RHINOPLASTY SURGERY

The purpose of the rhinoplasty surgery is to correct the deformities of your nose. At the same time, if you have problems such as deviation and turbinate hypertrophy which prevent breathing in your nose, it is necessary to solve these problems during the same surgery so that you can breathe easily after the operation. Thereby the operation becomes successful in terms of both functional and aesthetics.

Rhinoplasty surgery is one of the operations of facial plastic surgery. The facial plastic surgery branch is rapidly spreading worldwide as a side branch of ENT expertise. An otolaryngologist who is interested in facial plastic surgery will solve your problems best in terms of aesthetics and nasal respiration, which is very important for your life comfort.

Since nose size is usually reduced in the nose operations for aesthetic purposes, it is necessary to evaluate the anatomical structures of the nasal and surrounding structures by direct examination, endoscopic examination and, if necessary, radiological examinations. Even if you do not have a complaint of nasal congestion prior to surgery, it should decided whether your lower and middle turbinates should be reduced by appropriate surgical techniques during the same operation considering complaints that may occur after surgery.

It is very important that you identify all of your complaints that lead you to this operation before discussing with your doctor.

In addition to the problems you want to have been corrected aesthetically as well as determining whether you have breathing problems through the nose, runny nose, postnasal leakage and headache complaints will help your doctor to determine and solve the other problems in the nose area during this operation. You should discuss with your doctor about your own problems related to shape of your nose and the changes you want to make. Your surgery should be clearly stated by your doctor about whether your expectations are compatible with your current facial aesthetic ratios and your normal nose functions. Preventing post-surgery frustration will only be possible if this discussion is done adequately and when you have a mutual agreement with your doctor about your planned changes.

At this stage, your current face and nose measurements and your ideal nose dimensions (the length and the projection) can be calculated according to your face with the help of measurements made based on the specific points on your photos taken.

Present nose sizes and ideal nasal dimensions suitable for the patient’s facial structure are calculated on the basis of specific points and ratios.

Visualization of the possible different results of the operation by using digital imaging techniques on your captured photos makes it easy for you to decide on the shape of your nose profile, nose tip and nostrils.

It is possible to predict different results by using digital techniques prior to the operation, thus facilitating the decision about the desired outcome, and the operation plan is carried out to achieve this result.

Although preoperative evaluations and photo shoots are performed in an upright position, it may be difficult to make a decision about amount of tissue to be removed due to injections made during surgery and the resulting skin edema as well as surgery performed in supine position. For this reason, preoperative calculations and the exact planning of the procedures to be performed during your operation is extremely important for your surgery to be finalized as desired.

Occasionally, defects that appear too large with the patient’s eye can be corrected by a simple surgical procedure, while a very small defect can be corrected, perhaps only partially, by a long and difficult surgical intervention. Due to factors such as the long duration of full recovery, wound healing characteristics and the tissue characteristics of the patient which are effective at this time, 5-15% of all rhinoplasty operations may require to perform a little corrective intervention after completion of the recovery.

While the possibility of a second intervention increases with severe deformity correction and graft application in patients with light skin color and thin skin structure, this possibility is very low in patients who have not very thin skin and apparent asymmetry in the nose. It is one of the most common problems to detect some curvature or asymmetry after healing completion and taking the final shapes of the tissues due to the asymmetry of the entire nasal cartilage and bones in the noses ‘C’ or ‘S’ like asymmetrical and curved on frontal view. If the result is not satisfactory, it is best to eliminate these problems by simple camouflage techniques, such as supporting the collapsed areas with thin cartilage pieces placed under the skin.

After the surgery, the shape of your nose when dorsal splints and drapes are removed will not be its final form, reduction of the edema in the tissues and getting the final shape of your nose will be faster in first 2-3 months and completed about 6-12 months depending on the type and amount of grafts used during your operation (tissues, such as bone, cartilage added to the nose), the technique used, and the structure of your nose skin.

PURPOSE OF THE OPERATION

It should be targeted to make the most appropriate and natural looking nose to your face during rhinoplasty. The biological properties of your existing tissues have a significant effect on the outcome of this surgical procedure. That is, the thickness of your skin, the fineness and form of your existing cartilages, your wound healing properties, and your previous nose operations have a significant impact on the results of your rhinoplasty surgery.

Your nose is right in the middle of your face and when you look at the mirror or when someone look at you, it is the first one that draws attention. A beautiful and attractive nose is a nose that has certain proportions in itself, and at the same time does not remain faint between your other facial structures. Therefore, the purpose of the surgery is not to make a very nice nose alone, but the most appropriate one to your face. In order to achieve this goal, it is often necessary to reduce the existing tissues, but in some patients who have previously had surgery, it is needed to add some tissue to the nose to make some parts of nose bigger.

In cases where it is necessary to add tissue to the nose, the patient’s own tissues, such as the cartilage pieces taken from the ear or rib, are preferred. If the material other than the patient’s own tissue is used especially for support purposes, long-term success rates are low and there is a high likelihood of having problems such as infection and excretion. Rib cartilages obtained from cadavers called homogreft and whose antigenic structures have been cleaned by special processes are one of the most preferred materials for camouflaging dorsal irregularities. Despite their loss of volume in the medium to long term, their effect on the nasal lines continues due to their conversion to a strong connective tissue.

OPERATION TECHNIQUES

Rhinoplasty is the one of the most performed aesthetic surgeries. The duration of operation depends on the type of the structural problem in the nose, the intranasal deviation, anatomic variations, nasal growth, chronic sinusitis and surgical technique, but it usually lasts around 1.5-2 hours. However, this may be longer in special cases requiring tissue removal from other areas such as the ear and ribs.

