Plastic-SurgeriesRhinoplasty

Reshaping the nose for aesthetic purposes by preserving its physiology is called rhinoplasty

Rhinoplasty may be a good option for you, if;

If you are a female and your age is 16 or over and if you are a male and your age is 18 or over, you can benefit from rhinoplasty surgery. The development of your face is completed after these ages and rhinoplasty may be beneficial for you.

  • Rhinoplasty may be beneficial for you if the size of your nose is large for your face
  • Rhinoplasty may be beneficial for you if there is hump or depression on your nasal dorsum.
  • Rhinoplasty may be beneficial for you if the width of your nose is disproportionately large.
  • Rhinoplasty may be beneficial for you if the tip of your nose is prominently large.
  • Rhinoplasty may be beneficial for you if the tip of your nose is obviously dropped
  • Rhinoplasty may be beneficial for you if your nasal wings are obviously broad
  • Rhinoplasty may be beneficial for you if your nose is asymmetrical due to trauma
  • Rhinoplasty may be beneficial for you if your nose is blocked and you cannot breathe

What to expect from your surgeon on your rhinoplasty examination?

The face-to-face interview with your doctor will be the first step of rhinoplasty surgery. While your doctor is evaluating your physical and psychological compliance with rhinoplasty surgery, s/he should learn your aesthetic expectations about rhinoplasty and answer your questions. You should share your previous and current health problems with your doctor. You should give information about the drugs and supplementary products you are currently using. Your previous surgeries are important for your doctor. Allergens leading to shortness of breath (dyspnoea) and whether or not you use nasal spray should be evaluated. Your doctor should examine your nasal structure, thickness of the skin, the shape and size of your nose and pay regard to the relation of your nose to the other proportions of the face. After rhinoplasty surgery, you should question your postoperative image and additional procedures that may affect the condition of your breathing. Septoplasty surgery combined with rhinoplasty may be helpful in patients with deviated nasal septum. Jaw implants placed during rhinoplasty surgery may provide a stronger jaw profile. Rhinoplasty surgery can also be combined with concha surgery.

Preparation for rhinoplasty surgery

To obtain the best result from rhinoplasty surgery:

  • Quit smoking a few weeks before and after rhinoplasty
  • Do not take aspirin and derivative blood thinners one week prior to rhinoplasty surgery
  • Choose your companion who will take care of you at service and at home after rhinoplasty surgery

What awaits you during rhinoplasty surgery?

Although rhinoplasty surgery can be performed under local anaesthesia, we recommend that rhinoplasty be performed under general anaesthesia since it would be unappealing to remember such an experience. In accordance with the preoperative consultation, your nasal angle may change, the tip of the nose may be reshaped, your nostrils may become narrower, and the height and width of your nasal dorsum may be reduced by rhinoplasty surgery. Open technique can be used, if it is desired to view the tissues better throughout rhinoplasty surgery. If necessary, tissue transplantation may be carried out from the midline cartilage, ear and rib cartilage, hip and skull bone for the reconstruction of incomplete and inadequate bone and cartilage tissue during rhinoplasty surgery. Such tissue transplantations are usually performed in revision rhinoplasty surgery, and rarely in primary rhinoplasty. Tissue reconstruction with silicone and equivalent foreign body is not preferred in rhinoplasty surgeries because of the risk of infection. At the end of rhinoplasty surgery, nasal wings can be reduced and narrowed. Since the surgical incisions are situated in natural folds, no apparent scar is left in rhinoplasty surgery. Also, the repair of septum deviation and nasal concha hypertrophy is usually performed with rhinoplasty surgery. Rhinoplasty surgery takes 1-2 hours depending on the planned interventions. At the end of the surgery, you will have a simple nasal packing to prevent possible nasal leaks and you will stay in the hospital for one day. After rhinoplasty surgery is completed, cold is applied around your eyes, and 4 hours later, you can eat something and it is possible to walk. Potential bruises after rhinoplasty surgery can be prevented by preoperative cream application, mild swelling lasting for 1-2 days recovers within a week, and when the plastic splint placed in rhinoplasty surgery is removed a week later, you will have an appearance with which you will be able to participate in any kind of social activity confidently.

