Place: Organized and well-equipped clinic.
Duration: 1-2 hours.
Eve: A few hours or an overnight stay.
Pain: Limited, (despite general perception).
Swelling, swelling: Usually resolves in 7 days.
Social reintegration: 1-2 weeks after surgery (possible use of make-up).
Exercise: It is advisable to avoid it for 1 month.
Final result: From 3 to 6 months.
With the rhinoplasty a nose can change shape in many ways: to grow, to shrink, to become narrower, wider, straighter, etc. depending on the needs that exist on a case-by-case basis.
Of course there are limitations, so the plastic surgeon will help you understand the surgical procedure, the anatomy involved and whether your expectations are realistic.
Of course, the plastic surgeon should include in his plan other factors such as asymmetry, the quality of the skin (thick, thin, sebaceous), nasal dysfunction (crooked septum, existence of a nasal valve, hypertrophic niches), possible allergic rhinitis, etc.
The jaw also plays an important role in perfect harmony. A small jaw emphasizes a large nose more than a large nose, which is why many times, with the right “aesthetic diagnosis”, a rhinoplasty can be performed at the same time.
On the first visit
Before visiting the plastic surgeon, it is recommended that everyone should spend five minutes in front of the mirror and write down on a piece of paper what bothers them and what they would like to change.
The discussion in the clinic will be more constructive. With the thorough discussion and the help of the computer, each candidate for rhinoplasty can form an impression of the final result and the proposed changes.
This will be followed by a detailed discussion of all the stages of the procedure so that all questions are resolved and the candidate feels confident and secure.
The ideal candidates:
Not everyone is suitable for rhinoplasty. Ideal candidates are those who:
⁃ They are generally in good health.
⁃ It is at an age when the development of the nose is almost complete (over 16 years old).
⁃ They can describe specifically what bothers them about their nose.
⁃ They are “psychologically” ready to accept the change in their new appearance.
⁃ They have a problem with breathing (diaphragm etc.).
⁃ They may accept a small chance of reoperation (1-3% revision surgery).
⁃ Do not use “chronic” cortisone nasal sprays (they reduce healing ability, increase bleeding tendency).
Types of rhinoplasty:
At closed rhinoplasty all incisions are made inside the nose, so there are no visible incisions. It is statistically chosen by many surgeons, however it is recommended for the treatment of simpler cases where usually the removal of the tibia (hump of the nose) or some cartilage from the tip of the nose is done.
At open rhinoplasty the skin of the nose is lifted, allowing the plastic surgeon to get a direct view of the cartilage and bones. The incision is made in the skin and is located between the nostrils in the shape of the English letter W. The incision, although permanent, usually heals very well and is not visible. The disadvantage of the operation is the swelling, which lasts up to 6 months.
How the operation is performed
The upper half of the nose is made of bone and the lower half of cartilage, all of which is covered with skin. During rhinoplasty, the surgeon intervenes and modifies the bones and cartilage. When there is a “hump” in the nose, it is usually removed with a special osteotome and then the lateral parts of the bone are “broken” and moved more centrally by moving the fingers.
The cartilage can be modified either by removing part of it or by arranging it. At primary rhinoplasty the shaping of the cartilage of the tip is often done with special sutures, while in revision) it is common to use cartilage grafts (from the septum, ear or rib) to achieve the appropriate aesthetic result. Synthetic materials should be avoided.
In addition to the aesthetic effect, the nose should “work properly”. Causes that can cause breathing problems are:
- The crooked nasal septum
- The external nasal valve
- The inner nasal valve
- Hypertrophic niches
The plastic surgeon should carefully examine the patient (rhinoscopy, etc.) to diagnose possible malfunctions. The septum is a cartilaginous membrane that divides the nasal cavity in two. Very often it deviates to one side or the other, causing nasal obstruction. This deviation sometimes affects the aesthetic appearance of the nose (it turns to one side) and sometimes not. Η correction of the nasal septum is often done with the use of special cartilage grafts (spreader grafts) that support the septum like beams while at the same time improving the internal nasal valve (the point where the septum meets the upper lateral cartilage and should be >15°). With the use of grafts, the external nasal valve can also be corrected.
