Aesthetic Nose Surgeries (Rhinoplasty)


In rhinoplasty surgery the goal is to correct the malformations. If you also have problems like intranasal deviations that interfere with respiration, concha hypertrophy, in order for your operation to be successful aesthetically and functionally, i.e. breathing comfortably from the nose, these problems of ours have to be resolved during surgery.

Rhinoplasty surgeries are basically surgeries belonging to the facial aesthetic surgery. Facial aesthetic surgery is becoming more widespread throughout the world as a branch of otolaryngology. An otolaryngologist who is interested facial aesthetic surgery will solve your problems in the most ideal way in respect to aesthetic and breathing from the nose.


In rhinoplasty surgeries, since the nose is minimized to a certain extent, intranasal anatomical structures and the ones around the nose should be carefully evaluated before the surgery with direct examination, endoscopic examination an if necessary, with radiological examinations. Even if you do not he nasal congestion complaint before the surgery, considering the problem that you may have after the surgery, it should be decided whether to minimize your lower and middle concha to a certain extent with appropriate surgical techniques during the operation, or not.


DECIDING BEFORE THE SURGERY

Before consulting your doctor performing your operation, it is very important for you to determine all your complaints that directs you to this surgery.

In addition to the problems that you will like to be corrected, determination of the presence of problem while breathing through the nose, nasal discharge, discharge to the nasal cavity and headache will help your doctor in determining and solving the other problems that are present in your nose region during this operation.
You must discuss the problems that you determine and the changes that you would like to have with your doctor. The compliance of your expectations from the surgery with your present facial aesthetic proportions and your normal functions of the nose and the probability of occurrence should be clearly expressed by your doctor. In order to prevent the disappointment after the surgery will be possible by discussing these thoroughly and with a mutual agreement with your doctor on the changes that will be performed during the surgery.

The performance of visual informing on the possible different results of the operation with 3D digital imaging techniques on your pictures make it easy for you to decide the shape of your nose (figure 1).


Figure 1. Preoperative 3D imaging and digital animation helps deciding the desired results.

Though your evaluations are performed and your pictures are taken in vertical position before the surgery, performance of the operation in horizontal position, it may be difficult to decide on the amount of the tissue that will be removed also as a result of the injections and the skin edema that forms. Therefore, calculations of these measurements and planning the processes to be performed completely before the operation become very important for your operation to result as desired.



Sometimes the defects that the patient see as enormous may be corrected by a simple process, however, sometime a small defect may only be partially corrected with a long and difficult surgical intervention. Due to some factors like long duration of complete recovery, tissue properties of the patients, properties like healing of the wound, a minor corrective intervention may have to be performed following the completion of recovery at the rate of 5-15%.



In patients with fair skin and thin skin structure, if correction of advanced deformities and graft application is performed, the possibility of a second intervention increases; this possibility is quiet low in patients with not so thin skin and not having a conspicuous asymmetry in the nose. The most frequently seen problem in asymmetrical and deviated noses that are seen as “C” and “S” in the frontal view are incomplete recovery due to asymmetrical cartilages and bones and not being able to notice some amount of the curvature o the asymmetry following the achievement of the final shape of the nose. If the result is not satisfactory, the most appropriate approach is supporting the collapsed regions with cartilage pieces that are placed under the skin.

After the surgery, the nose that you will see when your cast and bandages are removed will not be the final result, the final result will form within 6-12 months, the fastest during the first 2-3 months according to the decrease in the edema and nose’s taking its final shape, the used surgery technique, the structure of your nose skin and the type and amount of the grafts used (tissues like bone, cartilage that are added to the nose).


THE GOAL OF THE OPERATION

In your rhinoplasty operation, shaping of the nose with the most appropriate and natural appearance should be targeted. The biological properties of the present tissues have important effect on the result of this surgical process. That is , the thickness of your skin, delicacy and form of your present cartilages, your wound healing properties and the nose operations that you have previously undergo have important effect on the results of your rhinoplasty.

Your nose is located in the center of your face and is the first structure that attracts attention when you look at the mirror or when someone looks at your face. A beautiful and attractive nose is the one that has certain proportion within itself and the one that is not indistinct and that shows itself. Therefore, the goal of the operation should not be making a very beautiful nose; it should be making the most appropriate nose. To achieve this goal, present tissues may be reduced most of the time, and in some patients who have undergone surgery before, some parts should be enlarged by adding tissue to the nose.

