Aesthetic Nose Surgery (Rhinoplasty)
Rhinoplasty is a procedure that reshapes the structure of the cartilage and bones. Sometimes, bones and cartilage need to be cut for an aesthetic nose shape; sometimes, on the contrary, the missing parts need to be completed and their shape changed very correctly to accept rhinoplasty or aesthetic nose surgery as the most challenging and unknown surgery of plastic surgery.
Why is Aesthetic Nose Surgery Difficult
Aesthetic nose surgery is complicated because the nose is like a closed box, and you have to do this surgery on only one side of this box. This surgery has many unknowns because the bones and cartilage that make up the nose structure exist independently of each other but as a whole and may behave differently during the recovery period. For this reason, this plastic surgery is followed by the most frequent revision, namely a second correction surgery. It is usual for a world-class surgeon to make revisions to one out of every 10 cases.
On the other hand, this surgery gives excellent results when done well.
SURGERY
Rhinoplasty surgery can be performed in two ways: open and closed technique.
In the closed technique, all cuts are made inside the nose, and the surgeon completes the operation by working from the inside. In the open technique, a 3-4mm cut is made at the nose's tip, and the nose's tip is opened.
The difference between the two techniques is related to the surgeon's command of the operation. The closed technique made from the tip of the nose is more like operating a bottle. If you are only planning to get something out of the bottle, there will be no problem, but if you want to make a model of a ship inside, it won't be easy. In the open technique, the surgeon can see the structures in the anterior 2/3 of the nose in front of them.
The doctors who perform this surgery always debate which technique is better, and no decision has been made.
As you can see from my descriptions above, my preference is mainly for the open technique. The most important reason is that I do not believe that the result of exemplary work done without actually seeing what is going on can be good. It is something that even the advocates of the closed technique cannot object, that many surgical maneuvers are possible only with the open technique, and corrections that cannot be imagined with the fast technique are possible with the available technique. The possibility of revision decreases after open surgeries.
The most significant handicap of the open technique is the scar on the tip of the nose. But this scar is almost vague after a well-done surgery and remains under the nose. Many patients forget this scar after surgery.
However, please consult your doctor about this and trust them. Every surgeon will get the best results with the methods they know best and believe they are the best. The above are just my personal opinions.
I SEE VERY BAD RESULTS; WILL I HAVE THEM TOO?
I also see "operated noses" that are unnatural and very small, with nostrils visible when viewed from the front. I explained how you can understand a poorly performed nose surgery on a separate page. Remember that the outcome of the surgery depends entirely on the surgeon's techniques, skills, and what they want to do.
Giving an upturned nose shape by only making the nose smaller creates an unnatural result. In modern techniques, almost nothing is removed; only the tissues' locations, positions, and shapes are changed.
If you examine this figure, you can see one of the most common aesthetic mistakes. This is a method often used in old techniques. In the past, the nose was smaller to make the nose look upturned, and the starting point was taken as low as possible. Thus, an illusion was created as if the nose was up, but the result would not be natural. It is necessary to start the nose from where it should start, that is, almost at the level of the pupils, and give its entire shape accordingly.
How Can I See What Kind of a Nose I Will Have After the Surgery?
There are computer programs prepared for this purpose. Your doctor will likely give you an idea with one of these. However, actual operation planning and measurement cannot be made with these programs; they can only provide a general idea.
If your doctor uses one of the new measurement-based techniques, they will want to measure your pictures. For this, they will either hold a ruler in your hand while taking your photo and measure accordingly or print the picture they took in actual size.
Before the surgery, I calculate the golden ratios and the ideal face profile by making fine measurements. Based on my calculations, I drew a profile picture by hand. Click here for detailed profiling information.
COMPLICATIONS AND PROBLEMS THAT MAY OCCUR
The risk of bleeding in every surgery may be more severe in rhinoplasty. The possibility of unwanted bleeding increases if non-aesthetic procedures are performed in the nose to relieve nasal congestion, which should be done if necessary. The nose is an organ that contains medium-sized vessels. But this type of bleeding usually does not reach dangerous levels and can be stopped with simple tampons.
Adhesions called synechiae may develop in your airways after surgery, making breathing harder for you than before the surgery. This is usually easy to treat but may require a second surgery.
Very rarely, a hole may occur in the " septum " structure, which forms the middle of the nose. This is usually not a problem, but in rare cases, it can cause a sound when breathing. It is challenging to treat and requires reoperation.
Infection in the nose is almost impossible. This organ, which has a powerful blood supply, is very resistant to inflammation. If infection develops after this surgery, you can enter the medical literature.
