Rhinoplasty (Nasal Esthetic)
The nose is the most prominent structure in the face following the eyes and a smooth quality skin. The surgical procedure performed for esthetic correction of noses that have deformities is called rhinoplasty. Esthetic nasal surgery, i.e. rhinoplasty, is the most frequently performed esthetic surgical procedure in Turkey. It is one of the surgeries among esthetic operations that require the most profound experience in technical sense.
Why is rhinoplasty a special and particular surgery?
Nasal anatomy varies greatly among individuals because the nose is a sui generis structure. For that reason, the surgical procedure to be performed should be individualized. No esthetic nasal surgery is a repetition of a previous surgery.
During a rhinoplasty procedure, it is necessary to correct both the form and functions of the nose. Almost all esthetic rhinoplasty surgeries are accompanied by septoplasty, which involves the correction of the curvatures in the cartilage called septum located in the middle section and/or reduction of the nasal flesh called concha including any swelling by means or radiofrequency or surgical techniques. Rhinoplasty is akin to sculpting. Every step that is completed during surgery brings the surgeon closer to the ultimate aim, i.e., a beautiful and natural-looking nose. The nose reacts to every action taken by the surgeon. In a way, the nose engages in a counter-action. For that reason, it is critical that the surgeon performing rhinoplasty has the sufficient technical skills and experience to respond to such counter-actions as well as any special instrumentation and equipment to implement these actions.
Having a natural-looking nose
In addition to the correction of shape and function, I would also like to underline the matter of natural look, which has been one of the most highlighted topics in recent years. Sometimes, patients tell me that nobody understand that they underwent surgery. This is a statement I enjoy greatly. This statement actually indicates that the result looks natural. In my opinion, a well-performed nasal esthetic operation corrects the shape and functions; however, one cannot understand that the nose was operated on. Naturally, the people who knew the patient before surgery can discern the difference in the nose. However, the people that the patient meets after surgery should not be able to understand that s/he underwent esthetic surgery. The essential requirement to achieve a natural-looking nose at the end of surgery is to remove the tissues that need removal at measured amounts and to meticulously maintain the tissues that do not need removal.
Who are eligible for rhinoplasty?
Most of the people who are not content with the shape of their nose and/or suffer from breathing problems may undergo rhinoplasty surgery. The important factures that may influence the result of surgery include the characteristics of nasal bone and cartilage, facial form, nasal skin thickness, age, previous accidents or surgeries.
It is important to wait till age 17 for girls and age 18 for boys so that the social and emotional development can be completed. It is possible to perform rhinoplasty surgery in elderly patients, as well. However, it is of utmost importance to be extra cautious regarding the loss of elasticity in skin and age-related changes in bones for these patients.
Rhinoplasty enhances your facial features. It makes you look better and boosts your self-confidence. However, you should not imagine that nasal surgery will make you the person in your dreams and suddenly change the feelings and opinions that people have about you. Persons who think that they will feel better after surgery and have realistic expectations about improved appearance are eligible candidates for rhinoplasty.
As in all the other esthetic surgeries, a beautiful and natural-looking nose brings about very positive changes in a person's appearance and self-confidence. However, persons who would like to undergo rhinoplasty should have realistic expectations regarding their improved appearance. Otherwise, rhinoplasty is not a sort of magic that would turn someone's life into a dream come true all of a sudden.
What are the benefits of a photo-based animation study?
In parallel with the advances in computerized animation software, it has now become possible to share with a patient the intended appearance of his/her nose after surgery. This way, both patient's expectations and surgeon's promises become more understandable. Animation software also makes it possible to assess in advance the adaptation of the newly designed nose to the entire face. The animation software that is used for this special surgery where not only the doctor's, but also the patient's wishes are important is very beneficial in order to speak the same language before surgery. However, a simulation only provides a virtual platform after all. It only gives a preliminary idea about the result of surgery. It should not be forgotten that the surgical procedures performed on the patient are completely independent from the computer. In addition to these virtual animations, comparative images in the patient's archive showing the appearance before and after surgery as well as images showing the recovery period are very beneficial to ensure a more realistic perception of the process. The comparative photos of nasal surgeries previously performed by your surgeon provide you with very important tips about the kind of result that can be expected. Furthermore, in my opinion, these photos may be considered more valuable than virtual results since they are real results.
Why is a preliminary discussion very important?
Full and complete understanding of the patient's expectations and doctor's promises are of vital importance for both parties involved. No matter how much time is required for this purposes, it is worth spending it. The essential requirement to avoid any disappointments in the future is to have a sound preliminary discussion, talk about and clarify everything realistically.
For all the patients presenting to our clinic for nasal esthetic surgery, detailed anamnesis, outer and inner (endoscopic) examinations of the nose, photography, simulation actions on the photo showing how the nose would look afterwards and explanations based on the comparative photos of previously performed surgeries are to be handled personally by your surgeon. Everything that should be known and that you would like to learn will be explained in the most detailed fashion.
You should inform your surgeon about whether you previously underwent nasal surgery or received any impacts on your nose, have any respiratory problems as well as any medicines or vitamins you take and whether you have a habit of smoking.
For any details which you feel has not been adequately clarified during the preliminary discussion or any questions that you may have in due course, you can feel free to contact your doctor.
What are the steps to perform rhinoplasty?
Rhinoplasty can theoretically be performed under local or general anesthesia. However, it is better to perform it under general anesthesia considering the operating steps and patient comfort.
With rhinoplasty, the nose can be more downsized and upsized. The shape of the nasal tip and nasal hump can be changed. The nasal thickness can be reduced. The tip of the nose can be lifted upwards. A congenital or accident-related defect can be corrected. Any complaints with breathing can be eliminated.
