The operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required. If alar base reductions have been performed then the scars will be found tucked into the base of the nostrils within the natural skin fold. These are also generally well hidden by the natural shadow cast by the position of the nose. In complex tip cosmetic surgery, you may require an external incision (open rhinoplasty) carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately. Any bump on the bridge is removed with a delicate chisel to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) can be altered accordingly. Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. Sometimes this is done with internal stitches, other times a small segment of your own cartilage is used. When the surgery is complete, small dissolvable stitches are used inside the nostrils and then foamy nasal packs are inserted. These packs are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. Indeed it is exceedingly rare for significant bleeding to occur following a Rhinoplasty. Finally a plaster cast is placed on the bridge and held in place by tape on the forehead and cheeks.