But no one will be surprised if you experience aesthetic problems or deformities after this surgery or don't like the shape of your nose. Therefore, the most common complication of this surgery is the aesthetic angle.
FREQUENTLY ASKED QUESTIONS
Should this surgery be performed by a plastic surgeon or an otolaryngologist (ENT physician)?
Your doctor may be a plastic surgeon or an otolaryngologist. However, do not forget that this is not an operation to say, "Let's take that bone while we're doing it." Sometimes, this kind of retouching done in good faith can be challenging to fix. Discuss everything with your doctor in detail.
Do you break bones?
We don't break bones. If we want to shape or remove parts of a bone, we "cut" it. Thin chisels are used for this. Sometimes, the bones are filed.
Can this surgery be performed with local anesthesia?
If something is going to be done about the bones, which is primarily necessary, local anesthesia will not be appropriate. This is an operation that requires general anesthesia.
Is it necessary to put a tampon in?
Tampons are not necessary after many surgeries. They are only needed if severe work has been done inside the nose. However, modern tampons are shorter than they used to be.
Will it hurt a lot when the tampons come off?
Tampon removal can be tedious, but it's no longer painful. Consult your doctor about this issue, and find out if they will use tampons and what kind they are considering.
Is the purpose of rhinoplasty to make the nose smaller and "remove bones"?
The answer to this question is no. This surgery aims to give the desired shape to the nose. Contrary to popular belief, this is usually achieved not by making the nose smaller but by enlarging the nose. If there is an excess of a bone called "hump" (in fact, it is mostly cartilage) on the back of the nose, this will, of course, be removed, but many of these types of noses have a low nose tip, and it must be raised. In the same way, although many nose tips look fat, the main problem is the shape, and reducing or thinning it only makes the problem bigger.
TIPS
It would not be an exaggeration to say that rhinoplasty is the most difficult plastic surgery. It is a surgery you will be delighted with if done well, but it is difficult to correct if done poorly.
Contrary to popular belief, the slightly upturned European noses we adore are not tiny but highly high. Therefore, the noses can't be raised only by making them smaller to stand naturally.
What to Expect Before and After the Surgery
This is minor to medium plastic surgery. It is necessary to receive anesthesia during the operation, so I do not recommend you have an operation with local anesthesia. The operation must be performed in a hospital; it does not have to be fully equipped or have an intensive care unit. I would not recommend you to have this surgery under the conditions of a doctor's office.
Your doctor may be a plastic surgeon or an otolaryngologist. I still recommend you have the surgery with a plastic surgeon, but I know that there are ENT specialists who do this surgery very well. However, do not forget that this is not an operation to say, "Let's take that bone while we're doing it." Discuss everything with your doctor in detail.
After the surgery, you will have a cast on your nose. You may also have tampons in your nose. Removing new-generation tampons is now problem-free. The tampons your friends told you were extremely long have become a thing of the past.
Your first night will be relatively complex. Breathing through your nose will be difficult even without a tampon; you will have a headache, need to apply ice constantly, and find it difficult to sleep. But the following day, you will feel much better.
How much swelling will occur depends on the procedures performed in the surgery, your body, and your doctor. In the second surgery, the swelling will be a little more. There will be a slight leak from the tip of your nose for the first 24 hours. This is also extremely normal.
You should not be worried if you vomit and there is blood in your vomit. Some patients may swallow blood during surgery, and this may cause vomiting after surgery. Do not be afraid if the bleeding is not fresh and does not continue, but be sure to inform your doctor.
After the second day, you can return to your everyday life and, for example, go to the cinema. After removing the cast, sticking a thin tape on the nose helps the swelling go away quickly.
ABOUT THE SURGERY
Anesthesia type: General
Where should the surgery be performed: In a hospital's operating room.
Duration of surgery: 1.5 to 2.5 hours.
Length of stay in hospital: You can be discharged on the same day.
Post-operative pain – distress: TA slight tingling may occur for a few days. Usually, a simple oral painkiller is sufficient.
Swelling, bruising: There may be severe bruising and swelling around the eyes between 3-7 days.
Dressing Tampons: Dressing Tampons, if any, are removed the next day. The cast is released on the fifth day.
Stitches: If open rhinoplasty is performed, the nasal tip sutures are removed on the fifth day with the cast.
When to return to work: 3-7 days.
Exercise: After two weeks, go for long walks. After three weeks, you can resume regular exercise. However, it's best to wait until five weeks at the earliest to start competitive sports like basketball and boxing.
Final shape: Most swelling disappears in the second week, but the final shape appears in the 6th month at the earliest. If there is swelling toward the forehead, especially between the eyebrows, it will continue for up to a year.
