Rhinoplasty Is the Most Commonly-Performed Aesthetic Surgery in the World.

Why? Because, the nose is greatly affected by environmental factors from the early days of life and may see its shape, structure and even function change over time. People usually do not really complain about the shape of their eyes, ears, mouth or face, and their appearance does not change greatly over the years. But with the nose, it is different: even a simple trauma can, even if not immediately obvious, cause deformation of the nasal bone and cartilage over time.

Rhinoplasty Aims to Improve Nasal Functionality and Aesthetics.

Rhinoplasty is the most commonly-performed aesthetic surgery in the world. The nose is located at the center of the face and significantly affects appearance. Every nose has a unique shape. Even minor changes in the nose can affect the appearance of one’s face. People usually seek rhinoplasty to achieve their idealized nose shape. Generally-accepted ratios and harmony between various sections of the face may be the key to achieving beautiful looks. While it is generally accepted that most people with attractive looks have a certain degree of facial harmony, there is no universally-accepted standard of beauty.

A primary benefit of the pre-operative interview is that it reveals the patient’s expectations and the degree by which the surgeon can meet those expectations. Patients are guided by their perceptions of beauty, usually shaped by social, cultural, communal and other factors, and intuitively decide how a beautiful nose should look. The surgeon’s task is a difficult one: construct a nose that the patient, the society and the surgeon themselves will like. The surgeon identifies the areas of concern for the rhinoplasty candidate to understand whether the patient has realistic expectations or extraordinary views, and tries to determine before surgery the deformities, if any, that need to be corrected. While doing so, the surgeon is guided by their own personal judgment, specific rules, ratios, angles and geometric relationships. The surgeon evaluates the cartilage structure and any existing marks, the patient’s age, sex and the quality of their skin, and develops an operative plan based on aesthetic and anatomic considerations, choosing a suitable technique that would yield a shape of nose that the patient would ideally like to have.

Anatomy

A wall consisting of cartilage and bone, called septum, is located inside the nose along the central axis. The outer walls are covered by concha, which are functional structures that warm up and humidify inhaled air. Skin thickness is an important consideration that significantly bears on the outcome of rhinoplasty. The bone-cartilage structure is modified during surgery, and a thin skin reveals all changes underneath, while a thicker one may obscure them. Better results are achieved with medium skin thickness.

What is the goal of rhinoplasty?

The primary goal of surgery is achieve a nose shape which agrees with your face, and which appears natural and better. Every surgery aims for improved results, but it is no realistic to expect every surgery to have a perfect outcome. The surgeon’s talent and experience are not the sole determinants of surgery outcome; the patient’s age, overall medical condition, skin condition, skeleton, smoking, healing and anatomic structures also have a bearing.

A successful nose surgery: the shape of the nose must be determined based on facial characteristics. It must be natural, and in harmony with other facial structures. A person who does not know you must not recognize that you had had rhinoplasty. And your close acquaintances who do know  that you had had surgery should recognize a positive change. Any breathing troubles should be concurrently addressed. Any denting or crookedness over time must be precluded. After a successful operation, the swelling goes away and the nose is perfectly settled in the face. Because the outcome is a natural one, the patient is not repelled by their new looks and they easily adapt. After successful surgery, the patient’s psyche is also favorably affected. Their expressive capabilities and self confidence are improved, and they acquire a more positive outlook on life.

What Is the Best Age for Surgery?

Rhinoplasty is usually demanded by young adults aged 18 to 35 years, and may be successfully executed through 40s and 50s. In the cases of severe nasal obstruction or posttraumatic deformities, surgery may be indicated at an earlier age. The recent consensus is that operation should be after the age of 17 in females.

Is Rhinoplasty Particularly Difficult?

Yes. Rhinoplasty is not a simple procedure, and in fact it is the most difficult type of facial aesthetic surgery. It challenges the unique characteristics of the face. The key challenge is to correct the shape of the nose in harmony with facial individuality while preserving or repairing nasal function. A successful outcome depends on a robust relationship between the patient and the surgeon.

Will Rhinoplasty Affect Nasal Breathing?

It is crucial to preserve physiological nasal function while aiming for a better look. In other words, highly important nasal functions must not be sacrificed for aesthetic looks. Normally, rhinoplasty will not cause nasal obstruction. The nasal septum divides the nose into two equal sections and forms the actual support mechanism.  Septum deviation may be caused by trauma or genetical factors. Also, growth of lateral concha structures may cause trouble breathing. The nasal mucosa may grow or swell due to allergy or smoking. All of these causes may lead to nasal obstruction in patients. The patient should be examined for these considerations and explained the findings. All obstructive factors should be corrected during surgery, since the air passage becomes narrower by 10 to 20% after rhinoplasty.

Is a Pre-Op Photo Necessary?

It is necessary to take a photograph before surgery. The surgeon photographs the patient from 7 angles: 1 from the front, 2 from the sides, 2 obliquely (45 degrees), 1 from the bottom and 1 of the forehead. Additional photographs may be necessary depending on the patient’s condition. Photography should be repeated 6 to 12 months after surgery.

Can I See How My Nose Will Look After Surgery?

