RHİNOPLASTY
Rhinoplasty (aesthetic nose surgery) is the procedure to correct or permanently reshape the nose, making it aesthetically more beautiful and attractive. Our eyes, mouth and nose are one of the most common parts people look at when talking face to face. As remarkable is the beauty of the nose, the prominent deformities in the nose is equally noticeable.
Deformities of the nose may be caused by trauma or birth defect and often accompanied by breathing problems. The person’s dissatisfaction with the shape of the nose or the prominent deformities in the nose can cause socialization problems, lack of self-confidence, continually looking at the nose or avoiding the mirrors, avoiding taking photos from certain angles. The need for rhinoplasty arises at this point to correct the shape of the nose.
Rhinoplasty is one of the most common plastic surgeries in our country and in the world. It is accepted by both ENT and plastic surgeons as one of the most difficult and delicate surgeries among plastic surgeries.
Rhinoplasty can be performed by an otorhinolaryngologists or plastic surgeons specializing and experienced in the nose surgeries.
If there are functional problems such as nasal breathing (deviation, concha enlargement , polyps, nasal valve stenosis, choanal atresia, etc.) along with the nasal shape disorder, it is recommended to perform the operation by the ENT specialist.
In these cases, if the surgery is to be performed by a plastic surgeon, it is recommended to get support of an ENT doctor.
In addition to the surgeon's skill, experience and patience, an aesthetic and artistic perspective point of view is also required in surgery process.
Besides, surgeons should also be open to innovations and follow developments.
Rhinoplasty process
Considering the period of thinking about having surgery, taking decision, researching the surgery and specialist, visits to the doctor, surgery, postoperative period, check-up examinations and follow-up period, rhinoplasty is actually a long process.
This process requires the candidate for the surgery and the doctor to work in full harmony with mutual trust and patience.
Such cooperation is one of the most important factors for achieving the desired result and facilitating the rhinoplasty process for both the patient and the doctor.
Who Can get Rhinoplasty?
People who have realistic expectations, know what they want, psychologically stable, understand the process of rhinoplasty, have high motivation, have no serious health problems that prevent surgery, and reached the age required for bone and cartilage formation are candidates for rhinoplasty.
Age factor in aesthetic nose surgery. How old do you have to be to get a nose job ?
Surgery can be performed after the age of 16-17 for girls and 17-18 for boys, when cartilage and bone development is mostly completed.
However, I should also mention that the development of cartilage and bone continue until the age of 22, albeit a little.
For this reason, surgery should be planned after the age of 18 unless there is a very pronounced deformity.
If there are no medical problems and the patient has no contraindications to anesthesia, there is no upper age limit for rhinoplasty.
Surgery can be performed even at the age of 70.
However, patients considering rhinoplasty at an advanced age should reconsider their expectations.
Rhinoplasty and General Health condition
The majority of rhinoplasty candidates do not have significant health problems.
However, patients with chronic diseases (hypertension, diabetes, bleeding coagulation disorders, lung diseases, etc.) should not be operated without being sure that these diseases are under control and without the approval of the relevant doctor. Those with ongoing psychological problems may experience more difficulties in this process.
For this reason, they need to make their decision in a period when they are psychologically stable.
Expectations of aesthetic nose surgery
Although rhinoplasty surgery improves the face perception-beauty of a person, this situation does not directly change one’s business success, social relations, friendship, relationship or marriage. It is not realistic and possible to achieve these expectations instantly and only by an operation.
In fact, the person should consider having surgery for him/herself only.
RHINOPLASTY (AESTHETIC NOSE SURGERY) PROCESS
Pre-Operational Interview
The preoperative interview is the most important stage of rhinoplasty.
Understanding of the doctor and the patient is necessary for good cooperation throughout the process.
Candidates for rhinoplasty often meet with two or three doctors and continue to cooperate with the doctor whose experience they trust and receive positive electricity.
A doctor, for his part, prefer to continue with patients who are positively motivated, knows what they want, what don't want and trust their doctor. Both sides should be open and honest with each other in the interview. The rhinoplasty candidate should explain in detail what changes he wants to his/her nose by surgery. In addition, the patient needs to clearly articulate unwanted changes.
On the other hand, the doctor will also have suggestions and determinations, and the patient should also evaluate them. Although rhinoplasty only changes the appearance of the nose, it also significantly improves the perception of the face. It is important to consider not only the nose itself, but also to take into account its harmony and with the whole face.
The patient should be informed in details and understandable way about the extent of the requests that can be done, the operation process, risks, postoperative and follow-up processes.
