Rhinoplasty

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Rhinoplasty

Rhinoplasty is a surgery, through which the shape of the nose is revised. The purpose of rhinoplasty may be to change the appearance of the nose and improve breathing. Rhinoplasty is the most common aesthetic surgery nowadays because it changes the person’s facial expression and appearance. The person can become a completely different person. The nose is the most important organ that affects expression, as it is in the middle of the face. It also has functional significance. Functional significance is that; it is the organ that allows us to breathe and connect us to life. When we cannot breathe, we cannot sleep at night, and we cannot do exercise. Our daily activities start to disrupt. Therefore, the nose is considered to be an organ, which affects us in terms of both functional and aesthetic aspects.

In fact, rhinoplasty has improved a lot over time. Along with the advancement in technology, the devices used in rhinoplasty have become smaller and gentler, and the sub-traumatic technique has emerged. While mentioning the sub-traumatic technique, I especially mean that the emergence of rhinoplasty surgeries with a minimalistic surgery by intervening the area to be corrected without uncovering the cartilage tissue completely. Considering the aesthetic and functional aspects of rhinoplasty surgery as the two pans of a scale, it is of great importance that both aspects improve parallel to each other. The components of the nose, which enable breathing functions, are the intrasanal area of the nose and the partition in the middle. The deviation in the middle partition may be a deviation towards either right or left.

There may be a deviation towards left in the upper part of the nose together with a deviation towards the right in the lower part. We call this an S-shaped deformity and it causes congestion in the intranasal area. When the partition deviates from the mid-line, congestion occurs in our air passages. The upper part of the nasal structure is bone and the lower part is cartilage. By rhinoplasty, the bone, cartilage, and also skin can be revised. You should talk to your surgeon about whether rhinoplasty is right for you and what it can achieve. While planning rhinoplasty, your surgeon will consider your face, nasal skin, and your opinion about what you desire to change, as well as the aesthetic concerns you have. If you are a candidate for the surgery, your doctor will develop a special plan for you.

Why is rhinoplasty performed?

Rhinoplasty can change the size, shape or proportions of your nose. It can be performed to repair damages caused by injuries, correct congenital defects, or treat some breathing difficulties.

What causes the deviation of the mid-line of the nose?

Traumas at young ages. Small fractures occur in the cartilages of the middle part of the nose, because of falling on the nose or hitting it somewhere. With growth, these cartilages lead to right or left deviations. As a result of these deviations, conchas in our noses tend to grow themselves functionally, and the growth of the nasal concha together with the deviation of the mid-line causes congestion in the nose. Insomnia may emerge. Solving this is essential for improving our daily activities and is an integral part of rhinoplasty.

Risks of rhinoplasty surgery

As with any major surgery, rhinoplasty carries the risks of adverse reactions such as bleeding, infection, and anaesthesia. Other potential risks specific to rhinoplasty are:

  • Recurrent nose bleedings,
  • Difficulty in inhaling through the nose,
  • Permanent numbness in and around the nose,
  • The probability of a nose that appears irregular,
  • Pain, discoloration or swelling,
  • Scarring,
  • Hole in the septum (septal perforation)

Please consult your doctor about whether these risks apply to you.

Preparation for the surgery

Within the process of rhinoplasty surgery and before the planning of the surgery, you should meet with your surgeon to discuss the important factors, which determine whether your surgeon is working well for you. This meeting generally includes the following issues:

Your Medical History

The most important question to ask your doctor is about the surgery and your goals. Your doctor will also ask your medical history. This includes the history of a nasal congestion, previous surgeries, and medications. If you have a bleeding disorder such as haemophilia, you may not be a candidate for rhinoplasty.

Physical Examination

Your doctor will perform a complete physical examination, including any laboratory test, such as a blood test. He/she will also examine your skin, inside and outside of your nose. The physical examination will help your doctor determine what revisions he/she should do and how the surgery will result based on physical features – for example, the thickness of your skin or the cartilage strength at the tip of your nose. Physical examination is also important to determine the effect of rhinoplasty on your respiration.

