The nose is a dominant feature of the face that stands out dynamically, which is why its anatomy directly influences the overall image.
Every person is “different” in shape, size and contour so the shape of the ideal nose varies accordingly. Nevertheless, certain proportions are considered aesthetically ideal for almost everyone.
Some such features are a straight bridge of the nose, an elegant and triangular tip, a slight rebound between the bridge, nose and tip, a specific angle (90-105) between the upper lip and nostrils, a specific length from the face, etc.
All of the above are measurements that the plastic surgeon must take into account as he or she prepares for surgery and wants to shape the existing anatomy into a new “ideal” one.
With rhinoplasty, a nose can change its shape in many ways: it can grow, shrink, become narrower, wider, straighten, 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.
Anaesthesia: General.
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
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:
Α. Closed
Β. Open
C. Preservation
CLOSED RHINOPLASTY
In closed rhinoplasty all the incisions are made inside the nose, so there are no visible incisions. However, it is recommended for the treatment of simpler cases where the tibia (hump of the nose) or some cartilage from the tip of the nose is usually removed.
OPEN RHINOPLASTY
In open rhinoplasty, the skin of the nose is lifted, allowing the plastic surgeon to have 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 is the surgery 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.
Cartilage
The cartilage can be modified either by removing part of it or by rearranging it. In primary rhinoplasty, the shaping of the cartilage of the tip is often done with special sutures, while in revision surgery it is common to use cartilage grafts (from the septum, ear or side) to achieve the appropriate aesthetic result. Synthetic materials should be avoided.
Functional Rhinoplasty
In addition to the aesthetic effect, the nose should “work properly”. Causes that can cause breathing problems are:
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. 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°). 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 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.
Postoperative instructions
GENERAL POST-OPERATIVE INSTRUCTIONS
⁃ Small deformities
⁃ Prolonged swelling
⁃ Bleeding
Thessaloniki east: Vasilissis Olgas & Aegean 34