If necessary, the interview should be repeated, taking into account that some of the doctor’s explanations may be forgotten or missed.
Preoperative examination
Aesthetic and Functional Evaluation
In the aesthetic examination, the cartilage-bone structures of the nose and the skin are on the table.
Deformities are determined. The patient looks in the mirror and shows the changes he/she wants to be done in his/her nose. In the meantime, the doctor reminds the deformities that the patient does not notice or ignore.
In functional examination, nasal septum, valve area, nasal concha, intranasal cavities are evaluated.
An endoscopic evaluation must be performed during the intranasal examination, otherwise the problems inside will be overlooked.
Most of the rhinoplasty candidates actually have functional (breathing) problems. In patients focused on the rhinoplasty, these problems are often ignored or the patient thinks his current situation is normal because he/she does not have a chance to compare his/her breathing with the normal one.
After a while, patients who are satisfied with the aesthetic appearance after rhinoplasty start to care more about functional problems.
For these reasons, aesthetic and functional evaluations are the parts of a whole.
If there are any problems, they must be corrected during the same session.
Moreover, approximately 20% of rhinoplasty patients who don’t have any problems with nasal breathing and have a straight septum may have breathing problems after surgery. The most important reason is not protected nasal valve and swollen nasal concha . Taking these points into consideration , if necessary, the nasal valve should be supported during the the surgery and the nasal concha should be reduced.
Photo Shooting and Design Before Surgery
After the examination, photo shooting starts. Photographs taken from the front, right and left sides, right and left oblique, bottom and top are helpful for the process.
Problems and points to be corrected are evaluated together with the patient on the photographs. Then, a special program draws the new form of the nose The size of the nose, the shape of the tip of the nose, the arch of the back of the nose, the nostrils, etc. Everything is drawn with the program. Usually 2-3 drawings are enough. Afterwards, we put the pictures side by side and compare these designs to decide which drawing looks better and in terms of balance and harmony. These drawings will also help the patient to get used to his new nose (first eyes and then mind get used to the change in the nose, the adjustment process includes the early postoperative period).It also helps us make the surgery plan. The pictures do not guarantee the results of the surgery. Nevertheless, they determine what we will target in operation. However, mostly we get 90% similarity with the morph we did.
Pre-operative Preparations
Before the operation, routine blood tests are performed and it is investigated whether there is any risk for the operation. Along with the results of the examination, an examination of the anesthesiologists is made to determine whether there are any anesthesia-related surgery risks. In the meantime, you must specify whether you have any diagnosed disease, previous surgery, a drug you use regularly, or allergies (medication, food, etc.) For minimum 1 week before the operation and 1 week after the operation it is recommended to quit blood thinners, vitamins and herbal supplements, and to quit smoking for smokers. It is necessary to fast minimum 8 hours before the operation.
If the surgery is scheduled for the morning time, you shouldn’t eat or drink anything (including water) after midnight before. If the surgery is scheduled for the afternoon, you may have a light breakfast early in the morning. It would be comforting to take a warm shower before surgery and go to bed, thinking positive about the results.
For the postoperative period, easy to wear, buttoned on the front clothes are required. Female patients who will undergo surgery should go to the hospital without make-up and nail polish.
Aesthetic nose surgery
Rhinoplasty can be performed under general or local anesthesia.
If there is no contraindication for the general anesthesia, general anesthesia is preferred.
In general anesthesia, the patient doesn’t hear anything, that makes the process more comfortable for both the patient and the doctor.
Since circulation and breathing are completely under control in general anesthesia, it is safe and all kinds of interventions can be performed if necessary. For those patients, who can’t take general anesthesia, operations that do not take more than 1.5-2 hours can be performed under local anesthesia or sedation.
However, you should remember that local anesthesia only prevents pain, but the patient still can feel touching. This situation may cause discomfort to the patient
There are Basically Two Techniques in Aesthetic nose surgery. Closed Approach and Open Approach
Rhinoplasty can be performed both with closed and open technique
In the closed approach, all incisions are made inside the nose and no incision scars are seen from the outside.
Recovery of the tip is faster.
Open technique is performed by making a small inverted V or W-shaped incision on the columella, the soft tissue that separates the nostrils and the skin is lifted. When the operation is over, the skin is sewn back to the same place. In the open approach, there is also no obvious incision scar after recovery. The scar can be seen by looking very closely and carefully. However, there is no rule that says one approach is better than the other. Closed or open technique surgery is determined according to the difficulty of the problems in the nose, the scope of the planned procedures, and the surgeon's habits. I perform both closed and open surgery with both techniques, depending on the condition and needs of the patient.