Surgical Techniques

The main techniques used in rhinoplasty operations are;
Microrhinoplasty
Tipplasty
Open Rhinoplasty
Closed Rhinoplasty

The operations performed with the aim of correcting the deformities of the cartilage structure without any intervention to the bone structures of the nose are called as Tipplasty. In this surgery, except for very limited problems, almost always open technique is preferred. With tipplasty surgery, it is possible to correct nasal tip and asymmetries, to reduce the nose tips, to clarify the endpoint in the nose profile view or to correct cartilage angulation that narrows the nostrils. Since there is no intervention to the bone structures during the operation, swelling and bruising around the eyes are generally not observed after the surgery. Since a one-week drape application on the nose is sufficient, it is very fast for patients to return to their normal daily life after the operation of tipplasty.

Open rhinoplasty technique is the ideal approach for patients with deformity or asymmetry at the nasal tip, who have had surgery before and/or who need to be intervened with the deviation of the septum in the nose during the same session. Open rhinoplasty is the most preferred surgical technique since the tip of the nose should also be interfered for most of the rhinoplasty patients.

In the open rhinoplasty operation, a horizontal incision is made from the middle part of the region between the two nostrils (Columella) to start to operation (Figure 3) and after elevating the nasal skin, all the cartilage structures forming the nasal tip are revealed and the operation is performed under direct view. In this operation, as well as providing complete symmetry, the cartilage supports can be inserted and fixed with sutures to the regions where needed, thus reducing the risk of nose tip change, nose tip drop and nasal septal dislocation.

Since nasal cartilage (septum) can be fully controlled in open technique, the deviations in this structure, especially near the nasal dorsum can be corrected by appropriate methods, if necessary, by adding cartilage pieces and cartilage deficiencies in previous operations can be repaired fully and symmetrically. In open technique operations, the incision made at the nasal tip fully heals in about 1.5-2 months when appropriate closure techniques and materials are used.

Closed rhinoplasty technique is preferred for patients, who have no specific problem in their nasal tip and septum, whose main complaints are dorsal hump or simple superficial irregularities related with previous operation in their nasal dorsum.

In this technique, the nasal dorsum are reached through incisions made inside the nostrils and the necessary interventions are made to the structural disorders. The closed technique allows the surgery to be performed in a shorter period of time, and the recovery takes shorter time due to the small amount of edema at the tip of the nose.

During surgery, after removal of the bone and cartilage hump, the nasal bones are broken and they are brought closer to each other to give a natural look on frontal view, accordingly some bruising and swelling occur around the eyes after the surgery. This edema and color changes almost completely disappear in about 7-12 days. The application called as ‘’Hilotheraphy”, which has been used recently, provides to apply 15-18°C around the eyes with the help of a special mask. Swelling and color changes around the eyes after the surgery can be prevented significantly with this application that keeps lymph and blood circulation active.

Since it is not necessary to place a nasal packing in the nose except in special cases, surgery can be performed without nasal packing in most patients.

External nasal splint and plastic plaster applied to the out of nose are renewed in the first week after surgery and removed between 10-14 days.

Since the nose is immobile, there is no serious pain after the operation and simple painkillers are usually sufficient.

If the techniques other than cauterization, radiofrequency or microdebrider are used to reduce concha hypertrophy during the surgery, it may be necessary to place a nasal packing in the nose to reduce the risk of bleeding after surgery. The structure of this nasal packing is like a soft sponge and does not cause any serious problems instead of obstruction and it is removed on the second postoperative day.

After the surgery, it is recommended to rest in an environment where is not too hot and with the head slightly elevated. Intermittent cold application on the eyes during the first 24-36 hours is useful for fast recovery and prevention of swelling and bruises. Within the first week, it may be necessary to come to the control for crusting and obstruction.

The nose heals day by day after the rhinoplasty and the completion of healing may last for 6-12 months depending on the type of surgery performed. In this period, the nose changes faster in the first weeks, followed by gradually until the desired result is reached. For this reason, it is very normal that the appearance of the nose in the early postoperative period is not as desired, the shape of the nose will change in the desired direction as the edema decreases over time and the skin reaches its normal thickness. Similarly, obtaining the desired outcome in the early postoperative period should bring to mind the possibility of a different result than the desired one, although there may be differences depending on the technique and the procedures used. It will be the most appropriate way to follow the changes in the nose shape in course of time together with the doctor.

POINTS TO BE PAID ATTENTION AFTER RHINOPLASTY

Nasal splint on your nose will remain between 10-14 days. It should not be wetted. If you are in hot or steamy places, this may cause nasal splint to loosen or come off.

During the first 24-36 hours, cold should be applied on to your eyes (5-10 minutes per hour).

After the surgery, you should avoid physical activity as far as possible for 5 days and rest as your head elevated.

You should avoid excessive facial expressions and laughs for a week.

If an open technique has been performed, your sutures at the nose tip will be taken by your doctor within 5-7 days.

There may be swelling under your eyes and face after rhinoplasty. These swellings and color changes will pass completely within 1-2 weeks.

After cast removal, you can gently clean your nose with liquid soap or special lotions. You can make up after removal of your drapes.

For 3 weeks following the surgery, it is appropriate not to wear a turtleneck or tight-necked clothes that increase the risk of an impact on the nose.

You should avoid touching your nose hardly for three weeks, and for the first 6 weeks, you should avoid activities that might damage your nose.

It is recommended not to wear glasses for 6 weeks and after that you should use glasses with a light frame.

During the 6 months following the operation, you should prevent your nose skin to tan in the sun.

It is recommended not to be in too hot environments, since excessive heat cause your nose to swell.

You shouldn’t take any medication other than the medication given by your doctor.