Rhinoplasty

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Rhinoplasty

Rhinoplasty refers to the surgery of the nose. This procedure aims to modify the shape of the nasal pyramid (either partially or completely) and can also if necessary correct nasal breathing problems.

A rhinoplasty can be carried out alone or in association with other facial surgery such as a genioplasty (surgery of the chin). This can be done at the same time to modify the facial profile. The aim is to improve the aspect of the nose. The problems present can be congenital, caused by an accident, or due to aging. The result should be a nose in harmony with the facial features, and which corresponds to the personality and expectations of the patient.

The technique uses incisions hidden inside the nostrils and remodels the bone and cartilage which give each nose its distinctive shape. The skin covering these elements will be re-draped and will adapt to the new nose. This point shows the importance of the quality of the skin for the final result which is obtained with no visible scar.

When a nasal obstruction impedes breathing it will be treated during the operation. This can be due to a deviated septum (the nasal partition) or hypertrophy of the nasal concha (bony structures inside the nasal cavity).

This procedure carried out both for men and women, can be done from the age of 16, when growth is complete.

Before the operation

Prior to the operation a thorough examination of the nasal pyramid and its harmony with the other features of the face will have been carried with an endo-nasal examination.

A simulation of the desired result can be done using photos and computer software. The virtual image obtained should be considered as a guide to help understand the wishes and expectations of the patient. Nevertheless, it should be understood that the final result may be slightly different and not an exact copy.

A preoperative check-up will be carried out as prescribed.

No aspirin-based medication should be taken during the 10 days preceding the operation.

For certain types of anaesthesia you must fast (neither eat nor drink) for eight hours before the operation.

Hospital stay and type of anesthesia

Type of anesthesia: This operation is usually performed under general anesthesia. An anesthesiologist will see you in consultation at the latest 48 hours before the operation.

Hospital stay: Rhinoplasty is usually carried out on an out-patient basis – the patient leaves on the same day after some hours of medical supervision. However, in some cases a short hospital stay can be preferable. The patient arrives in the morning (or sometimes the previous evening) and is discharged the following morning, or the following day.

The procedure

Techniques are adapted in order to obtain the best results in each case. We can however give some basic points:

Incisions: As a rule, they are invisible, hidden inside the nostrils or under the upper lip, there are therefore no visible scars. It can however be necessary to use an external incision which will be hidden beneath the upper lip. It can also be necessary to use an external incision concealed at the base of the nose wings if reducing the nostrils, or across the columna, between the nostrils in order to perform an ‘open’ rhinoplasty (giving access to the internal structure of the nose. This can be used when repairing serious deformations or for touch-up surgery.

Dissection: These incisions permit separation of the cartilage from the skin and mucosa.

Reshaping the nose: The osteo-cartilaginous structure will then be reshaped as planned. This important step can be carried out in a multitude of ways taking into account the individual case and the preferred technique of the surgeon. The nose may be made smaller or straightened, a bump removed, the tip may be redefined, the septum may be straightened or the nasal concha reduced in size. In some cases, a cartilage or bone graft will be used to fill a hollow zone, to support part of the nose or redefine the tip.

Sutures: The incisions are closed with fine sutures, usually dissolving ones.

Dressings and splints: The nostrils are packed with wadding. An external dressing of tape is applied then a splint of plaster, plastic or metal is molded and fixed to the nose, this can sometimes extend to the forehead

The operation can take between 2 and 3 hours depending on the specific requirements and complexity of the case.

After the operation

There is rarely actual pain, it is rather the fact that the wadding makes it impossible to breathe through the nose which is a problem for the first few days.

Swelling can be observed around the eyelids with bruising which is variable in degree and duration for each patient.

During the first few days rest is advised, with no physical strain.

The wadding is removed 2 to 5 days after the procedure. The splint is removed 5 to 8 days after surgery, to be replaced by a smaller splint for a few more days.

The nose will appear bigger because of swelling and it will still be difficult to breathe because of swelling of the lining of the nose and possible scabs in the nostrils.

The visible signs of the operation will disappear gradually and a return to normal social and professional life is possible after 10 to 20 days.