Returning to normal daily life after rhinoplasty surgery

When rhinoplasty surgery ends, you will regain consciousness in the recovery room and your respiration will normalize. Then you will be transferred to the service. After rhinoplasty, limit your activities at the service and do not let the environment be too hot. After you rest one day in the hospital and one day at home following rhinoplasty surgery, you can return to your desk activities on the third day. If nasal concha surgery is performed in combination with rhinoplasty surgery, your nasal packing can be removed on the second day. At the end of the rhinoplasty, there will be a plastic splint on the nasal dorsum. In the first week of rhinoplasty, the splint will be removed and a bandage will be applied for a week to prevent your nose from swelling. In the third week of rhinoplasty, your oedema will reduce and then, you can visit your doctor for the first serious evaluation. In the first six weeks of rhinoplasty surgery, you cannot use glasses. Although the final result after rhinoplasty surgery is probably obtained after a year, a good appearance can be obtained in a fine-skinned female nose at the third month and in a routine male nose at the sixth month. The next day after rhinoplasty, you will breathe during the first visit and dressing, however the intranasal oedema that will form will return to normal within a few weeks. In the sixth month of rhinoplasty surgery, during the first consultation, your photographs before and after rhinoplasty can be compared to see the change in line with the planned target.

Cosmetic complaints and breathing complaints should be resolved simultaneously in rhinoplasty surgery.

While the shape of the nose is changed in rhinoplasty surgery with cosmetic concerns, nasal congestion should also be corrected. In addition to cosmetic nasal procedures during rhinoplasty surgery, if there are deviation, asymmetry, and associated breathing problems in the nasal cartilage, called septum, interventions to correct these (septoplasty) should be carried out. If the nasal conchae, which play an important role in breathing, are also large and narrow the air passage, nasal concha surgery should be performed with rhinoplasty surgery. If narrow air passage (inner valve failure), usually seen in patients with narrow nose and sometimes confused with revision rhinoplasty, is present, this narrowness should also be repaired. It should not be forgotten that performing the breathing surgery in advance reduces the success of the subsequent nasal surgery.

Revision rhinoplasty

Revision rhinoplasty accounts for 10% of all rhinoplasty surgeries. In cases of rhinoplasty to be revised, apart from the surgeon’s experience, the factors such as preoperative bleeding, oedema and wound healing with scarring may result in revision. For revision rhinoplasty surgery, it would be appropriate to wait for the oedema to resolve. This period is one year after the first rhinoplasty. Although the largest volume change in the nose occurs in the nasal root, nasal tip oedema resolves most lately. The doctor to perform revision rhinoplasty should be more experienced than the doctor performed the first rhinoplasty surgery. Because revision rhinoplasty is much more difficult than the first rhinoplasty. In revision rhinoplasty, bleeding is more common, tissues are adherent and the anatomy has undergone a change. In revision rhinoplasty, the decision on whether only a local deformity will be corrected or the whole nose will be modified in accordance with the face profile is of importance. For example, while only the nasal hump will be corrected in revision rhinoplasty, it may be necessary to shorten the tip of the nose, if the nose gets longer when the hump is removed

In which conditions revision rhinoplasty should not be performed?

  • If the patient has unrealistic expectations or if the doctor and the patient do not think in parallel
  • if the nose shape is far removed from the classical appearance
  • if the skin of patient planned to undergo revision rhinoplasty is too thick
  • if the patient planned to undergo revision rhinoplasty has serious health problems
  • if the skin of patient planned to undergo revision rhinoplasty is under the age of 14-15
  • It should not be forgotten that we do not change the style of patient with revision rhinoplasty; we only provide the nose with smooth lines. We cannot solve the psychological problems of patient with surgical techniques. If the patient is not happy with himself/herself, psychiatric treatment will be more helpful instead of surgery

What makes a beautiful nose?

