentation to a straight profile. See dorsal hump removal.
• A crooked or post-traumatic nose. Straightened by repositioning the nasal bones and the cartilage beneath. One of the harder problems in rhinoplasty, because deviated structures tend to pull back towards their old shape as they heal. See crooked nose and broken nose.
• A wide bony base. Narrowed with controlled osteotomies, only as far as your facial width will carry.
• A bulbous or under-projected tip. Refined with suture techniques and structural grafting. If the tip is your only concern, tip rhinoplasty may be the better operation.
• A nose that is too large or too long. Shortening and de-projection are possible, and this is where conservative reduction matters most. See big nose.
• Wide nostrils. Alar base reduction from £4,500.

Neither is better in general. Open rhinoplasty uses a small stitch line across the columella, the strip of skin between the nostrils, and gives full view of the framework. Closed rhinoplasty hides every incision inside the nostrils, so there is no external scar at all. The approach follows the work the nose needs.

What can closed rhinoplasty achieve?

More than its reputation suggests. Through the nostrils it is possible to reduce a dorsal hump, narrow the bony base with osteotomies, and do modest tip work. For a man whose only concern is a hump on an otherwise straight nose, closed rhinoplasty can achieve the whole plan, and no external scar at all is worth a good deal to some men.

What it cannot easily give is the exposure to position and fix structural grafts accurately, or to see how the two halves of a crooked framework sit relative to each other. Thick male skin over a tip that needs rebuilding is exactly where that exposure earns its place.

What decides which approach is best for your nose?

How much structural support the tip needs, whether the septum has to be straightened and cartilage harvested from it, how crooked the nose is, and whether it has been operated on before. Most of my surgery is open, because those are the problems male noses most often bring, and structural work and grafting need that view. Where the work allows, I use a closed approach. I will tell you which one I am planning, and why, before you consent to anything.

The columellar scar is what men ask about most. In most patients it settles over several months into a fine pale line under the nose. Scars do vary. Some thicken, widen or notch, and a few stay more visible. It is a real scar, and I will show you where it sits at consultation.

Yes, and in men it often needs to. A deviated septum, collapse of the internal or external nasal valve, and enlarged turbinates all narrow the airway, and breathing difficulties frequently sit behind what looks like a purely cosmetic request. Where both need treating I perform a septorhinoplasty: the septum and airway inside, the shape outside, under one general anaesthetic.

Because I am an ENT surgeon, examining the inside of the nose is part of my assessment, with nasal endoscopy where indicated. A nose that looks better and breathes worse is a poor result.

What do breathing difficulties actually feel like?

A blocked nose is easy to live with for years without ever calling it a problem. The usual pattern is one side more blocked than the other, or a blockage that swaps sides through the day and gets worse lying down. Around that sit mouth-breathing at night, waking with a dry mouth or a sore throat, snoring, broken sleep, and having to breathe through your mouth on a run or under a heavy set in the gym. Some men only notice it when a cold clears and the nose still does not open. If several of those are familiar, the airway is worth assessing whatever you decide about the shape.

What is a deviated septum, and how is it found?

The septum is the partition of cartilage and bone running down the middle of the nose, separating the two airways. A deviated septum is one that bends, buckles or spurs to one side. That narrows the side it leans into, and it can disturb airflow on the other side too, which is why a deviated septum often makes both nostrils feel wrong.

It is found by looking inside the nose, with a light and, where indicated, an endoscope. It cannot be established from the outside, which is why the examination matters more than the photograph. Straightening the septum can improve the airway, though results vary between patients and no operation guarantees a particular outcome. See septoplasty.

Can a nose broken years ago still be straightened?

Yes, whether it happened last year or twenty years ago. What matters is what the bones and septum did as they healed, and that is what the examination establishes. A nose can look straight from outside and still be obstructed inside, often only obvious under exertion.

