Rhinoplasty (Nose Surgery)
Rhinoplasty is definetely the most challenging and sofisticated operation within all aesthetic procedures. Today, we can obtain more natural and functional results using modern rhinoplasty techniques.
It is obvious that the best results in rhinoplasty are the nose simply appear naturel, not look operated and in harmony with the other facial features.
Rhinoplasty is a highly delicate and technical aesthetic surgery operation, although if it is performed well the patient satisfaction is very high. The resulting improvement in appearance may be psychologically beneficial, almost always bringing increased self-satisfaction and self-confidence. Patients, however, should not always expect universal approval from all of their family members, friends, and acquaintances following surgery since they may not be aware of your reason and motivation for a change in your appearance. It is more important that patient and surgeon be pleased with the eventual surgical outcome. Ethically no surgeon can guarantee the results of any cosmetic surgery he can only promise to do everything possible to do his best to correct the patient’s problem.
Although rhinoplasty usually performed on the younger age groups, excellent results may also be obtained in patients in their fifties and sixties.
Rhinoplasty surgery is performed by using special delicate instruments. During the surgery the bone, cartilage, and soft tissues of the nose are sculptured, the angles with the lip and the forehead are readapted to obtain a desirable natural appearing result. At the present time rhinoplasty is not a routine reduction procedure of the nose. It is rather a balancing procedure in which the reduction of some skeletal structures and augmentation of some deficient parts are performed together, for aesthetic and functional improvements. Functional problems can be also corrected during the rhinoplasty operation. Deviated septal cartilage can be straightened and hypertrophic turbinates can be reduced together with reshaping of the nose.
Today open rhinoplasty technique is more popular and reliable due to its several advantages. It allows wide exposure to the surgeon, better evaluate anatomy and deformities, and executing maneouvers under direct vision. I prefer open rhinoplasty technique in majority of my patients. A five mm incision at columella disappears within a few weeks and is never visible if it was performed adequetely.
Plastic surgical correction of the nasal deformities should never be performed without contemplating and analyzing the surrounding facial features. During the consultation we will explain to you how we can best accomplish the changes you desire, always keeping in mind the need to keep the nose in harmony with your particular individual facial features. At times, as your surgical advisor, we may recommend other subtle changes in your face (chin contour, lip shape, etc), to help you look your very best following surgery.
All surgical procedures carry some degree of risk. Fortunately, the risk factors in rhinoplasty surgery are quite low. In the vast majority of patients undergo surgery, postoperative healing with no significant complications of any kind. Rarely and infrequently, complications such as some degree of postoperative bleeding, delayed healing, and small irregularities and slight asymmetries of the nose can occur, since not all of these factors are under the control of the surgeon.
A succesful rhinoplasty begins with careful preoperative preparation and planning. The initial consultation is essential to evaluate the problems and understanding expectations of the patient. On the physical examination the skin envelope, internal skeletal nasal structures are evaluated together with nasal airway function.
Computer imaging is performed on the pictures taken from several views to show what changes may be possible after rhinoplasty. Computer imaging is very helpfull for both surgeon and patient, in planning of the surgery, demonstrating the possible result and understanding expectations of the patient. During the consultation all possible changes are discussed with the patient.
Plans will be made for your admission to the hospital the morning of your surgery for a general physical examination by the anesthesiologist, appropriate blood tests, and occasionally chest and sinus x-ray films. These are certainly important and necessary preoperative studies to ensure your well being during surgery. The operation is performed under general anesthesia, however the majority of the patients can be discharged a few hours following surgery feeling quite comfortable and generally free of pain.
Aesthetic rhinoplasty typically is performed to reduce the overall size of the nose, reshape a tip, remove a nasal hump or improve a poor angle between the nose and the upper lip. In some patients it is necessary to add tissue in order to improve contour. One or all of these changes can be made during a single operation.
You will find your operation essentially a comfortable experience, generally with little or no discomfort. Anesthesiologists will administer intravenous sedatives and tranquilizers before the operation to keep you very comfortable. Happily, little if any pain occurs after rhinoplasty. Pain medication, however, is always available should you find it necessary.
The small cast protecting the outside of the nose remains in place for 5 to 7 days. We never place intranasal packs, however if a significant airway correction is performed silicon intranasal splints can be placed. These splints are also removed together with external cast on the 5-7 days after surgery.
We will provide you with a detailed list of “do’s and don’ts” to optimize your postoperative course. The patients are advised not to take aspirin—it may precipitate bleeding—and take care to not hit your nose in any way and to keep the nasal splint bandage dry.
At approximately 6 or 7 days of the surgery, external nasal cast will be removed. If internal nasal splints were placed during the surgery they will be removed and paper tapes are placed on the nose. The paper tapes will stay 3-4 days on the nose and will be removed by the patient. Generally patients are able to return to normal activities such as work or school at this time. Strenuous sports, exercises, swimming, or other heavy physical activities should be curtailed for approximately 3 to 6 additional weeks.
Although the new shape of nose is apparent rather quickly after removal of the splint, it takes several weeks for the majority of the swelling to disappear and shrinkage of the new nasal configuration to occur. This is a gradual process that cannot be hurried. Small, subtle, and generally favorable changes take place over a period of several months.
The degree of improvement depends on the extend of the corrective work undertaken and basic structure of your nose and skin. An obviously disfigured nose will show dramatic results. On the other hand, a slight bump and a tip that is a bit too large may be succesfully corrected, yet the results may be subtle. It is common after some types of rhinoplasty for relatives or friends to remark that they do not see a major difference. Do not consider such a reaction an indication of failure. On the contrary, if it looks better and natural, it may go unnoticed. The intention, after all, is not to create a “new” nose that draws attention to itself, but rather one that blends subtly into the overall features of the face in the proper proportions.