Surgeons use different methodologies to demonstrate the expected outcome of surgery, including mirrors, hand drawings, life-size photographs and computerized images. Computers provide a medium on which the patient and the surgeon can exchange views and expectations, and agree on the outcome. A computerized image by no means represents a guaranteed or definitive outcome of surgery. It is important that patients should be aware of this.

Will I Have Post-Operative Facial Scars?

There are two main techniques in rhinoplasty: the closed technique and the open technique. In the closed technique, all incisions are made internally inside the nose, leaving no discernible scar on the skin. The open technique has a number of benefits, which made it popular. In this technique, a V-shaped incision is made across the narrowest area of the nostrils. No discernible marks remain, and 90% of surgeons prefer this technique. It is also possible to have good results with the closed technique performed by an experienced surgeon. In any case, it is up to the surgeon to decide which technique to use, and neither would have any adverse ramifications for the patient.

What Should I Avoid Before Surgery?

Most importantly, the patient should avoid taking aspirin or similar blood thinners which may cause bleeding. If you have pain, you may take paracetamol or acetaminophen. Do not smoke, as nicotine impairs blood circulation, and thus healing of wounds. Have a blood test, ECG and lung X-ray. Be sure to advise any concurrent conditions. Withhold alcohol a few days before and a couple of weeks after surgery, as it may cause nasal obstruction and bleeding.

During the pre-operative interview, the paint states their expectations and undergoes a detailed ear-nose-throat examination to evaluate the nose for both aesthetic considerations and breathing problems. Afterward, your photographs will be taken and a detailed facial analysis is performed. During the interview, you will be also informed about the surgical technique to be used, anesthesia, the hospital where surgery would be performed, any pre-operative preparations, and potential risks and complications of surgery.

How Is the Surgery Performed?

I recommend performing rhinoplasty under general anesthesia. Surgery may take from 1 to 4 hours, depending on the existing nasal deformities. Revision rhinoplasty may take even longer. After making incisions using the closed or the open technique, the surgery begins with correcting any deviations of the septum (crookedness of the central wall inside the nose). This procedure is important for functional considerations. After correcting the deviated septum,  all deformities are corrected according to the pre-operative plan, which may include removal of curve, if applicable, eliminating any irregularities, and closing any gaps developing on the back of the dose by demolishing the side walls of the nasal bone. Cartilages at the tip of the nose are also attended. The cartilage harvested from septum are used for various corrections during surgery, or to support or shape tissues. If the patient previously had rhinoplasty and lacks sufficient cartilage, these may be harvested from the ear or ribs. The initial incisions are sutured and sealed. A silicon plug, which would not bother the patient, may be placed inside the nose. The back of the bone is patched and protected using a cast or other materials to finish the procedure.

After Surgery

• Sleep with your head held high, using 2 or 4 pillows. Avoid turning your head more than 45 degrees. Moving further may cause nasal curvature. Follow this rule for the next 3 weeks after surgery.
• To prevent bleeding, hold your head up high when standing up or leaning forward.
• Because steam from hot foods may aggravate bleeding and nasal obstruction, avoid having very hot meals for first several days.
• A gauze placed above your upper lip will prevent potential bleeding and the resulting staining of your clothes during the first two days.
• Cold gels or ice applied in the periphery of the eye and cheeks will help reduce swelling and bruising.
• Be careful when brushing your teeth to avoid harming your nose.
• Avoid chewing very hard foods, and prefer softer foods in the first few days after surgery.
• Bed rest is essential during the first three days after surgery.
• Avoid engaging in sports and sexual intercourse for two weeks after surgery; you may take walks.
• You may wash your face, taking care not to wet your dressing. Do not wash your hair for 1 week. If you have others who can help you, you may have your hair washed as in a hair salon. Do not wet your nasal plugs or outer dressing.
• Avoid prolonged telephone calls or social activities for 2 weeks.
• Avoid wearing tight clothes for 1 week.
• Avoid sun and direct sunlight for 6 weeks, otherwise it may take longer for facial swelling to resolve. Skin bruises exposed to sunlight may cause permanent marks on the skin.
• Avoid swimming for one month, as it may induce a trauma.
• You may have facial swelling 3-4 days after surgery. The swelling will mostly resolve within 2-3 weeks; but in some cases, it may take up to 12 to 18 months for reduced swelling to go away.
• Bruises after surgery may persist for up to 2 weeks. They usually disappear after 10 days. If they persist longer, you may use makeup to cover it.
• Use only the drugs that I recommend.
• Do not use eye glasses for up to 3 months.
• You may start using contact lenses 2 days after surgery.
• Do not take any risks. Be sure to contact us for any questions or concerns.

How Long Is Post-Operative Follow-Up?

The results of rhinoplasty are predictable. The nose is a dynamic organ and the surgeon can predict the shape of the nose after healing and in the long term. The surgeon will examine the patient in regular intervals, but more frequently during the first 3 weeks. Routine follow up protocol indicates checking up on the patient at 6 weeks, at 6 months, and at 1 year. This protocol allows the patient and the surgeon to jointly evaluate the surgical outcome.