Before And After Rhinoplasty
Rhinoplasty is an operation that allows you to change the aesthetic characteristics of the nose (shape, size, deformities and defects such as the arch of the nose) by affecting the bones and cartilage of the nose and making the face proportional. Prior to the operation, the surgeon must perform a detailed examination and careful evaluation of the imaging materials and create a layout with the patient to be carried out during the surgical procedure. It is important to perform accurate examinations before the surgery (they can be done from the age of 16, which means when the bone tissue development in humans is complete). Rhinoplasty is a painless surgical procedure that is performed under general anesthesia in a hospital for a maximum of one day.
Rhinoplasty candidates are those who would like to have one of the options below:
Increase or decrease in the size of the pyramid of the nose
Change in the shape of the head or bridge of the nose
Narrowing of the nostrils (nose openings)
Change in the angle of the forehead – nose – upper lip
Septoplasty and Rhinoplasty
In the first meeting, the surgeon performs a comprehensive examination to analyze the basic condition of the patient and choose the most appropriate surgical procedure for rhinoplasty to achieve the best aesthetic and functional results.
Particular attention is shown to the proportions between the nose and the face, the degree of deformation and the type of skin of the nose: healing is achieved by reshaping the skeleton of bone and cartilage and is affected by the quality and shape of the skin as well.
Careful analysis of these factors allows the surgeon to choose the most appropriate surgical technique for the patient’s condition:
Closed rhinoplasty (closed technique) is mostly used to make minor corrections such as simple removal of a hump or lightly replacing the tip of the nose. Experienced surgeons use the closed rhinoplasty technique to correct the highly complex nose and nasal septum. This technology has the advantage of not leaving visible marks with the naked eye.
Open rhinoplasty (open technique) is used in the case of a very crooked nose so that the surgeon can see the area in detail and get the best results. One of the disadvantages of open rhinoplasty is that it leaves a visible scar on the nasal stent (a thin piece of cartilage covered with skin that separates the nostrils).
Types of incisions used in rhinoplasty
Rhinoplasty and septoplasty can be performed with different types of incisions depending on the surgical technique chosen:
The incision through the nasal columella made along the stent (the structure that separates the nostrils), used only in the open technique, is an external skin incision about 3 mm in length.
Making a cartilaginous incision in the space between the triangular cartilage and the upper cartilage.
Making an incision on both sides of the cartilaginous septum.
Making a marginal or subchondral incision along the edge of the upper cartilage for better access to the tip of the nose.
Killian incision. It contains the approach to the nasal septum, which is believed to be less harmful and is used to support the tip of the nose. An incision is made about 2 cm behind the cartilaginous septal wall.
Transverse meniscus incision; It is composed of mucous membrane and lower cartilage to remove excess upper cartilage and reduce the size of the nasal tip.
What to do before rhinoplasty surgery
A month before rhinoplasty and rhinoplasty, it is necessary to take a break from:
Medicines that contain acetylsalicylic acid (such as aspirin, etc.), non-steroidal anti-inflammatory drugs (such as Voltaren and others), omega 3 and vitamin E because they increase the risk of bleeding.
Treatments that include oral contraceptives and estrogen hormones (which also increase the risk of bleeding).
Smoking (the incidence of complications increases significantly in smokers, as nicotine acts as a peripheral vasoconstrictor and thus greatly hinders the healing process).
The patient should undergo laboratory tests, ECG with a detailed cardiac examination, and other tests that the surgeon deems necessary.
The patient should fast from midnight on the day of surgery and can continue to follow a fluid diet the evening of surgery.
On the eve of the surgery, take a good shower, remove nail polish from the fingernails and toenails, and go to the operating room after cleaning your face well, without makeup (for women), and with a carefully shaved head (for men).
Rhinoplasty is performed under general anesthesia and takes an average of two or three hours, depending on the technique chosen and the difficulty of the case. It is performed in an outpatient clinic or during one night in the hospital.
Rhinoplasty – stages of rhinoplasty:
The patient is placed under anesthesia.
Incisions are made inside the nostrils (in the open technique, an incision is made for the outer skin on the nasal stent).
The skin is separated from the main skeleton and the dorsal region of the nose is formed by removing the osteochondral tuberosity
If necessary, the nasal bones are broken and the back of the nose is reconstructed, reducing the width of the pyramidal region of the nose
If the width of the nostrils is reduced, two small pieces of skin are excised from the base of the nose
If necessary, cartilaginous segments of the nasal septum, nasal tip or ear (especially in the case of septoplasty) are placed to support the limb, improve respiratory function and improve the end result.
We continue to sew the incisions.
At the end of the surgery, nasal tampon (silicone) are placed in both nostrils and a spare nose strip (splint, plaster) is placed on the back of the nose (made of plaster, aluminum or plastic) to stabilize the cartilaginous and bony structures.
It is recommended to spend the first days of the recovery period in a cool environment resting with the head higher than the body (two pillows are placed under the head during sleep allowing you to elevate your back without disturbing the neck) and to take the recommended analgesics and/or medications regularly.
The silicone placed inside the nose in the surgery is usually removed 4-5 days after rhinoplasty. The cast is removed after 7 days and replaced with a protective splint which will be removed after 7 days. It is recommended to apply a special ointment inside the nose and over the entire area affected by the surgical incisions in the days after removing the silicone from the inside of the nose as recommended by the doctor.
A few drops of serum or blood may come from the incisions even if there is a tampon in the nose for the first 12-14 hours after surgery; It is enough to dry it and clean it with a sterile cotton swab.
On the day after the surgery, bruising and edema may appear on the face, eyelids and nose and disappear within about half a week. Only in some cases, there may be tears that heal spontaneously in the days following postoperatively.
After rhinoplasty, temporary imbalances in the symmetry of the pyramidal region of the nose may occur. It may be due to edema, which can be speeded up with proper massage recommended by the surgeon.
Edema (swelling) may make it difficult to breathe through the nose for a few days after the tampons are removed.
Do not force exhalation from the nose for at least 20 days after rhinoplasty so that the nasal bones do not separate and cause the nasal spine to swell.
During the day, a simple nasal rinse with sea water (taken from the pharmacy) is recommended to keep the nasal passages clean and prevent crusting after the procedure.
Hair can be washed 8 days after the procedure.
Avoid physical exertion and driving a car to stay away from things that lead to changes in pressure and bleeding until at least a week has passed.
It is recommended to eat a liquid diet and soft foods that do not require much chewing effort at least one week after the surgery.
After the operation, blood sports, saunas and baths should be avoided for at least 4 weeks.
Exposure to the sun is not allowed until 3 months after rhinoplasty, after which it is possible to go out under the sun, but gradually and using sunscreen.
Do not smoke for at least one month after the surgery to avoid the expected complications after the operation.
It is not allowed to start simple sexual activities before one week after the surgery.
Pain is controlled with analgesic medications as per the surgical prescription.
Bleeding: Although its occurrence is rare, it may occur during or after surgery. If bleeding occurs after surgery, immediate treatment may be required to remove the accumulated blood (hematoma) or an urgent blood transfusion. Factors that may increase the risk of bleeding (medications, oral contraceptives, estrogen hormones, vitamin E) are explained in the pre-operative advice. Irregular high blood pressure may also sometimes cause bleeding (high blood pressure).
Infection: rare in this type of surgery. Treatment includes giving antibiotics or other intervention.
Deep skeletal injuries: Nerves, tear ducts, blood vessels and muscles may be damaged during surgery. The injury can be temporary or permanent.
Unreassuring results: Medicine and surgery are not exact sciences and there is a possibility that the outcome may be unreassuring at times. Nose surgery may lead to loss of nasal function, unacceptable deformities visible to the naked eye, or visible deformities in the nose that can be touched by hand. Additional surgery may be required and will be performed at least 6 months after the first surgery.
Delayed wound healing: There is a possibility that the wound will open after the operation, and therefore its healing will be delayed.
Loss of sensation in the skin: occurs as a result of pressure or injury to the sensory nerve and can be temporary or permanent.
Asymmetry: The human face is usually asymmetric. There may be asymmetry between one end of the nose after surgery.
Chronic pain: Chronic pain rarely occurs after rhinoplasty.
Allergic reactions: Allergic reactions to the topical substances used are rare. Systemic reactions to a drug used during surgery or prescribed after surgery may occur. Their treatment may require further use of medication.
Perforation of the nasal septum: The surgery can increase the incidence of perforation of the nasal septum. This rarely happens and if it does then other surgeries will be needed to remove it. In some cases it is impossible to treat this problem.
Changes in the nasal airway: After rhinoplasty, there may be changes that block the passage of air through the nose and lead to difficulty breathing.