Very hypertrophic niches can be reduced by various techniques such as cautery, microfractures, etc. The issue of nasal dysfunction is quite complex, so the patient and his or her surgeon should discuss it in depth and in great detail. It is possible that after a rhinoplasty there may be difficulty with nasal function and, if this happens, reoperation may be needed.
AFTER THE INTERVENTION:
After surgery, the patient is discharged from the hospital wearing a splint in the nose area. Gauze is placed inside the nose and remains in place for 48 hours, while the splint is usually removed after 7 days. The majority of the swelling and bruising will gradually subside within 2 to 4 weeks. The patient can return to their daily activities after about 3 days. External stitches (if any) are removed in 5 to 7 days.
About 80% of the aesthetic result is visible after 3 months, while the final result will be visible in 12 to 14 months.
Recurrent bleeding and loss of sense of smell may be a result of this surgery, but these problems usually resolve quickly. The result of rhinoplasty is permanent and any remaining abnormalities can be corrected with a much smaller surgery under local anesthesia.
- Head elevated with two pillows during sleep for the first 7 days.
- Ice compresses or crushed ice (in a bag) on the eye area (without touching the splint) for 72 hours (3 days) after surgery placed. It helps to reduce swelling (swelling) and bruises.
- Taking a painkiller every 3 to 4 hours, such as DEPON , MESULID etc., if there is pain.
- A light diet of fluids and soups for 48 hours, and caution in the first 2 weeks to avoid foods that require excessive movement and effort, such as hard apples.
- Possible minor bleeding the first 3 – 4 days – change of gauze.
- Avoiding loud sneezing for the first 2 weeks.
- Attention-protection of the nose from possible blows (hugging, opening doors, etc.).
- No water in the narthex. Washing like in the hairdresser’s.
- Once the internal gauze is removed, clean the area with a cotton swab and a little bit of acetic acid and a nasal spray.
- Splint removal usually in 7 days.
GENERAL POST-OPERATIVE INSTRUCTIONS
- Avoid strenuous exercise, gym or anything that can raise the heart rate above 100 beats/minute for 2 weeks. After the 3rd week, gradually, one can come back.
- Be careful not to injure the nose for 4 weeks after the operation.
- After removing the splint, it is advisable to avoid wearing glasses for at least 4 weeks.
- Protection of the sensitive skin of the nose for 6 months with SPV 15 sunscreen and the first days careful cleaning with moisturizer.
- A possible feeling of numbness of the tip of the nose and some of the front teeth is normal and improves with time.
- Swelling of the nose for up to 12 months.
- Possible feeling of “hardness” and stiffness of the nose, especially when someone smiles. It improves with time.
- Faithful and consistent adherence to the surgeon’s instructions for the use of medications, changes, cleanings, etc.
- If nausea, vomiting, rash, difficulty breathing or fever over 38°C occur, contact your doctor immediately.
Plastic surgery of the nasal septum – Nasal valve dysfunction
In addition to the aesthetic result, the nose should “function properly”, which is why it is described as an “aesthetic and functional” rhinoplasty.
Causes that can cause breathing problems are:
Α. The crooked nasal septum
Β. The nasal valves
Γ. The hypertrophic niches
Α. Causes of a crooked diaphragm:
⁃ A hit (in sport, childhood, etc.).
The patient complains about
⁃ Difficulty in breathing consistently and always on the same side (of the scoliosis).
⁃ Fatigue during exercise.
⁃ Feeling of dryness in the mouth, throat.
The plastic surgeon should carefully examine the patient (rhinoscopy etc.) to diagnose possible malfunctions. The septum is the cartilaginous membrane that divides the nasal cavity into two nasal chambers that are covered by mucous membrane and as air enters the nose they are moistened, heated and cleaned of foreign particles.
The septum very often deviates to one side or the other causing nasal obstruction. This deviation sometimes affects the aesthetic appearance of the nose (it turns to one side) and sometimes not. The correction of the nasal septum is often done by using special cartilage grafts (spreader grafts) that support the septum like beams while at the same time improving the internal nasal valve (the point where the septum meets the upper lateral cartilage and should be >15).
Hypertrophic niches can be reduced by various techniques such as cautery, microfractures, etc.
Like all procedures, rhinoplasty, to a small extent, can have certain complications, such as:
⁃ Nasal distress
⁃ Small deformities
⁃ Prolonged swelling
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