Photos

Your doctor may take pictures of your nose from different angles. Your surgeon will be able to show you what kind of result will be achieved and the final version of your nose by revisions on the photos thanks to software. You can see what your nose will look like after the surgery with the 3D Vectra method, which is used extensively in rhinoplasty surgeries. Your doctor will use these photos in the evaluations before and after the surgery, during the surgery and in long-term reviews. Most importantly, photos allow a discussion about the aims of the surgery.

Determine and State Your Expectations

You and your doctor should talk about your motivations and expectations. The recovery of aesthetic, plastic and reconstructive surgeries is unfortunately very difficult. Your doctor will explain what rhinoplasty can and cannot do for you and what the results may be. It is normal for people to feel a little conscious when discussing their appearance, but it is very important for you to be clear about your desires and goals while talking to your surgeon. In the first few days after anaesthesia, you may experience a slow-down in your memories, a slow reaction time, and may make judgmental decisions. For this reason, you can ask a family member or a friend to help with your personal care during the recovery process after the surgery.

Food and Medications

Avoid medications containing aspirin or ibuprofen in the two weeks before and after the surgery. These medications may increase bleeding. Only take medications approved or prescribed by your doctor. If you smoke, do not smoke. Smoking slows the recovery process after the surgery and increases the possibility of getting an infection.

How Should Your Expectations be?

Rhinoplasty is not a procedure performed with a number of specific steps. Each surgery is unique and customized for the specific anatomy and objectives of the person, who undergoes the procedure. Rhinoplasty can be performed through a small external incision in your nose or in the base of your nose, between your nostrils. Your surgeon will probably re-arrange the bone and cartilage beneath your skin.

During the surgery

Rhinoplasty requires local anaesthesia by sedation or general anaesthesia, depending on the complexity of the surgery and your surgeon’s preferences. Discuss with your doctor what kind of anaesthesia is the best in your case.

We go through the incisions we have made in the intranasal area. We uncover the cartilages and bone. A hump in the bone, any tissue structure that may have protruded, or all the elements that will make the nose deviate to the right or left are eliminated, corrected, and the nose is reshaped.

We can perform these procedures very easily through technological ultrasonic cutters, radio frequency, which we use to reduce the size of the concha or lasers, which we call diode laser. The nasal structure that we form as a result of these processes should be within the ranges of angles and measurements created by scientific principles.

If we apply our own appearance, our own structure to the patient’s nose with our own opinions, we ignore the scientific criteria, and a nose structure that will not fit the patient’s face may be revealed.

A clear evaluation of the patient’s face, jaw structure, the state of the cheekbones, the asymmetries of the right side and the left side when we divide the face into two are of great importance in terms of harmony of our result with the face.

In other words, if we can make a clear assessment beforehand, we can also determine the result beforehand. By minimizing the interventions, that we can do in the nose, we can minimize swelling and bruising, that will occur in the eyes after the surgery.

In this regard, thanks to the surgery performed within the low blood pressure state, proper application of the hemorrhagic medications to the nose, sufficient post-surgery ice application, no bruising occurs in some of our patients.

Local anaesthesia by sedation: This type of anaesthesia is usually used in the clinic environment and is limited to a specific part of your body. Your doctor injects a painkiller into nasal tissues and stimulates you with medications injected through an intravenous line. It makes you dizzy but does not let you sleep.

General anaesthesia: You will receive the anaesthetic medication either by inhalation or through a small tube placed in your hand, in your neck, or in your chest. General anaesthesia affects your entire body and causes a temporary loss of consciousness. General anaesthesia requires a breathing tube.

After the Surgery

After rhinoplasty, our patients can breathe through the silicon splints, that we have placed in the nose, and the big packing, we formerly used, is no longer applied. There is an airway in these silicon splints. Through that, you can breathe very comfortably. We remove them 2-3 days after the surgery. Our patient is then completely relieved. After the surgery, to reduce bleeding and swelling, you should rest in bed, with your head lifted above your chest. Your nose may be congested due to splints placed in your nose during the surgery. On top of the nose, there will be thermoplastic splints, which we remove on average 7 days after the surgery. Our patients can go to school or work with these splints. However, patients who do not want to go out with these can easily return to work after their removal 7 days later.