Rhinoplasty is a common operation with a well-documented safety profile, but no surgery is risk-free. A 2020 systematic review of 36 studies (Sharif-Askary et al.) reported infection in 0 to 4% of patients, significant bleeding in 0 to 4.1%, septal perforation in 0 to 2.6%, and revision surgery in 0 to 10.9%.

The risks that come up most often in men are prolonged tip swelling under thicker skin, loss of definition if too much cartilage is taken, asymmetry, and temporary numbness of the tip. Rhinoplasty also carries the risks of a general anaesthetic, including a small risk of blood clots. Breathing can be left unimproved or made worse, sense of smell can be reduced or altered, and you may end up with a result you do not like that cannot be fully corrected. I go through all of this at consultation and again before you sign consent.

If revision is needed within twelve months of your original operation with me, I do not charge for my own time. You would still be responsible for the Weymouth Street theatre fee and the anaesthetist's fee, billed directly and typically £3,000 to £4,500 combined. After twelve months, revisions are priced case by case.

Both routes produce good rhinoplasty surgeons. What matters is the individual: whether they are on the GMC Specialist Register, what cosmetic certification they hold, whether they assess the airway as well as the appearance, whether you get a written quotation and a proper reflection period, and whether they are willing to tell you surgery is not the right answer.

Two of those you can check yourself, in about two minutes, without asking anyone's permission. The GMC Specialist Register lists ENT surgeons under Otolaryngology and plastic surgeons under Plastic Surgery, and an entry on either means completed UK specialist training in that specialty. Cosmetic practice sits on a separate register. The Royal College of Surgeons of England certifies surgeons in named cosmetic areas, and that list is public too. My GMC number is 4372358 and my certification includes the nose, so both are there to be looked up.

Not every man who comes to see me needs an operation, and part of my job is to say so. If you are weighing up what you have been told, a second opinion from another expert in nasal surgery is always reasonable, and I would never take offence at one. What I would want you to check is that whoever you see can correct both the shape and the airway, because a nose is one structure, and treating half of it is how patients end up disappointed.

I trained in both. ENT surgery covers how the nose works. Facial plastic surgery covers how it looks. My guide to choosing a rhinoplasty surgeon in London sets out how to test any surgeon on this.

The men who do well are in good health, have finished facial growth, arrive with a specific concern rather than a general wish to look different, and hold realistic expectations. Age at the upper end matters far less than health, and facial growth is usually complete from around seventeen to eighteen. Any condition affecting a general anaesthetic or wound healing needs to be right first, and smoking and nicotine use both affect healing. Where how you feel about your appearance looks like it needs addressing first, I will say so and help you find the right assessment and support. Sometimes the honest answer is no.

Two consultations with me before a surgical date is confirmed. The first is a full clinical assessment: history, examination of the outside and inside of the nose, and 3D VECTRA imaging so we can look at a planned profile together. You leave with a written quotation and a personal surgical plan. The second finalises the plan and takes written consent. I take the consent myself and I perform the operation myself. A mandatory two-week cooling-off period runs before any date is booked, so nothing has to be decided in the room.

Consultations are at 9 or 25 Harley Street, surgery is a day case, and the splint week is the only phase obvious to anyone looking. Deposit and cancellation terms are in the written quotation and in my terms of service. My complaints policy sets out how to raise a concern, and the independent route if you are not satisfied.

How do you test whether my expectations are realistic?

That is what the imaging and the second appointment are both for. Words are a poor way to describe a nose, so the VECTRA simulation puts a planned profile on a screen and gives us one shared reference to work from. Then you leave, two weeks pass, and at the second consultation I ask you again what you want changed. If what you describe then does not match what we planned the first time, we have not finished planning and the date waits.

What I am aiming at is a nose that looks natural on your face and in keeping with the rest of it. Individual results vary, no surgeon can promise a specific outcome, and the simulation is not a prediction of yours.

