Rhinoplasty (nose surgery) – Procedure
Rhinoplasty is usually performed under general anesthesia. Incisions are made inside the nostrils. Through these incisions, the necessary corrections are made to the supporting structures of the nose (bone and cartilage) in order to achieve the desired result. When required, all necessary manipulation to restore the functionality of the nose is done through these incisions. The duration of surgery is 1.5-2.5 hours. A special splint is placed over the nasal bridge, and special gauze or silicone tubes are placed in the nostrils. This achieves hemostasis,protection from accidental damage, reduction of edema and free breathing immediately after surgery.
After rhinoplasty, swelling and possibly small bruises under the eyes may appear, which subside very quickly. The gauze in the nostrils is removed on the first or second day after rhinoplasty while the splint remains for up to two weeks in order to protect the nose. Great care is required to avoid injury to the nose for at least a month.
Return to work after rhinoplasty is estimated at a week after surgery. There will be some indistinguishable swelling, which gradually subsides after 2-3 months. The appearance of the nose, which is perhaps the most important feature of the face thanks to its three-dimensional structure, concerns both men and women. Furthermore, there is often a functional problem in breathing. A successful rhinoplasty boosts a person’s self-confidence and improves their quality of life by restoring and breathing.
The prominent area on our face is the tip of our nose. Therefore, the nose is very important for our appearance. Nose tip plastic surgery (Tip plasty) is a surgical procedure that specifically aims to correct deformities of the nose.
Acrorinoplasty is very popular in recent years. Patients who are dissatisfied with the shape or size of their nose are good candidates for this procedure. Here, we cover everything you need to know about acorn plastic.
What is Acrorinoplasty (Tip plasty)?
Acrinoplasty is a type of rhinoplasty that is preferred by patients from all over the world to change the nose and get an aesthetically pleasing image. The goal of the operation is based on the needs of the patient and does not affect areas such as bones, cartilage, skin and mucous membranes.
Different techniques can be applied to the procedure according to the patient’s needs. The closed rhinoplasty technique is one of them. In the closed technique, the duration of the operation is shorter than the other techniques and the recovery after the surgery is much faster. Another technique is the open rhinoplasty technique. As with other open rhinoplasty surgeries, the surgeon’s control area is much wider with open rhinoplasty surgery. Thus, in difficult cases where cartilage grafts need to be placed accurately, open acryoplasty is preferable. Both methods have advantages and disadvantages. Depending on your situation, you can evaluate both methods and choose with the help of the specialist.
How long does the surgery take?
The duration of nose surgery varies from person to person, as in other surgeries. The duration ranges from 30 to 60 minutes depending on the problem. Recovery time may be shorter if the patient pays attention to the doctor’s instructions.
What are the precautions after post-plasty surgery?
It is necessary to avoid heavy and intense sports for a certain period of time. Avoid using glasses with thick frames. You have to be careful when brushing your teeth. Postpone activities such as swimming during the recovery period. Avoid blowing your nose and sneezing as much as possible. As with other rhinoplasty surgeries, protect your face from sunlight.
If you do not have an anatomical problem with your nose and you are just not happy with the tip of your nose, acupuncture may be the most suitable operation for you. To decide which rhinoplasty surgery will be right for you, you should consult a plastic surgeon.
Liquid rhinoplasty, or non-surgical rhinoplasty, is an injectable treatment with hyaluronic acid in the subcutaneous area of the nose in order to correct its shape. It is an excellent choice for patients who have individual deformities in their nose. An example is a hump in the back of the nose, a crooked nose, a drooping tip or various small asymmetries.
Moreover, liquid rhinoplasty is an excellent choice for those who want immediate results. It is also suitable when they are unable to pay for a rhinoplasty surgery or can not waste a week on recovery time. Finally, patients can also undergo liquid rhinoplasty to “test” if they want to undergo surgery in the future. The effects of liquid rhinoplasty are temporary.