After the surgery, the recovery of our patients may take between 20 days and 1 month on average. However, it takes approximately 3-4 months for oedema to recover completely and for the nose to settle. The nose starts to take its final shape gradually, starting from the 6th month, and the nose takes its final form at the end of 1 year. Our patients need to be a little bit patient after this surgery, as they are required to wait for the nose to take its final shape. Very small problems can occur after rhinoplasty. However, the revision rate of a meticulously and carefully performed surgery is very low. There are no serious problems in the surgeries of surgeons, who are generally sensitive and treat the tissues respectfully.

Rhinoplasty is the most common surgery today, and as the doctor’s experience increases, we begin to see a great deal of successful surgical results.

There is no need to be scared of rhinoplasty. A painful post-surgery process does not wait
for us. One of the least painful plastic surgeries is rhinoplasty.

There are even patients, who do not use painkillers after the surgery. In the post-operative period, our patients can easily go to work with the splint after 3-4 days, as I have mentioned.
Mild bleeding, mucus, and old blood drainage are common after a few days following the surgery or after the removal of the dressing. Your doctor may place a small piece of gauze, fixed with tape, under your nose to absorb the drainage. Change your gauze as indicated by your doctor. Do not place the dropper pad firmly in your nose.

To reduce the likelihood of bleeding and swelling, your doctor may ask you to apply the following precautions in a few weeks after the surgery.

  • Avoid exhausting activities such as aerobics and jogging.
  • Have a bath instead of taking a shower, when bandages are placed on your nose.
  • Eat high-fibre foods such as fruits and vegetables to prevent constipation.
  • Constipation can cause pressure on the surgical site.
  • Avoid laughing or similar excessive facial expressions.
  • Gently brush your teeth to limit the movement of your upper lip.
  • Wear clothes closing on the front, do not pull clothes like shirts or sweaters over your head. Additionally, do not wear goggles or sunglasses on your nose at least for four weeks after rhinoplasty to prevent pressure to your nose.
  • Use SPF 30 sunscreen on your nose, especially when you are out. Too much sun can cause permanent and irregular discoloration of the skin of your nose.
  • There may be temporary swelling of your eyelids or a black-blue discoloration two to three weeks after the surgery. It takes longer for the nose to swell. Limiting your sodium diet will help your swelling disappear faster. Do not place anything on your nose, such as an ice or cold pack after the surgery.

Your nose changes for your lifetime, when you undergo surgery. Therefore, time is required to have the final result. Nevertheless, most of the swelling disappears in one year.

Results

Very small changes in the structure of your nose can make a big difference in how your nose looks. Often, an experienced surgeon can achieve the outcome, that both of you are satisfied with. However, in some cases, slight changes are not sufficient and you and your surgeon may prefer a second surgery for further refinement. In this case, you should wait at least for one year for surgery, because your nose may change during this time.

Berkay's rhinoplasty surgery

We have witnessed an unfortunate incident of the famous artist Berkay in a flash news came in the previous days. Berkay, whose nose was injured as a result of a quarrel, applied to reconstructive surgery specialist Erdem Güven, MD, and the specialist decided on plastic and reconstructive surgery. The surgery was quite successful.

Rhinoplasty Frequently Asked Questions

Rhinoplasty is a surgery, aiming to change the shape of the nose. Since breathing and nasal shape are interrelated, rhinoplasty is sometimes performed not to change the shape of the nose, but to improve nasal breathing.

Septoplasty is a surgery that improves breathing by flattening the wall (nasal septum), that divides the nasal passages into right and left. When the septum is crooked, it can make it difficult to inhale through the nose. A septoplasty is often combined with rhinoplasty.

No. Rhinoplasty is one of the most challenging surgeries. This is due to several factors. First, the nose is a complex three-dimensional shape, located in the middle of the face. Changes made during rhinoplasty are usually very small, but they can make a significant difference in terms of the appearance and function of the nose. Since these changes are small, so is the margin of error.

Swelling and local anaesthetic placement on the skin deform the nose during the surgery, camouflages the most of the fine revisions. Rhinoplasty is not only a procedure, either. In other words, a standard plan or the order of steps are not determined in advance. Each surgery is planned according to the needs of the patient.

