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WHAT IS RHINOPLASTY - SURGICAL CORRECTION OF THE NOSE?
Rhinoplasty – aesthetic and functional nose surgery, in other words means shaping the nose. If surgical correction of the nasal septum (septum) is also needed, we are talking about septorinoplasty .
Probably the most common consultation in head and neck plastic surgery is certainly the one about nose surgery. Mainly it is about possibilities of improving the function and appearance of the nose. The reasons can be different: the bad appearance of the nose since childhood, changes caused by aging or the result of an old injury (in that case, along with rhinoplasty, old scars on the skin often have to be corrected . It is undeniable that the nose has the greatest influence on the appearance of the face, and even small changes in its appearance can contribute to a significant improvement, and thus to the overall aesthetic harmony of individual parts of the face.
The main goal of the operation is to improve the aesthetic appearance so that the nose is in a more correct relationship with the rest of the face. At the same time, we are thinking mostly about the central focus of the observer of our face, which are our eyes and, to a lesser extent, our ears. Images of our patients before and after rhinoplasty realistically illustrate this concept.
AESTHETIC AND FUNCTIONAL RHINOPLASTY - CONSULTATION
The first and most important step
Regardless of whether the reason for the operation is functional (difficulty breathing) or aesthetic , choosing a qualified operator is the most important step in making a decision. A head and neck plastic surgeon is trained to perform nose, ear and throat surgery and head and neck plastic surgery, which guarantees the safe performance of the operation.
The first and most important step in planning the operation is to examine the nose and assess its relationship to the rest of the face. This includes a detailed consultation where the surgeon must find out your reasons for the operation.
You should think about what really bothers you about your nose and be able to explain it clearly during the consultation. A convenient way is to make a small list. Don’t worry, all surgeons like precision and clear expression 😊.
An accurate and in-depth understanding of your problem, attitude and expectations is an essential part of planning the intervention. After all, the same applies to any other aesthetic surgery. For example your surgeon wants confirmation that you are asking for the surgery because YOU want it, not to please someone or something else.
You should also understand that it is not possible to simply take a photo from the Internet and expect it to become your nose. While it is certainly very important to look at photos and imagine what your nose might look like, it is unrealistic to expect a plastic surgeon to “give” you someone else’s nose.
As already commented, the outcome of your surgery may depend on factors such as skin thickness, size of other facial structures, cartilage and bone strength as well as breathing condition prior to surgery.
The thickness and type of skin can affect the success and final appearance of the nose after surgery.
Your functional needs may be a limiting factor in what can be done aesthetically. Additionally, the way the tissue underneath the skin (scar tissue) can affect healing, sometimes in unpredictable ways.
What does your surgeon want to hear?
Tell your surgeon how you want your nose to look, but be open to suggestions and opinions from your doctor if he informs you that your wishes are unrealistic or suggests alternative changes. For example most patients want a straight nose in profile, but in some facial configurations a minimal hump can look even better.
Duty and professional standards oblige the operator to answer all your questions. In this way, you get complete information about the possibilities and limitations of rhinoplasty, as well as the mandatory safety for the patient, which must be taken into account when making a decision for or against surgery.
Your operator and you must agree on the goals of the procedure. If you have doubts or additional questions after the consultation, arrange another interview at the Polyclinic or choose a “second opinion” interview with another surgeon, it’s a great way to make everything important fall into place. You should be confident and satisfied with the chosen surgical plan and have realistic expectations of what can and cannot be achieved.
Photography
Photographing and planning the surgical procedure are an integral part of the preoperative preparation. It will be explained to you how the cartilaginous and bony structures of the nose can be shaped to give the nose a new shape and how, for example, reshaping the chin can further improve the desired results. As part of rhinoplasty planning, photography is done from several viewing angles.
It shows the relationship between eyebrows, nose and chin. It allows measurement of projection (how far the tip of the nose goes forward) and rotation (position of the tip of the nose up or down).
It shows the possible curvature of the nose, problems with the deviation of the septum (nasal septum). It also shows the width of the nose well.
It shows the triangular shape of the tip of the nose, the width and shape of the nostrils. It also shows the columella (skin between the nostrils).
It shows the harmony of the nose with the cheeks and other parts of the face.
Evaluation of the nose in facial expressions such as laughing.
Simulation of results
Although computer simulation results can be exactly what you want, it should be remembered that it is only about harmonizing wishes, i.e. surgeon’s preferences when planning the procedure. That picture does not show the result as it will be after the actual surgery.