- Liquid rhinoplasty :The use of hyaluronic acid in rhinoplasty
It is also important to remember that during the liquid rhinoplasty procedure, we inject hyaluronic acid, so we add volume. Liquid rhinoplasty will increase the size of the nose, so it is not a good choice for those patients who already have large noses. While there are a variety of techniques we can use to create the illusion of a smaller nose, the nose will be objectively larger.
The most important thing to remember is that there are risks associated with this process. The nose has a complicated vascularity. Essentially, a connection is made in the area of small arteries and veins that eventually connect to the vessels of the eye. The purpose is not to create fear in the candidates for non-invasive rhinoplasty but to awaken the world. Liquid rhinoplasty should be performed by a Plastic Surgeon as he is the specialist who knows the anatomy and the techniques of bloodless rhinoplasty.
- Complications and Risks in Liquid Rhinoplasty
Some side effects associated with injecting hyaluronic acid redness, tenderness, swelling and bruising may occur. These are never very serious and are resolved within a few days. Liquid rhinoplasty treatment in the hands of non-specialist doctors can cause ischemia of the skin and even necrosis.
The most serious complication is the intravascular injection of the material resulting in obstruction of the ocular artery and loss of vision up to blindness. Cases have been reported in the millions of treatments worldwide.
It is obvious that it is a treatment that should be done by doctors specialized in the use of hyaluronic acid but also in anatomy. The plastic surgeon is the appropriate doctor in the application of injectable implants as he understands better than any other doctor the anatomy of the human body and head. The plastic surgeons experienced in the use of liquid rhinoplasty and understands better than anyone the perfusion and ischemia of the tissues. These abilities are a guarantee for treatments without serious events.
I’m sure this varies, but in my practice, it ranges between about 500 and 1000 euros depending on the type and amount of injection used.
- Duration of effect
Unlike a surgical rhinoplasty, the results of this non-surgical procedure are temporary and last between 6 and 18 months.
- How soon can I have a nose job after a bloodless rhinoplasty
The injection should be dissolved before the nose job. As the results of rhinoplasty are permanent, it is wise to show your surgeon the true shape of your nose without having the nose changed from a recent wet rhinoplasty. So the surgeon has a good idea of the changes he needs to make with his technique.
Secondary Rhinoplasty is the most demanding cosmetic surgery. It is also known as Reconstructive Rhinoplasty, Revision Rhinoplasty, Rhinoplasty Reoperation. It is essentially the revision surgery of a failed Rhinoplasty. Many of these surgeries result in reoperation as patients are usually not satisfied with the aesthetic result.
The majority of plastic nose surgeries that result in functional failure (the patient’s breathing does not improve) are not due to anatomical failures of the surgeon. They are mostly due to incorrect preoperative assessment of coexisting inflammation and thickening of the mucous membranes. Failure in the cosmetic part of the operation is usually the responsibility of the surgeon. He must have explained and agreed with the patient the expected result. Rarely, it may simply fail to deliver the expected result. Rarely can an operation be “spoiled” by the patient following the wrong postoperative instructions.
During the closed rhinoplasty, all the incisions are made inside the nose, so that the operation does not leave visible scars. Manipulations performed on the nasal cartilage, bones and septum are completed with these internal incisions. Closed rhinoplasty is a perfect technique for specific imperfections. It cannot be compared to open rhinoplasty as a technique. With open rhinoplasty the surgeon is given more comfort for the use of more extensive surgical manipulations and consequently more complex problems are corrected.
This is the main reason that closed rhinoplasty has a shorter recovery period and less swelling compared to the open technique. The recovery time of closed rhinoplasty is 7 to 10 days. The result of the operation is permanent.
Closed rhinoplasties are performed as an alternative to the open technique. Instead of exposing the nasal structure, incisions are made in the nasal membrane at various locations to access different parts of the nasal cavity. By opening the nose, patients are able to have reduced recovery times and invisible scars. Whatever your goals may be, whether it be ethnic rhinoplasty or rejuvenation, a closed technique can probably be used.