Two things have to be right before a date is safe: your general health, and a nose free of active infection or inflammation. The rest is logistics.

Everyone has a pre-assessment before the day. It covers your medical history, long-term conditions, previous anaesthetics and how you reacted to them, allergies, and baseline observations plus any tests the anaesthetist wants. Bring a complete list of everything you take, including anything bought over the counter and any supplement, because several common ones affect bleeding and clotting and need discussing. Do not stop or start a prescribed medicine on your own account. Ask me or the anaesthetist first.

Smoking and nicotine matter more in nasal surgery than in most procedures, because the blood supply to the skin is what heals it and nicotine narrows those vessels. Vapes, patches and pouches all count. How long you need to stop for, before and after, is settled at consultation.

Then the practical part. Book the time off before you book the surgery, arrange for an adult to take you home and stay with you the first night, and remember the splint is on for about a fortnight when you look at your diary.

Rhinoplasty and septorhinoplasty are day-case procedures at Weymouth Street Hospital, so admission and discharge both happen on the same date.

You arrive in the morning, having eaten and drunk nothing for the period the hospital tells you beforehand. A nurse admits you, checks your details and your consent, and you change. I see you before you go through to theatre, we go over the plan a last time, and anything still unasked gets asked there. You meet the anaesthetist too, who takes their own history and explains the anaesthetic and how they will handle pain and sickness afterwards.

The operation is done under general anaesthetic, so you are asleep throughout and remember none of it. Theatre time is around two and a half hours for a primary rhinoplasty, and around three and a half where septal work is included.

You wake in the recovery area with a splint on the outside of the nose. I do not use nasal packing. Where septal work has been done you will have soft internal splints instead, and those come out with the external splint at your Harley Street visit in the second week. Your nose will feel completely blocked. That is expected.

Discharge follows once you are awake, comfortable, eating and drinking, and the nursing staff are happy, usually the same evening. You cannot drive and you cannot travel home alone, so someone has to collect you and stay the night.

• Day of surgery. Home the same evening with a splint. Most of the discomfort is congestion.
• Week 1. The splint is the most visible part of the whole thing. Bruising varies from patient to patient.
• Week 2. Splint off, bruising fading, desk work realistic. Plan for seven to ten days off.
• Weeks 4 to 6. Light cardio, then a progressive return to weights. Nothing that risks a knock.
• Three months. Contact sport and sparring can resume. Shape close to final. The bones knit into their new position through the first six weeks and go on consolidating to around three months, which is why a knock early in that period matters far more than one after it.
• Twelve months. Deep swelling cleared, tip settled. Judge the result here.

These are expected, and are not complications: a blocked nose for two to three weeks, numbness of the tip and front teeth recovering over months, swelling worse first thing, and a tip still improving at nine months.

Call me on 020 7183 0220 for heavy fresh bleeding, pain that is increasing rather than settling, fever, spreading redness, or any change in vision. Out of hours, use the number in your discharge information, or NHS 111 or an emergency department. See recovery for the full timeline.

Follow-up for twelve months is included in the fee, because a rhinoplasty result is not finished when the splint comes off. Every review is with me personally:

1. Week 2. Splint removal at Harley Street, and removal of any internal splints.
2. Six weeks. Early shape and airway check.
3. Three months. Return to full activity reviewed.
4. Six months. Swelling and tip definition assessed.
5. Twelve months. The result judged, and the airway checked again.

The later appointments carry the most information. Swelling leaves thick skin slowly, and the tip is the last part of the nose to settle. Each visit is a chance to check the airway as well as the shape, which is the point of having both assessed by the same surgeon.

Between appointments you can reach the practice on 020 7183 0220 or at enquiries@nose.london. I would sooner hear about something small early than find out about it late. For the red flags above, call the same number.

Continuity of care is also what the question about going abroad really turns on. It means a named surgeon in the same city who can look inside your nose within a few days when something changes, for the whole twelve months.