¬ Nose Surgery

NOSE SURGERY (Rhinoplasty, Septorhinoplasty)

Nose is an aesthetic and functional organ that affects the appearance of face. Rhinoplasty often referred to as nose surgery is a surgical procedure that reshapes the nose. It is one of the most popular cosmetic surgeries among men and women in our country and so in the world.

Aesthetic nose surgery is performed to restore the nasal tip, improve the nose size, reshape the hump on the nasal bridge and increase the narrow angle between the upper lip and nasal tip. In addition, impaired breathing due to inner and middle cartilage deformation and weakness can be corrected with septorhinoplasty or rhinoplasty.

To fix breathing problems, surgical attempts like septoplasty, resection of nasal choncha can be combined with aesthetic nose surgery. With the nose surgery the goal is to achieve a natural look  considering patient concerns and demands. Especially in nose surgery, function and aesthetic are inseperable parts of a whole. A successfull nose surgery results in a nose naturally  shaped and harmonious with the facial features while correcting impaired breathing associated to nose. 

Am I a good candidate for nose surgery?

If ;

Your nose size is big and not proportionate to your facial structures

Nose profile, there is hump or projection at nasal bridge

Angle between nasal tip and upper lip is not enough and upper lip looks shorter

From the front your nose is wide and big

Your nose tip is large and bulbous

Shape of your nose makes your image tough 

There is unevenness and depression in your nose shape

There is breathing problem

Your nostrils are wide and large

Your nose sidewalls(alar) are wide  

Also, if you have realistic expectations and good health status both physically and pyshcologically, you are an ideal candidate for nose surgery. 

Nose surgery can be performed to every men and women. Generally, until facial growth is completed in other words before 17 years old it is not suggested. On the other hand, if emotional growth is completed and nasal deformity is very significant male patients at age 16 and female at age 15 can be operated. 

Pre-op Initial Consultation 

If you are considering nose surgery you should seek an experienced plastic surgeon and consult with the doctor.In this consultation you should clearly tell your complaints and expectations with this surgery.

Over the course of consultation  your doctor will evaluate general health status both physically and psychologically . Your pre-existing health problems, treatments, medications and possible allergy that impaires your breathing should be looked for. 

In the physical evaluation your doctor will examine your nasal bone, cartilage state, structure, shape, size and its proportion in relate to face structure from the outside. Moreover, symettry of nostrils and width of sidewalls is examined. With intranasal examination your doctor will be able to detect if you have septum deviation or growing choncha that leads to blockage of nasal breathing.

Considering your expectations and examination findings your doctor will offer you the best and tailor made option and give you detailed information that includes what should you realistic ally expect from the surgery. Also, your doctor will explain the surgical method, anesthesia, the place of operation room(theatre), complication of risks associated to the procedure and pre-op instructions. Before deciding nose surgery ask all the questions you have in your mind and until you get satisfactory answers and fully comprehend. In this consultation you may also get a quote. Based on the whole information you may finalize your decision.

Once you decide to go with the procedure you will be asked to have several tests done. If test results are normal, the surgery time, date and place will be determined. Aesthetic nose surgery should be performed in a hospital.

The surgery date

Following registration in the hospital you will be smoothly transferred to your room. Doctor will make your surgery plan and then anesthesist will inform you about the anesthesia and ask related  questions. Before the operation, a sedative injection that will relieve and encourage you, will be administered. This will help you manage the anxiety and the excitement related to surgery which is very common.

In the operating room anesthesia will be applied. Nose surgery is frequently performed under general anethesia that will provide you and your doctor comfort. Local anesthesia with sedation is another choice but it is not preferred by the surgeons. Your doctor will offer you the best choice that fits your case.

The nose surgery

Aesthetic nose surgery is performed to restore the nasal tip, improve the nose size, reshape the hump on the nasal bridge and increase the narrow angle between the upper lip and nasal tip. In some cases a tissue or cartilage may be grafted to enhance the nose shape. Either one or all of the alterations mentioned can be done in the same nose surgery. Size of the surgery depends on what changes you want and your doctor considers necessary for your case. While surgical procedure can be done to enhance the nasal tip also, it is possible to straighten the deviated septum besides reshaping the nasal bridge which is defined as septorhinoplasty.

There are two methods in rhinoplasty : closed and open. In a closed procedure, through incision  hidden inside the nose cartilage and bone that form the shape is reached. In the open procedure surgeon reaches to nose cartilage and bone through incision made across columella, a narrow strip in the  middle of nostrils, to the inside of the sidewalls (alar). Doctors are still undecided on which method best works. Both methods have advantages and disadvantages. Doctor who performs both methods successfully will suggest you the best option that works for you. That is why consult with your doctor all the details and count on him/her. After open or closed incisions reshaping is realized and cartilage and bone that alter the appearance of nose is reached . 

Bone that forms a hump on the nose and cartilage is sculpted with specific instruments. Then, nasal bones are gathered to create a narrower roof. Cartilage is reshaped, nasal tip is resized and angled and a better image is provided. To correct the angle between the lower part of the nose and upper lip nasal tip is reshaped. If the nose is short or long nasal structures can be reduced or augmented. This procedure is achieved by shortening the septum, cartilage seperates the nostrils. And if sidewalls of the nose are wide from the inside of the sidewalls a wedge shaped cartilage is excised that results in a narrower nose base.

After the operation is completed tampon in the nostrils can be  placed if necessary (depending on the surgical procedures in the operation vaselin soaked up tampon or special silicon splinter-Doyle can be preferred).On the nasal bridge a plastic bandage or a cast is to protect the new structure during the initial healing. Approxiamately surgery takes 1.5-2 hours. It may extend depending on the degree of deformity and the required steps.

 How is the nose surgery recovery?

First day following the surgery you may spend the day with resting in the bed. In fact there will be no pain but if you feel pain a simple pain killer can subside the pain. It is important to keep your head in the upright position and apply icepack on your eyes to reduce the swelling and the bruising. Necessary instructions will be fully explained. Medical staff will help you while you stay in the hospital. First day a blood leak can occur which is very common. 3-4 hours after the surgery liquid food can be advised according to your condition. Afterwards gradually you can eat daily food. First days warm liquid food is suggested rather than hot soup, food or other beverages are not. Later on, you may resume your daily routine.

Swelling practically emerges several hours after the surgery and reaches peak level on the second day of post-op.This is a normal process and gradually it mitigates.If bruising occurs around the eyes it will subside within a week. If tampons  are placed they will be taken out 2 days following surgery.  This is absolutely not a painful step. A week after surgery splint or the cast is removed and also the stitches if done. If necessary a protective small cast or bandage can be wrapped. This may stay for 3-5 days. You will see the positive difference with your nose. Swelling and bruising will have been cleared but still you may have some eudema.This will go off over time and you will notice your nasal contour is refining day by day. It is important to avoid for 3 weeks strenuous exercise, jogging, swimming, bending, sex and  activities that increases your blood pressure. It is also crucial that nose is not subjected to force, abrasion, motion or sun exposure for 2 months. During this time you should not wear glasses. 5-7 days after the surgery as soon as patient feels better and swelling subsides contact lenses can be worn. Final nasal shape will be noticed within 3-6 months. When done right nose surgery result is permanent.

 

Prof. Dr. Muhitdin Eski