In other words, the technique to be used varies and is determined according to the condition and needs of the each case.
Different surgical tools can be used for shaping the nasal bones in the surgery.
Tools such as osteotome , surgical saw, piezo, micro saw can be used.
These instruments are not surgical techniques, contrary to the explanation in media.
Ultrasonic rhinoplasty, piezorinoplasty etc.
All of them got its name only from the tools we use to cut bone.
For example, while the piezo device provides an advantage for smooth and controlled incisions, the inability to use the device in a closed technique.
The same incisions can be done with a thinner micro saw, both in open and closed techniques.
Treating these details, which should be the subject of surgery and surgeons, as different techniques is not the correct approach.
Recovery after rhinoplasty
It is recommended to stay in the hospital for 1 night after surgery.
Staying in the hospital is preferred in terms of follow-up and feeling safe.
However, patients who was operated in the morning can be discharged in 3-4 hours after surgery, if there is no problem. To minimize the possibility of swelling and bruising after surgery, you should lie 45 degrees upright and apply ice for 10-15 minutes per hour. This application should continue for the first three days. After the 3rd day, you can lie lower, and there is no more need to use ice.
Applying more ice than recommended reduces tissue nutrition and increases skin edema.
There may be mild to moderate pain after the operation.
Patients often rate the pain level on a scale of 1-4 out of 10.
The pains can be easily relieved with normal painkillers (for example paracetamol).
We remove the silicone splints 3-4 days after surgery.
The process of removing the splints takes 5-10 seconds and may be a little painful.
After the silicone splints come out, there will be scaling and edema in the nose for several weeks
During the healing period nasal congestion is possible from time to time. Crusting process takes more time in cases of concha reduction or deviation surgeries in combination with rhinoplasty.
In this period, saline water (saline, seawater, ocean water) is used to soften the crusts and reduce edema.
In 7-8 days after the operation, the external nasal splint is removed. This procedure is painless
After the splints are removed, we place tapes. The tapes are removed after 1 week. You can wet the tapes while taking a shower. If the tapes do not bother you visually, you can start to work or study in 8-10 days after the operation. Your nose will still look swollen after the splints or tapes are removed.
You shouldn't worry about it. There will be a rapid improvement within the first 1-3 months.
The swelling sometimes may be asymmetrical and descend at a different rate.
In this case, patients may get the perception that there is an asymmetry in the shape of the nose while they are still in the recovery period.
As the swelling passes, the nose will return to its appearance at the end of the surgery.
You may take a warm shower one day after the operation. Hair can be washed without wetting the plastic splint on the nose. There are no restriction on meal and drinks. You can return to your normal diet before the surgery (soft, easily digestible foods that prevent constipation are recommended on the first day).
You can brush your teeth with a soft-tipped brush 1 day after the operation.
After 3-4 days when the internal nasal splints are removed, you can use a vehicle and travel.
You should not enter a pool for one month to prevent infection. Glasses are not used for 2 months (including sunglasses). If you are going to the sun it is necessary to wear a hat or use a high factor sunscreen (50+ factor). Otherwise, permanent discoloration and stainingmay occur on the nose and surrounding skin. It is crucial to protect the nose from traumas for two months after surgery.
You can do gentle kinds of sports 1 month after the operation. Sports (basketball, football, etc.) with a high probability of injuring the nose can be done after the 3rd postoperative month. An impact that may come before the nasal bones fully heal can cause a deterioration in the nasal structure.
Massage of the nose normally is not required after surgery.
If the massage is needed, your doctor will show you how and how often to do it.
Postoperative follow-up period
After dressings (splints, tape) are finished, check-up examinations are required after 1, 3, 6 months and 1 year. Through checks and follow-ups, we can understand if everything is going good or does the massage or simple external intervention is required.
Patients who live in another city or country are also recommended to be followed up by sending photos.
Complications
Like any surgery, rhinoplasty surgery has its complications.
According to statistics, from 5 to 15% of operations have complications or patient dissatisfaction.
These rates vary depending on the experience of the surgeon in difficult cases and the difficulty of the problem in the first operation.
There is no standard rhinoplasty.
Everyone's face and nose are unique and have their own proportions.
For this reason, making the same nose for everyone is far from aesthetics way.
Each surgery is specific to the person and should be planned accordingly.
More detailed information about rhinoplasty www.revizyonrinoplasti.com.
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