The skeleton of the nose, ie the cartilage and bones are not exposed as in open rhinoplasty, which means that much of the operation is done by touch. The addition of a rhinoplasty endoscope increases the possibility of visual inspection. When the operation is completed, minimal sutures are placed and a splint is placed. With the closed rhinoplasty we can erase the hump of the back of the nose, to thin the bone structure but also the cartilaginous one in order to thin a wide nose. Closed rhinoplasty can be used to correct breathing problems caused by abnormalities inside the nose. Diaphragm and groove plastic can be made without any restrictions. The goal of a closed rhinoplasty is to achieve the harmony of the face by changing the shape, size or angle of the nose.
On the contrary, we are not given the possibility of big changes in the tip, ie in the tip of the nose. Implant placements where they are needed are less accurate. Closed rhinoplasty is therefore a very useful technique on noses that are suitable to be corrected by this method. Briefly, with the method of closed rhinoplasty we correct: the size of the nose, the shape, the angle and we perform a functional rhinoplasty for free breathing.
- Complications of Rhinoplasty
As with any major surgery, rhinoplasty carries risks such as postoperative bleeding and infection. Other potential risks specific to rhinoplasty include:
- failure to improve respiration
- a permanent tenderness around your nose
- persistent bruising
- a deformed scar
- the perforation of the diaphragm
- the failure to achieve the desired result for the patient. .
For every possible complication, a doctor prescribes and takes measures so that they do not occur. For example, before starting rhinoplasty, the patient receives appropriate intravenous antibiotics while the nasal chamber is depilated and stained with iodine antiseptic.
When the patient is asleep, local anesthesia is performed. It may seem like an oxymoron, but local anesthesia is a very important part of the operation.
Injection with local anesthetic has a dual role. On the one hand to prevent the transmission of stimuli from the area to the brain so that the patient is not in pain during the postoperative period and on the other hand to create hemostasis conditions for a bloodless surgery. This is achieved because the local anesthetic solution is mixed with 1: 100000 adrenaline which strongly constricts the blood vessels of the nose. Poor hemostasis with bipolar diathermy also plays an important role in preventing possible postoperative nasal bleeding.
With hemostasis we prevent the possibility of postoperative nosebleeds and intense bruising. You can see that countermeasures are being taken for every possible complication. With hemostasis we prevent the possibility of postoperative nosebleeds and intense bruising. You can see that countermeasures are being taken for every possible complication.
Achieving the desired plastic nose result is achieved when the doctor listens carefully to his / her patient in order to understand what his / her expectations are and to analyze in detail the possibilities of achieving the goal. It must be understood that there is no one-size-fits-all pattern.
Understandably, changes to a scoliotic, slanted, crooked, crooked nose are legitimate. What patients sometimes do not realize is that dramatic changes in the length and elevation of the nostril are undesirable as it is not legitimate for example to change to a long but full male face a nose with a large elevation of the nostril (French nose). On the contrary, in a slim woman face can highlight the features in the best way.
- The planning of a Rhinoplasty
Before planning your rhinoplasty, you should meet with your surgeon to discuss important factors that determine the success of your surgery. This meeting generally includes:
The medical history.
An important question is about the motivations that pushed you to ask for a plastic nose and what are your goals. You will be asked questions about your medical history – including a history of nasal congestion, allergies, surgeries and any medications you are taking. If you have a bleeding disorder such as hemophilia as you may not be a good candidate for rhinoplasty.
Your doctor will perform a complete physical examination, including any laboratory tests, such as blood tests. It will also look at the features of your face and the inside and outside of your nose. A physical exam helps your doctor determine what changes need to be made and how your physical characteristics, such as the thickness of your skin or the strength of the cartilage in the nostrils, may affect your results. Physical examination is also crucial in determining the effects of rhinoplasty on your breathing.
It is very important to take pictures of your face from different angles. Computer software can be used to manipulate photos to show you what kind of results are possible. Your doctor will use these photos for before and after evaluations, report during surgery, and long-term reviews. Most importantly, the photos allow for a specific discussion of the goals of the surgery.
A discussion of your expectations.
We need to talk about your motivations and expectations. It must be understood what a rhinoplasty will offer you. It is normal to feel a little embarrassed talking about your appearance, but it is very important that you are open about your desires and goals.
If you have a small chin, your surgeon can talk to you about performing surgery to increase the visibility of your chin. This is because a small chin will create the illusion of a larger nose. It is not common, but a so-called prophylaxis can better balance the profile of the face.
Once the surgery is scheduled, you should arrange to have someone to take you home when you are discharged.
Foods and medicines:
Avoid medicines containing aspirin or ibuprofen and generally non-steroidal anti-inflammatory drugs for two weeks before and after the nose job. These drugs can increase the body’s bleeding mood. Take only medicines that have been approved or prescribed by your surgeon. Also, avoid herbs and supplements.
If you smoke, it is a very good idea to quit even temporarily. Smoking slows down the healing process after surgery and can make you vulnerable to ischemia and infections.
- What to expect before and after Rhinoplasty
The access of the nasal skeleton to Rhinoplasty can be done as Closed Rhinoplasty, with incisions inside your nose or Open Rhinoplasty through a small external incision in the stylus at the base of your nose, between your nostrils. This is followed by the preparation and separation of the skin from the cartilage and nasal bones. Then follow the adjustments to the structures that will bring the result you want.
It can change the shape of your nasal bones or cartilage in a variety of ways, depending on your needs. For small changes, cartilage taken from your diaphragm or ear can be used. For larger changes, cartilage can be used on your side. After these changes, the skin of the nose is repositioned, the signal is checked and the wound is closed.
If the dividing wall between the two sides of the nose (diaphragm) deviates, a diaphragm is performed to improve your breathing.
After the operation you will stay in a recovery room, with specialized staff.
After surgery: After surgery you should rest in bed with your head in a position higher than your chest, to reduce bleeding and swelling.
In most cases, the internal splints remain for one to seven days after the rhinoplasty. The external splint stays on your nose for a week and offers protection against accidents that may occur.
Mild bleeding, gonorrhea and clots common for a few days after surgery or after removal of the bandage. Your doctor may place a “gauze pad” under your nose to absorb fluids.
- Postoperative Rhinoplasty Instructions
- Avoid strenuous activities such as aerobics and jogging.
- Take baths and showers while having bandages on your nose.
- We do not blow our noses.
- Eat foods high in fiber, such as fruits and vegetables, to avoid constipation. Constipation can force you to strain, putting pressure on the area of surgery.
- Avoid extreme facial expressions, such as smiling or laughing.
- Brush your teeth gently to limit the movement of your upper lip.
Wear clothes that fasten at the front. Do not pull clothes, such as shirts or sweaters, over your head.
In addition, NO glasses or sunglasses on your nose for at least four weeks after surgery to prevent pressure on your nose. Use SPF 30 sunscreen when outdoors, especially on your nose. Too much sun can cause permanent irregular discoloration on the skin of your nose.
Temporary swelling or bruising with discoloration of your eyelids can rarely occur from two to three weeks after rhinoplasty. Swelling of the nose lasts longer. Limiting dietary salt will help it escape. Do not put ice on your nose after surgery.
- Rhinoplasty results
Very small changes in the structure of your nose – often measured in millimeters – can make a big difference in how your nose looks. In most cases, an experienced nose plastic surgeon can achieve the desired results. Even the most experienced will warn you or even discourage you if you are not a suitable candidate. If you have already had a rhinoplasty, you should wait at least a year for the secondary surgery.
- Rhinoplasty and septoplasty
Rhinoplasty is a surgery to change the shape of the nose. Because both breathing and the shape of the nose are interrelated, a rhinoplasty can sometimes be done not only to change the way the nose looks, but also to improve nasal breathing.