It should not be forgotten that a good part of rhinoplasty is a matter of aesthetic criteria and the taste of the surgeon. It is part of what is known in the professional literature as the “Art of rhinoplasty” and is a very important part of the concept of rhinoplasty.
Be sure you understand the goals of your prospective carrier! The fact is that there is no such thing as a “perfect” rhinoplasty. Even if a surgeon performs identical surgery on identical twins, there is no guarantee that the noses will look the same. It is always about variations in the long-term healing process.
Some surgeons like the so-called simulations of results, while others draw on printed photographs or explain surgical procedures graphically for patients to understand. Each of these methods is equally valuable, and the surgeon chooses the one he is most comfortable with.
Ideal age for rhinoplasty
Many questions focus on the minimum or maximum age for surgery.
Aesthetic nose surgery is best done after the physical growth of a young person is over. This usually means 16 years for female, 17-18 for male patients. The exceptions are very severe deformities with difficulty breathing, when surgery can be performed at an earlier age.
On the other side of the age spectrum, rhinoplasty can be performed in the elderly if there are no other medical obstacles. In older people, the cartilage becomes thinner and loses its elasticity, which leads to the “lengthening” of the nose and the fall of the tip of the nose. Then the nose can consequently look more humped than at a younger age. There may also be a decrease in the space inside the nose and difficulty breathing.
All of this can be the subject of additional surgical steps to improve or prevent the problem.
They always remain the same - a significant improvement in appearance, a natural-looking nose without the so-called "appearance of the operated nose", a nose that is in harmony with other parts of the face and maintained/improved function.
SURGICAL TECHNIQUES OF RHINOPLASTY
How do we perform the operation?
Rhinoplasty – aesthetic and functional surgery of the nose, begins with incisions to access the cartilaginous and bony structures of the nose. Most incisions are made inside the nose, ie. they are invisible from the outside. In other cases, the incision is made in the area of the columella (skin between two nostrils). In the next step, the cartilage and bone are removed, added or reshaped to give the nose a new look. For example, if the tip of the nose is too large, the operator can reduce its size in this way.
At the end of the operation, the incisions are closed with surgical sutures, and immobilization (plasters and a plastic splint) is placed on the outside of the nose.
Usually we put nasal nasal tamponade from the inside on both sides to maintain the stability of the nasal septum in order to keep the nasal 3-dimensional shape achieved at the end of the operation. Regardless of whether nasal package is applied, most patients experience some difficulty breathing through the nose for the first few days after surgery. This is the consequence of increased swelling inside the nose, which furtunatelly improves very quickly.
After the surgery, monitoring in the recovery area (intensive care unit) is mandatory, usually for several hours, until you are ready to be discharged from the Polyclinic.
Risk factors for rhinoplasty are generally small, but all of them will be discussed in consultation.
Preservation structural rhinoplasty
Modern techniques of rhinoplasty include recent findings that are applied in preservation rhinoplasty.
AFTER THE OPERATION
The vast majority of patients do not feel significant pain after the procedure. In any case, analgesics are administered as needed.
Minor swellings and hematomas around the eyes and surrounding facial tissue may appear in the first few days after rhinoplasty. In this case, cold compresses help reduce swelling and the feeling of pressure. If the nose is packed, the tamponade is removed on 3 – 5. day after surgery. Resorptive sutures are placed inside the nose and do not require removal. All external stitches, if present, are removed after 5 – 8 days.
After detamponade, severe nasal swelling should be avoided for the next week. Immobilization serves as protection against trauma, ie. to keep the structure of the nose stable for 5 – 7 days. It is very important to follow the instructions of the surgeon, and especially to keep your head raised while lying down and sleeping for a short time after surgery.
It is necessary to adhere to the recommended postoperative controls for the purpose of monitoring healing. All unusual changes should be reported to your doctor in time.
A few more useful instructions:
Sometimes nasal drops or a spray are given in the nose after the procedure to help restore the function of the nasal mucosa.
Remember, always inform your doctor when changing recomendation or if prolonged use of nasal drops happens.
Increased physical activity should be avoided for several weeks after surgery.
If you wear glasses, be careful not to press on the skin of the nose in the sensitive operated area. As an alternative, the application of steripore thin bandage may be recommended to reduce the pressure of the spectacles in the sensitive phase after surgery.
Excessive sun exposure, strenuous exertion and the risk of injury during summer activities should also be avoided.
With a thorough prior consultation and clinical examination, as well as achieving realistic expectations of the patient, experience and qualification of the rhinosurgeon, rhinoplasty can significantly add to the quality of life of both the patient and the operator.