Sport and strenuous exercise should be avoided for 3 months.

Picture Gallery

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The result

The result usually corresponds to the expectations of the patient and is fairly close to the initial project drawn up before surgery. The changes brought about by this operation are permanent. The only modifications which can occur are those which would have occurred in the normal aging process as for a nose without surgery.

Imperfect results

These can result from a misunderstanding concerning what can reasonably be achieved or be caused by unusual scarring phenomena or unexpected tissue reactions such as poor healing and retractile fibrosis.

These imperfections can be remedied by corrective surgery if necessary, usually under local anesthesia from the 6th month following surgery. It is necessary to wait until the healing and scar tissue are stabilized. This touch-up surgery is simpler than the first procedure both regarding the technique used and the postoperative care.

Possible complications

A rhinoplasty, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here. We must distinguish between risks related to the anesthesia and those related to the surgery. For the anesthesia, the risks will be explained by the anesthesiologist during the preoperative consultation. You must be aware that anesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anesthesiologist, in a surgical context, means that the risks are statistically practically negligible.

In fact, techniques, products and monitoring methods have progressed considerably over the last decade, giving optimal safety, especially when the operation is not an emergency and the patient is in good general health. Fortunately, real complications are rare following a rhinoplasty which has been carried out correctly. In fact, practically all the operations go well and patients are completely satisfied with the result. However, possible problems may include:

  • Bleeding: this can occur in the first few hours after surgery but is usually moderate. If bleeding persists more wadding should be added, or a return to the operating room may be necessary.
  • Hematoma: these must be drained if too painful or too large.
  • Infection: in spite of the natural presence of germs in the nostrils this is very rare.
  • Abnormal scarring: this can only concern external scars (if any) and is rarely a problem to the point of requiring a second procedure.
  • Sores: these are rare but can be caused by the splint. Small sores or wounds heal spontaneously leaving no mark, but skin necrosis, which is very rare, will leave a small scar.

My Way ….  “Metron Ariston”

The nose plays a crucial role in creating facial balance. Changing the nose can actually make the entire face look more symmetrical and proportional.

Although the Golden Ratio plays an important role in aesthetic surgery, ethnicity, and individuality are the most important determinants in order to get functional, balanced and natural results.

It is thus outstanding surgical skill, in conjunction with expert knowledge of an experienced plastic surgeon, that can determine the right nose shape for a specific facial structure & size, taking into account ethnicity, gender and cultural aesthetic perceptions. This will require the customization of techniques in each individual face to deliver an aesthetically perfect result.

Scar-less Rhinoplasty

Scar-less (closed or endonasal) Rhinoplasty is an advanced Rhinoplasty technique, performed only by a limited number of highly-skilled surgeons worldwide, enabling an artistically precise and minimally invasive approach to nose alteration.

My wide experience with patients of different ethnic backgrounds has earned me a place among the top plastic surgeons for scar-less rhinoplasty. It requires more skill by the Plastic Surgeon as a set of complex tasks are performed through the natural openings of the nostrils. Yet, there are numerous advantages in it:

  • No visible scarring
  • Less pain
  • Less postoperative bruising and swelling
  • Better Circulation to the Skin of the Nasal Tip
  • Shorter Surgery time
  • Shorter recovery period

 Non-surgical rhinoplasty

A large number of studies have indicated substantial improvement in patients’ self-esteem following rhinoplasty.

Is it possible however to have the benefits of rhinoplasty without undergoing surgery?

Yes, it is! (to some extent…)

Non-surgical rhinoplasty (or Liquid rhinoplasty) is steadily increasing in popularity both among men and women. Using hyaluronic acid-based fillers in 3 injection points (radix, dorsum, tip) the plastic surgeon can correct minor deformities such as saddle nose, prominent humps and proportion issues (or can be used to correct imperfections of a surgical procedure).

However, you need to be particularly careful, as in non-expert hands, it can have devastating complications. Good knowledge of the nasal anatomy is essential for avoiding complications including vascular compromise and necrosis!

This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

 

Source:

American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery