Rhinoplasty (nose re-shaping)

Maddy Leathley had a complex operation on her nose at the age of just 16, making her Mr Manu Sood’s youngest rhinoplasty patient. Here, she tells her story...
“When I was ten years old, I ran into a glass door, broke my nose, and knocked myself out. It was quite a big whack. Some time later, I broke my nose again while trampolining. After that, my nose was like glass; it got weaker and weaker. I got bopped on the head joking around with friends and it broke; I played hockey or netball and it broke; I went running and it broke. Practically every time I breathed heavily, it broke! It wasn’t solid, because I’d grown up with it constantly broken. In total, between the ages of 10 and 16, I’d broken my nose 17 times."

Impact on Maddy's health

"In the end I’d broken my nose so often, that it didn’t bleed. I could smell and taste blood, but it didn’t come out because it was stuck. It wasn’t a nice feeling. It would go numb rather than feel really painful.I couldn’t sleep or breathe at all for two days, then I just had to get on with things. I knew it would happen a couple of times a year. It changed the shape of my nose each time. I’d come home at the weekend – I board at school during the week – and my mum would say "Oh, you’ve broken your nose this week" - even if I hadn’t told her.

It had a big impact on my health. Because I could only breathe through my mouth I wasn't getting enough oxygen and would get really bad headaches. I had to sit in the dark, it hurt so much. I had a dry mouth all the time. It sounds like such a little thing, but it had a huge impact. I couldn’t smell or taste properly, although I didn’t realise that until after my operation.

When I was about 12, I had my adenoids removed so that I could breathe better, and from then on I was pretty adamant that I would have the surgery to fix my nose at some point, for health reasons. I was told originally I had to be 18 to have it done.

My school and friends were very supportive, but it did affect me; I didn’t go out as much, for example. It was very difficult in photographs. I had to position myself so that it wasn’t noticeable. I never held my head straight, but always at a slight angle, so that my nose would look straight. At my prom, I looked at the photos afterwards and thought oh my gosh, my nose is so broken. As you get into your teenage years, you start to feel more self-conscious.

There’s a gap in my life – about two years, 14 to 16 – where I don’t have any photographs with me in them, because I didn’t like how I looked. That’s two years lost, when I’m older, to look back on. My friends would have photo shoot parties and I wouldn’t go to them because I didn’t want photos of me; I literally looked like I had one nostril, the other one was non-existent."

Manu Sood agrees to operate and Maddy becomes his youngest rhinoplasty (nose re-shaping) patient

"At my first consultation with Mr Sood, a month before I turned 16, I was nervous but excited because I knew it was the beginning. It was agreed that my nose was so bad, with such repercussions for my health, that I could have the operation done at the age of just 16. He knew I was ready for it, even though it was a big decision. I’d lived with it for a long time. We got on with Mr Sood so well; he knew exactly what I wanted and he understood it completely. He was going to work in tandem with another top surgeon, Mr Kotecha, who would repair the inside of my nose and leave Mr Sood to repair the outside.

My mum found Mr Sood brilliant because he knew I was 16 and he treated me as a 16-year-old. For example, I was really interested in how the process was carried out, so he was very informative. He didn’t try to hold back – he warned me to be realistic – but he also used language that I understood; it wasn’t doctors’ language that might confuse you. I felt like I knew every single thing that was going to happen in the operation before I went in, and that calmed me and made me feel safe.

I left every appointment feeling that I’d learned something from it. There weren’t too many appointments, so I didn’t have to miss school, and he was very flexible and understood that I needed evening appointments. I only saw him three or four times; he and Mr Kotecha discussed what would happen in the operation and everything was clear-cut between them before we went in.

The night before my operation, I boarded at school and I was nervous; I went into my friend’s bedroom and said, I can’t do it! But I woke up the next morning and realised it was everything I wanted. I wanted to wake up and breathe; I wanted to have sleepovers with my friends. I thought, I have to do it!"

Operation day 

"I was still at school on the day of my operation. I left at 3pm and my operation was at Spire Hartswood at 6pm; I only had to miss one lesson. Mr Sood came in promptly, drew on my face, and I was taken down to theatre shortly after 6pm. The anaesthetic team were amazing. They laughed and joked, which was exactly what I wanted: it made a huge difference in relaxing me. I knew that these people would be sitting with me throughout the operation, and I felt like they were on my side. When I woke up afterwards, both my surgeons were there to talk to me, even though they’d finished work some time before. It was great to wake up and have both of them there. They took me up to my room, so that I could ask them any questions on the way up.

Because the two surgeons operated on me in one session, the surgery had taken about five hours. The inside of my nose had been worked on first by Mr Kotecha – cartilage grafts and so on, so that it was strengthened on the inside – and then Mr Sood had done the outside work.

The first night, my face was numb, so there was no pain. I wasn’t very tired for some reason, and all the nurses were so nice to me. They came in and chatted and kept me company, which was brilliant, because my parents couldn’t stay. It was so nice that after a major operation, at just 16, I wasn’t left alone – I thought that was brilliant. They’d asked me what I wanted to eat before my operation, and they had it ready for me afterwards. I felt that they cared."

Recovery and rediscovery

"I was able to leave Spire Hartswood at 9am the next day, so it was a really quick turnaround. I was swollen and bruised afterwards; I had a cast on for ten days, but I thought, even at that point, that my face already looked more symmetrical. I had gauze up my nose for the first 40 hours and, when they took it out, the nurse warned me I wouldn’t be able to breathe yet – but as soon as she did it, I said, I can feel air up my nostrils! My mum was nearly in tears because I’d had no feeling in my nose for six years. To suddenly have something was amazing.

To smell things again was the oddest thing. I’d thought I’d been able to smell before… I could obviously smell faintly… but after eight to ten days you get your senses back properly and I suddenly could smell and taste really strong smells. Everything tasted better. Previously I’d put loads of salt and pepper on my food, but I didn’t need to any more. Strangely, the things that I most enjoy now are things with subtle tastes, that I hadn’t been able to taste before… yogurt, for example. Sugar in my tea. Gravy. When I drink fizzy drinks now, I feel the bubbles on my nose! I couldn’t feel anything there before.

Five days after the op, I came back for a consultation and it probably took a month for the bruising and swelling to go down and for it to look normal. I saw Mr Sood a few more times afterwards, just for him to check all was OK. What's great about Mr Sood is that he really explains it all; the repercussions; realistic, helpful things to know. You don’t feel like you’re just a patient; you feel you’re being looked after.

I didn’t miss any school, because I had it done over a two-week half term. I didn’t really expect anyone to notice my nose, because I hadn’t told that many people – but everyone noticed! I didn’t want a fuss, but everyone was very supportive and could see why I did it. You think it’s only a little part of your body, but it’s such a key part. Visually, it’s the central part of your face, it even changes the level of your eyes.

I had been really sporty when I was younger, but I had become wary of doing sport – and so had my teachers, quite understandably. Now, I can be more active again. I can go swimming for longer now, run longer, go to the gym for longer. And cycling is possible again – you need to be able to breathe through your nose for cycling, as you become out of breath really quickly if you breathe through your mouth.

Mr Sood took photos before and after the operation, and he showed them to me last month. I couldn’t believe it – and I couldn’t thank him enough for taking those photos. You forget; you don’t realise how much you’ve changed. I looked at the photos and thought, that’s a different person, a different face.

I was 17 in August and I realise how much I’ve changed. Yes, my nose has changed, but I have a new air of confidence too. When I had my nose done, I had my hair dyed at the same time, and my mum joked, it’s a new girl! I feel I can do that now: I can be a little bit different.”

The consultant’s view by Mr Manu Sood, 
Consultant Plastic, Reconstructive and Hand Surgeon

Dissatisfaction with the shape of the nose is a very common complaint especially following an injury. An injury can also result in difficulty in breathing due to problems with structures inside the nose. 

This situation is even more difficult to deal with in a young person as not all young people are sufficiently mature to have what might be termed as a cosmetic procedure. However, in Maddy’s case, it was quite clear that she was a mature young lady who was well supported by her parents and had a functional problem with breathing and displacement of the septum (the partition between the two halves of the nasal cavity). In my initial consultation with Maddy and her mother I noted that she needed both a cosmetic correction to the nose and a functional correction to improve her breathing. 

My colleague, Mr Bhik Kotecha, is a Consultant ENT Surgeon with significant experience in work of this nature. I asked him to see Maddy and let me know whether we could do the surgery as a combined procedure to help her to recuperate more quickly. Mr Kotecha confirmed that he would be able to correct the position of the septum and correct her breathing at the same time as I performed the rhinoplasty. An added benefit of this approach was that I was able to use the cartilage from the septum (which would otherwise have been discarded) to reconstruct and support  the nose and to give Maddy a really good cosmetic result. 
Following her surgery, Maddy is able to breathe much better due to the work that Mr Kotecha has done. She is also very happy with the appearance of her nose. This is a rewarding example of teamwork between two consultants with specialist interests, who have come together to give a patient the best result possible.