What we call a nose droop is certainly not the case with the proper application of the technique, the protection of the structures which form the nose, and the protection of cartilages and bones. However, with the removal of supportive cartilage carrying the nose, a drooping nose may be present.

For example, we may remove the crooked tissue in the surgery. We fix it outside and place it back. If it is not placed back, a nasal drooping may occur. The pre-evaluation of the final shape of the nose is one of the most important elements of our communication with the patient.

Listening to the patient’s expectations and finding a common ground between the doctor and patient, depending on how realistic these expectations are, is one of the most important golden standards, affecting the success of rhinoplasty. In other words, if the patient’s expectation coincides with what the doctor can do, then the result is likely to be satisfactory for both the doctor and the patient.

Almost everyone having rhinoplasty can safely leave the hospital after the surgery. And, like everyone else, the patient might be worried, if he/she will need to have a surgery again. In very rare cases, if you have difficulty with nausea or have other health problems that need to be monitored, you can stay in the hospital for one night.

Plan to take one week off from work, school, or other obligations. During the first week, you will feel better every day. People usually feel like themselves at the appointment, which is one week later.

There will be some swelling after the surgery. Most people may not notice after a few months, but swelling may take months to dissolve. Most people usually return to their daily activities one week later, and they return to all activities after two to four weeks.

All surgeries have risks. Fortunately, the risks of rhinoplasty are small and complications are rare. In the preoperative period, your doctor will discuss with you in detail about the risks and benefits of the surgery.

Rhinoplasty prices depend on various factors. You can find an answer to the question “What are the prices of rhinoplasty?” depending on the complexity of the surgery, the doctor’s education, experience, location, your desires, and needs.

Yes. You can see how your nose will look after the surgery. Your doctor will take standardized photos of your face from multiple views before the consultation. With these photos, you can plan everything from the nasal tip view to the side profile view. These photos are aimed at giving you an idea of ​​how your nose will look after the surgery and you can see how your nose will look after your surgery with the 3D Vectra method.

Not for most people. There will not even be a process, which will require you to stay in intensive care. In the postoperative visit, most people evaluate their pain as 4 out of 10.

Most rhinoplasty surgeries are performed by plastic surgeons, facial aesthetic surgeons, or otolaryngologists (ENT). If you want a good rhinoplasty surgeon, training and certification in one of these qualifications are a good starting point.

If you want a surgeon with a good reputation among patients and his/her colleagues, it is an indication that your surgeon has proven his/her expertise in rhinoplasty, if your surgeon has published a large number of articles in the medical literature about rhinoplasty and has been invited to speak at training conferences.

Make sure your surgery is performed at an accredited surgical facility or hospital. You should also feel comfortable with your surgeon. Your surgeon should be able to explain what will happen during the surgery with the terms that you can understand.

The age of completion of the nasal anatomy and bone development has been determined as approximately 17 years of age. If there is no severe functional deformity, rhinoplasty surgeries are performed after 17 years of age.

Revision surgery is performed in cases, where the first surgery is not satisfactory, shape deformities are not completely corrected, and inhaling channels are not working properly.

It is more difficult than the first rhinoplasty. Because the nose was intervened in the first surgery, the inner tissue was worked on. Therefore, it is a more difficult surgery. However, this does not prevent to obtain the desired result in revision rhinoplasty. One of the most common problems encountered in revision surgery is that the tissues required by the nose were removed to obtain the desired shape in the first surgery.

Cartilage tissue is where this is encountered at most. In brief, there is not any difficulty for the patient in either the surgery or the recovery process, except for the extension of the recovery process, if a cartilage transplant is not required. For the plastic surgery expert, it is a more difficult surgery compared to the first one.

It is the displacement of the nasal cartilage and bones. In some cases, this displacement is reflected on the external image of the nose, while sometimes, it is not noticed from outside. As we mentioned briefly above, the deviation is a health problem, that restricts adequate breathing and oxygen intake.

Deviation surgery is called Nasal Septum Deviation. It is usually performed under general anaesthesia and is concluded in 1 hour on average.

Author: Doç. Dr. Erdem Güven
We're writing about our patients.

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