It should not be forgotten that the most important part of the facial beauty is not the nose. First of all, the nose should not hide the beauty of the eyes and the skin. In other words, the nose should be proportional to the face, and its lines should not draw attention so that the other elements of the face are noticed. Contrary to what is believed, a beautiful nose is high, in other words, the nasal root should not be hollow. Its lines are smooth, in other words, there are no ups and downs. Its size is in harmony with face. A retrousse nose does not fit with the long-faced patient, and a fat woman with a narrow nose is not nice. The imaginary line passing under the eyebrows ends at the tip of the nose without interruption, the tip of the nose is a little higher than the previous. When viewed from the side, the nasal septum is not far ahead of the wings. The angle between the nose and the lip is 95 degrees in women and 90 degrees in men. Although there are many other details that the aesthetic surgery is attentive to, a nose that is in harmony with the face, high and have strong and uninterrupted lines is beautiful in our opinion.

Risks and complications of rhinoplasty surgery

Although rhinoplasty surgery does not involve serious health problems, some problems are rarely expected. Despite the fact that rhinoplasty surgery is performed with cosmetic concerns, nasal concha interventions carried out in the airway have the risk of bleeding. After rhinoplasty surgeries performed on excessively deviated noses, nasal adhesions, called synechia, may occur due to internal skin ruptures. In conclusion, the main problem to be discussed after rhinoplasty surgery is how successful the surgery is in terms of aesthetics.

Anatomy and function of the nose

When we take our breath through the nose, the air inhaled is heated, humidified and freed from dust. Olfactory receptors, also known as odorant receptors, are intense inside the nose. Apart from smooth nasal septum and non-overgrown nasal conchae, the air passage should be wide enough to allow air turbulence to be able to breathe well. The angle of the nasal valve (the angle of the nasal wing with the nasal septum) should be at least 15 degrees. The nose is divided into three main structures: immobile nasal bone, immobile cartilage and mobile cartilage in the forefront

False facts about rhinoplasty

There are no techniques called micro-rhinoplasty or mini-rhinoplasty in the world literature. Performing the standard simple surgery carefully is enough to get the desired result from rhinoplasty surgery. Although botox, in very rare cases, provides the elevation of nasal tip, its use is very limited and should be repeated every 6 months. The use of filler in the treatment of nasal collapse usually fails to satisfy and is not permanent. If the permanent filler migrates, permanent disability may occur. Suspension of the nasal tip with suspension suture will form the first step of the adventure that will result in damage to the patient. Some ruptures in the cartilage of the nasal tip may result in permanent damage as there is no equivalent.

Frequently asked questions about rhinoplasty

How many days after rhinoplasty surgery can I leave the city?

  • Your plaster and sutures will be removed a week after surgery. Then, you can leave the city.

When can I start using glasses?

  • Nasal bone unions after 1.5 months of rhinoplasty surgery and then you can use glasses

Can I come through rhinoplasty surgery without bruise and swelling?

  • If bruise removal creams are used 3-4 days before rhinoplasty surgery, no bruise forms. Bed rest for the first 48 hours will be very helpful to prevent swelling that may occur after rhinoplasty surgery.

Should I use scar removal cream after rhinoplasty surgery?

  • In closed rhinoplasty, no scar removal cream is required, but if the nasal wing is narrowed in open rhinoplasty, scar removal cream is very helpful for the first 3-4 months.

Which surgery can be combined with rhinoplasty surgery?

  • The combination of rhinoplasty surgery with chin tip surgery can be very satisfying. Contrary to this, the combination of rhinoplasty surgery with eye periphery surgeries such as facelift should not be preferred except for special conditions

When can revision rhinoplasty be performed at the earliest?

  • If possible, waiting for 8 months is sufficient in many patients to soften the tissues.

What is the possibility of revision rhinoplasty surgery?

  • The need for revision in a good clinic is 10% provided that there will be minor interventions that will not create the nose over again. In the best hands of the world, this ratio is one in twenty patients

Tip Plasty

A special form of rhinoplasty surgery is tip plasty. If the patient planned to undergo routine rhinoplasty surgery does not have problem with nasal dorsum and width of nasal root, tip plasty can be performed. The basic preparation, planning and practice in tip plasty are not different from that of routine rhinoplasty. The difference between the procedure and rhinoplasty is that the procedure is limited to the tip of the nose and there should not be any problem requiring intervention in the nasal dorsum and nasal hump. The procedure takes shorter than rhinoplasty surgery and can be performed under sedation. Unlike rhinoplasty, it does not require hospitalization. Postoperative swelling and bruising are limited compared to rhinoplasty and the healing is faster. While there is intervention to the bone in rhinoplasty, no bone is broken in tip plasty. Tip plasty is a critical surgery that should be taken care of as much as in rhinoplasty. The nasal tip cartilages are reshaped into the desired form as in rhinoplasty. As in rhinoplasty, septum deviation and concha hypertrophy treatments may also be added to the surgery in tip plasty in the case of respiratory problems. As in rhinoplasty, the patient can return to social life and start doing exercise earlier when the bone is not intervened.

Closed rhinoplasty

In the closed rhinoplasty technique, no visible scar forms in front of the nasal septum. There are cases where both closed rhinoplasty and open rhinoplasty are preferred. In cases where closed rhinoplasty is preferred;

  • The nasal tip has a perfect shape. It is neither too large nor asymmetric. The nasal tip is not very flattened and is not very prominent.
  • If the nasal dorsum is going to be reduced by closed rhinoplasty, the hump is not too large.
  • If closed rhinoplasty is going to be performed, the nose is not too distorted.
  • If closed rhinoplasty is going to be performed, the use of very complicated technique should not be required.
  • Under these conditions, the closed technique is used at the rate of 5%.

Open rhinoplasty

In the open rhinoplasty technique, a triangular or step-like line-like scar is present on the front wall of the nasal septum. Open rhinoplasty surgery offers many advantages to the surgeon compared to closed rhinoplasty surgery. Since the surgeon reaches the cartilage and bone tissues s/he wants to reach more easily and evaluate their positions more clearly in open rhinoplasty surgery, the intervention is easier. In large noses, long noses, noses with high nasal tip and high nasal dorsum, performing open rhinoplasty provide an advantage for the surgeon and the patient. Open rhinoplasty makes things easier since the tissues are very adherent, especially in revision rhinoplasty surgeries. These facilities sometimes allow obtaining appearances that are impossible to obtain with closed rhinoplasty. When the correct incision technique is used, the scars of open rhinoplasty may not be apparent. Giving shape to the tissues atraumatically with open rhinoplasty accelerates the wound healing and leads to obtain the final result earlier.

Septorhinoplasty

The structure with bony and cartilaginous components, which supports the external structure of the nose and regulates the airflow, is called “septum”. If septum deformity and deviation prevent breathing and make the nasal deformity more noticeable, the septum can also be corrected with rhinoplasty surgery. Only 23% of adults had a smooth septum. Therefore, it is intervened during rhinoplasty only if there is an aesthetic and functional loss. When we use septoplasty in combination with rhinoplasty, we usually use the two-tunnel technique, but one, three, four tunnels can also be used. In rectangular septum cartilage, deviated cartilage and bones are removed by preserving a 1 cm cartilage tissue on the upper and front wall which carries the nose. The cartilages taken when septoplasty is performed in combination with rhinoplasty will not be wasted as they will be used to support the nasal tip and air passage.