Some rhinoplasty surgeries are performed by means of incisions made inside the nostrils. This is called the “closed rhinoplasty” technique. Some surgeries are performed by cutting the tissue termed columella, which separates the nostrils, in order to provide better vision and comfort of movement. This technique is called “open rhinoplasty”. I use the open rhinoplasty technique in all my rhinoplasty surgeries.
The surgery takes approximately 2-2.5 hours. During surgery, the nasal cartilage and bony structures are detached from the soft tissues and shaped as desired in general terms. To explain it in brief detail, the septum that constitutes the cartilage part of the nasal hump and upper-side cartilages are incised and the bony part is trimmed in order to shape the structures. Any curvatures of the septal cartilage in the mid-section are corrected. The lower side cartilages are thinned. Support is provided where necessary using the cartilage tissues called graft which are derived from the septum. The nasal tip is thinned and shaped. The nasal bones are cut on the line where they join the cheekbones and brought closer to the midline. After that, the skin and other soft tissues are spread on the shaped skeleton once again. If the skin is thicker than normal, a slight thinning can be performed carefully from under the skin. If the skin is extremely thin, the soft tissue grafts can be used to support the skin from underneath. The above-mentioned explanations summarize the procedures performed for a person who did not undergo surgery before. The techniques to be employed in patients who had prior rhinoplasty and still have shape deformities are different. In such cases, it may be necessary to harvest supportive cartilage tissue from the ear or rib cage if there are not enough cartilage reserves inside the nose. The cartilage tissues necessary for supporting the nasal tip and midline are generally obtained from the inner parts of the tissue called septal cartilage in the nose. However, in cases where the nose was damaged due to previous surgeries or accidents, cartilage tissues harvested from the ear or rib cage can also be used for supporting the cartilage. Naturally, this possibility is explained to you in advance by your surgeon.
The use of cartilage grafts has gained significance in recent years in order to maintain and/or improve the functional structure and to preserve the new shape of the nose for the long term after surgery. These cartilage defects are derived from pieces of cartilage that we remove during surgery. These grafts are placed at the necessary support points after the nose is shaped. These prevent the created shape from being disrupted over time due to the movements of soft tissue and gravity over time. Furthermore, they help the patient breathe better, as well.
What does the recovery period after rhinoplasty look like?
Following surgery, the surface of the nose is fixated using plaster and thermoplastic splint. Silicon plugs are placed inside the nose. The phase of plug removal, which is much feared by the patients, is no longer fearful thanks to silicone plugs. Silicone plugs can be removed in an almost pain-free way and the bleeding that may generally accompany plug removal is now history. Furthermore, the grooves on the plugs ensure that the patient can breathe comfortably even if the plugs are in the nose.
The attention showed during surgery and some special practices ensure that the post-operative recovery period is shorter and more comfortable. Today, the recovery periods where both lower and upper eyelids are so swollen that the eyes become invisible is a thing of the past. Shorter recovery periods now ensure that patients can more quickly return to their usual lives. Therefore, the waste of time, which has become ever more important, is reduced. It should still be kept in mind that certain people are more prone to bruising. Furthermore, the intake of medicines and supplements such as aspirin, gingko balboa and ginseng or heavy consumption of green tea may result more bruising than expected.
There may be edemas in the face, slight bruising on the lower eyelids, slight leakage from nostrils and a feeling of fullness in the nose may be observed for 2-3 days after surgery. However, these complaints are relieved by medication. There is not much pain. It is appropriate for the patient to lie on his/back in a semi-sitting position and stay in that position other than toilet breaks. The patient can be mobilized the following morning.
Application of cold compress on the eyes after surgery would not only reduce swelling but also make the patient feel better. The majority of swelling and bruising should disappear within 2 weeks.
The plugs are removed 24-72 hours later depending on the type of surgery. The thermoplastic splints and any sutures are removed 1 week later and plasters are removed 12-15 days later. Once all these supporting instruments have been removed, the patient may want to see his/her nose. However, all the edema and bruising should first disappear. To facilitate the healing of edema, your doctor will provide you with the required recommendations and ask you to apply certain massages. Generally speaking, the nasal bridge assumes its final shape 1 month after surgery and the nasal tip 2-3 months after surgery. Until the end of six months, the nose assumes its final shape with minor changes and generally preserves this shape.
The patient is discharged the following morning and can go back to school or week once 1 week has elapsed.
After surgery, the patient should not vigorously blow his/nose for about 2-3 weeks, not do any sports for 1 month (fitness, pilates), not wear glasses for two months and avoid any impacts on the nose for at least up to 6 months. Since martial arts and team sports are risky in terms of impacts, they are not recommended after surgery.
Your doctor will schedule regular follow-up visits after surgery. However, you should feel comfortable to contact your doctor for any questions or queries you may have apart from these routine controls.
Would I have any problems following rhinoplasty surgery?
My essential aim as a plastic surgeon is to achieve a result that would please the patient in one go with rhinoplasty surgery as in all my surgeries. In spite of all the attention and caution paid before and during surgery and in the recovery period, it is possible to see certain unanticipated healing problems and related, minor defects in one out of 20-25 patients. This possibility is applicable to all those who perform surgery and those who claim to be good in this. In such a situation, it is important that you know that your doctor is supportive of you with the same attention and sincerity to solve this problem and is able to correct this problem with a much smaller secondary intervention as compared to the first one.
In today's world where appearances, i.e., image have become much more important, I highly recommend that those who would like to feel better with an improved appearance feel comfortable in seeking the necessary support from a trusted esthetic surgeon.