Nasal septum surgery is a surgery to improve breathing by adjusting the septum that separates the nasal chambers on one right and one left side. When the septum is crooked, it can make it harder to breathe through the nose. A septoplasty is often combined with rhinoplasty. Another parameter to be investigated is the presence or absence of hypertrophic conchae. Usually, a radiofrequency ablation is the best solution. In case of particularly hypertrophic cavities, I prefer conchoplasty. This consists of trimming the conchae so that they do not recur.
- Autologous fat transplantation (microfat and nanofat grafting) for small asymmetries and abnormalities in the skin of the nose
A great weapon in the quiver of the Plastic Surgeon to smooth out abnormalities expressed in the skin of the nose but also to rejuvenate tissues is the autologous fat transplant. Fat is usually obtained from the lower abdomen or from where the candidate wishes. The fat graft is processed in a very thin graft layer (micro-fat) and homogenized so that the Plastic Surgeon can pass it through a thin cannula and without much pressure on the plunger of the syringe and on the other hand to ensure maximum viability of the graft. This implant can correct small abnormalities which are not easy to correct without a nose plastic. It is understandable that this minimally invasive technique is gaining more and more ground. When applied by specialists the results are particularly satisfactory with little recovery time.
- Is rhinoplasty a simple operation?
No. Rhinoplasty is a demanding operation. This is due to several factors. First, the nose is an intricate 3D shape located in the middle of the face. The changes that occur during rhinoplasty are often very small. But these changes can make a big difference in the way the nose looks and works. Because these changes are small, the margin of error is even smaller.
Swelling and the application of local anesthetic to the skin change the nose during surgery, hiding many of the subtle changes that have been made. The surgeon’s experience in this operation is what determines success. The Plastic Surgeon must recognize what changes each movement will bring about by looking only at the skeleton of the nose. Rhinoplasty also does not have a standard design or a defined step algorithm. The Plastic Surgeon adapts each operation to the needs of the patient.
- Rhinoplasty cost
Rhinoplasty cost is mainly determined by the complexity of the operation and consequently by the required surgical time to achieve the desired result. Undoubtedly another factor is the choice of hospital. Understandably, a clinic with non-negotiable principles in the quality of health care tends to be more expensive than clinics that simply maintain the level of safety alone.
In the field of health and cosmetic surgery, perfection is required and not only what is provided by law. Thus, it is good not to look primarily at the cost but at the quality of services provided by the respective hospital and the doctor.
It is understandable that the operated nose is a much more difficult task for the specialist as all the structures and tissues of the nose show postoperative fibrosis. Thus, the operation becomes time consuming. It is very important to choose as patients a competent surgeon but it is equally important that we surgeons choose the cosmetic rhinoplasty operations that we will do.
A percentage of people have unfulfilled expectations. It is our obligation to diagnose such cases in the preoperative discussion (Body Dysmorphic Disorder). This is often difficult and requires caution as these patients are “trained” by repeated rejections by previous surgeons. Finally, I believe that the potential financial benefit of the surgeon but also the most economical operation to which a patient-surgeon can agree is a big trap. The golden opportunities especially in a nose plastic often prove to be quite expensive both financially and psychologically
Rhinoplasty on a curved nose with a strongly convex and drooping tip
Reconstructive secondary rhinoplasty to restore the symmetry of the nostrils and the projection of the nose after an old operation. The nostrils were narrow and the nose was too short. These failures caused, in addition to an aesthetic and psychological problem, intense difficulty in breathing. The patient is satisfied and can and does breathe properly.
Reoperation after a failed Rhinoplasty a year ago to another surgeon. The patient was not satisfied with the aesthetic result. He also had more severe difficulty breathing. This is his 3 month postoperative image happy in both the aesthetic and the functional part.
- 1,5 - 2,5 hours
- Recovery period
- 1 - 2 weeks