Concha surgery

On both sides of the nasal cavity, there are slice-shaped structures, called conchae. The task of the conchae, which have plenty of blood vessels inside, is to heat, cool, humidify and filter the inhaled air. The size of the conchae is not stable and varies depending on many factors such as temperature, humidity of the air, body activities, body position, and hormonal changes. Overgrowth of conchae is called concha (turbinate) hypertrophy. In the surgical treatment of concha hypertrophy, a portion of the enlarged concha is reduced. The reduction procedure can be performed with rhinoplasty surgery. Preferentially, first concha surgery and then rhinoplasty operation are completed without a break. The reduction procedure can be performed by using a few different techniques. Radiofrequency surgery is the most preferred method today. It is a method that allows reducing the portion rich in blood vessels inside without deteriorating the functioning surface of the concha. After entering the concha with the needle of the radiofrequency device, the energy given in the frequency of radio waves allows the concha to shrink over time. We use surgical reduction in more severe cases. After concha surgery, packing can be placed inside the nose for one or two days to prevent bleeding. In the first week after concha surgery, nasal congestion increases. The final effect of the performed surgery is obtained 1-2 months after the procedure therefore; nasal congestion should not be expected to recover immediately. If nasal congestion cannot be sufficiently eliminated by the reduction procedure, the same procedure or an alternative reduction procedure may be repeated a few months after the first rhinoplasty.

Reduction rhinoplasty

Reduction of the nose by preserving the skin on the nasal skeleton and nasal dome composed of bone and cartilage is called reduction rhinoplasty. In routine rhinoplasty surgery, the junction of the nasal bones and the facial bone is broken and the nose width is narrowed. The bone and cartilage on the nasal dome are removed to prevent the upper fold. The front tip of the septum cartilage is cut and the length of the nose is shortened. The immobile middle and mobile front upper (ala) cartilages of the nose are shaved to adapt to this reduction. While the nose is reduced by preserving the main skeletal physiology of the nose in reduction rhinoplasty, the skin is expected to shrink and adapt to the nose. Nevertheless, this adaptation can sometimes be facilitated by removing the skin from the natural fold on the nasal wings with reduction rhinoplasty surgery.

Broken (fractured) nose

The nasal bone is the most damaged bone in traumas to the face. Posttraumatic bleeding, edema, bruising and nasal congestion may occur. The diagnosis is made by physical examination and x-ray. In early diagnosis, nasal bone reduction and splint may be necessary. One and an half months later, late-term sequelae can be corrected during rhinoplasty surgery. Rhinoplasty surgery and septoplasty have been performed on many patients with a history of broken nose.

Fractured septum

The septum, which divides the nasal cavity into two and is composed of bone and cartilage, leaning towards one side or sometimes both sides is called septum deviation. If the fracture in the septum prevents breathing, it may lead to pharyngitis and sinusitis due to breathing through the mouth at night. If the fractured septum prevents breathing, it should absolutely be intervened during rhinoplasty surgery. Because nasal dorsum collapse and dropped nasal tip may form in isolated surgeries. Septoplasty surgery is an integral part of rhinoplasty surgery. If septoplasty surgery is added to rhinoplasty surgery, placement of nasal packing is beneficial for the early resolution of oedema. However, the special silicon packing used in rhinoplasty surgery does not prevent breathing

Damaged septum

The skin damage of the septum, which forms the midline of the nose and is composed of bone and cartilage composition, may be due to previous rhinoplasty surgery, intranasal bleedings, drugs used or trauma. Small nostrils may sometimes make a sound in respiration. Although small perforations are ignored, perforations larger than 1 cm are repaired during rhinoplasty surgery. Three-layer nasoseptal repair is easier in open rhinoplasty surgery compared to isolated repair. Because in open rhinoplasty, the perforation area is approached from the large area, and the cartilage graft is found by searching the entire area. Moreover, since the entire mucosa (intranasal skin) can be dissected in open rhinoplasty, skin shift is relatively easier. Ear and rib cartilage can also be used if the donor cartilage is insufficient.

Broad nose

Narrowing the broad nose is an important part of rhinoplasty surgery. What we mean when we say broad nose in rhinoplasty surgery is that the upper 1/3 of the nasal root is broad and as the extension of this condition, the base of the nose is broader than normal. Usually, a broad nose is completed with a high and prominent nasal tip. In many cases, there may be traumatic broad noses resulting in broad nasal tip base caused by dropped nasal tip after nasal septum collapse due to broken nose or previous airway surgery. Osteotomies that narrow the bone are performed to correct a broad nose with rhinoplasty. In most patients, the nasal wings are also required to be narrowed at the end of rhinoplasty. In the case of nasal tip collapse due to previous rhinoplasty, the elevation of the nasal tip with cartilage graft will improve the broad appearance of the nose. Inner valve repair, which is very important for a good respiration, will also need to be repaired in rhinoplasty surgery to narrow a broad nose.

Depressed nasal dorsum

In saddle nose deformity, the nasal dorsum is 2-3 mm below the nasal tip and nasal root line. Although this collapse usually results from a previous rhinoplasty surgery, it may be associated with the genetic structure. If only the nasal dorsum is collapsed during the first rhinoplasty surgery, it is simply solved with a rib graft in general. However, if both the nasal dorsum collapse and shortness occurred in the first rhinoplasty surgery, the repair is difficult and requires a rib graft. If the tip of the nose has also collapsed during the rhinoplasty surgery, this hides the deformity. In such a case, both the nasal tip should be elevated and the nasal dorsum should be filled.

Dropped nasal tip

If the ratio of the nose length to nasal tip height is less than 0.67, the tip of the nose is flattened. This is also determined by the height of the chin and the height of the middle face. Nasal hump is usually present in patients with dropped nasal tip. The removal of nasal rump in rhinoplasty surgery will show the nose more flattened and wide. When a correct diagnosis is made in rhinoplasty surgery, strengthening the nasal tip and less removal of nasal hump will fix the problem.

Aquiline nose

Correct evaluation of an aquiline nose affects the result of rhinoplasty surgery. Of course, the line between the nasal tip and nasal root should be straight, but if the nasal tip and nasal root are planned correctly! A flat, high and non-fragile nasal dorsum is required for a beautiful nose. When the nasal root is too hollowed, the nasal dorsum appears to be humped which is very deceptive. Likewise, if the nose of the patient who will undergo rhinoplasty is flattened, the nasal dorsum seems to be humped. In such a case, it would be more appropriate to elevate the flattened nasal tip or to fill the hallowed nasal root instead of removing the hump in rhinoplasty surgery.

Deviated nose

Deviation of the nose may be originated from bone or cartilage. In many of them, the trauma occurs in childhood, and the prominence increases in the growth period. In cases of trauma before the development of nose, the base of the nasal bone is also deviated and its repair is more difficult than adolescence fractures. Unfortunately, the recurrence rate in cartilage reduction technique used in the treatment of deviated nasal cartilage in rhinoplasty surgery reaches up to 30%. When the septum-middle cartilage that has recovered after cartilage scratches carried out during rhinoplasty surgery is supported by cartilage grafts-meshes, the recurrence rate decreases to 5%. Although the correction of deviated nasal bone is technically more difficult in rhinoplasty surgery than cartilage, the result is more guaranteed and recurrence is less common.

Narrow nose

Although narrow nose is encountered more after rhinoplasty surgery, we also encounter with noses that are genetically narrow. While the nasal base width is evaluated, the width of the nasal wings should be as much as the length between the two eyes, or the line passing through the nasal wing should reach to the edge of the eye. The upper width should not exceed 75% of the lower width. The difference between the nose width and the nasal tip width should not be obvious. In patients with narrow nose, there is no good air turbulence, so the nasal dorsum should be enlarged with expander meshes during the surgery. The increased use of new techniques has strengthened the surgeon’s hand.

Elevated nasal tip

If the ratio of the nose length to the nasal tip height is roughly above 0.67, the tip of the nose is elevated. This is also determined by the height of the chin and the height of the middle face. A flattened or elevated nasal root sometimes makes the evaluation difficult. Although it is technically very easy to reduce the nose height, the results should not be ignored. When the nose height is reduced during rhinoplasty, the nasal wings will be enlarged and will be narrowed, if necessary. If the prominence of the nasal tip is increased by the size of nasal tip cartilage not by the septum height, the most complex manoeuvres of rhinoplasty surgery are performed. The natural structure of the nasal tip is distorted and it is reconstructed by new hand-crafted small cartilages in rhinoplasty.

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