In situations in which addition of tissue to the nose is necessary, patient’s own tissues like cartilage pieces that are taken from the ear or the ribs are preferred. If all kinds of materials other than the tissues of the patient himself/herself are not used for supportive purposes, long term success rates are low and the probability to experience problems like infection, rejection is high. Cartilages of the ribs that are called homograft, obtained from the cadavers and refined from their antigenic structures with special process are the mostly preferred materials to hide the superficial contour irregularities. Though they use volume in the middle and long term, since hey turn into a strong connective tissue, their effects on the contours of the nose continues.


SURGERY TECHNIQUES
Rhinoplasty operations are the most performed aesthetic operations. Though the duration of the operation varies according to the type of the malformation in the nose, pathologies like intranasal deviation, anatomical variations, concha hypertrophy, chronic sinusitis that may be present concurrently and to the surgical technique that will be applied, it usually lasts for 1.5-2 hours. However, in special situations in which tissues are required to be taken from other regions like the ear and the ribs, this period may be longer.

Surgical Techniques
Main techniques that are used in rhinoplasty are as follows;

  • Microrhinoplasty
  • Tipplasty
  • Open Rhinoplasty
  • Closed Rhinoplasty



In patients having a small amount of malformation at the edge of the nose and with patients not having a wide upper bone, microrhinoplasty technique may be used. In this technique, the edge of the nose is reached through the intranasal incisions and the edge of the nose is shaped by using special shaving systems (microdebrider). Since the intervention is quiet limited, fractures of the side bones in order to give the edge of the nose its natural round shape are not required and the intervention to the tip of the nose is very limited, recovery is usually completed within a very short period without the occurrence of purple spots and swelling around the eyes. The most important condition in being successful in microrhinoplasty technique is the selection of the appropriate patient and realistic clarification of the expectations of the patient and the doctor from the surgery.

Operations that are performed just to correct the malformation of the tip of the cartilage structure without intervening the bone structures of the nose is called tipplasty. In these operations, except for very limited problems, always open technique is preferred. Correction of the lowness and asymmetries of the tip of the nose, reducing the stuffed nose tips, to make the tip in the appearance of the profile explicit or correct the cartage angulations that narrow the entry of the nose is possible with tipplasty surgery. Since bone structures are not intervened during the operation, swelling and discoloration around the eyes are generally not observed. After the tipplasty operation since the application of a bandage for a week is enough, patients return back to their normal daily life quickly.

The most ideal approach for patients having a malformation or asymmetry on the tip of the nose, patients who have undergone surgery previously and/or patients whom have to be intervened due to intranasal septum deviation with rhinoplasty in the same session is open rhinoplasty technique. Since in most of the patients who will undergo rhinoplasty the tip of the nose should also be intervened, open rhinoplasty is today the most preferred surgical technique.

In the open rhinoplasty surgery, the operation starts by making a horizontal incision in the middle of the region between the two nostrils (columella) (Figure 3) and after the skin of the nose is lifted by this way, all cartilage tissues that form the tip of the nose are revealed and the surgery can be performed under direct vision. Since symmetry can be provided completely in this operation and since cartilage supports can be placed and fixed to the regions where required with sutures, the risk of shape changing for the nose or the tip of the nose, lowness of the tip of the nose, shifting of the septum after the surgery is minimized.

In the open technique, since septum can be controlled completely, the deviations especially near the edge of the nose can be completely corrected with the addition of cartilage pieces with appropriate methods, cartilage deficiencies that formed in previous surgeries can be repaired completely and symmetrically. In open technique surgeries, since the incision made to the tip of the nose is closed with appropriate technique and materials, it recovers within 1.5-2 months as it can not be noticed from the outside.

Figure 3. The incision line performed in open rhinoplasty surgery.
In patients who do not have a significant problem on the tip of the nose and in the septum, having the main complaint as bone and cartilage protuberance on the edge of the nose (dorsal hump) or having simple superficial irregularities on the edge of the nose following a previous surgery, closed rhinoplasty technique is preferred. In this technique, the edge of the nose is reached through the incisions made through the nostrils and the required interventions are made to the malformations. Closed technique provides short duration of the operation in selected patients, since a small amount of edema is formed at the tip of the nose, recovery takes a shorter time.


In the operations, after the bone and cartilage protuberance at the edge of the nose is removed, in order to give a natural appearance to the nose, the bones of the nose are brought together by breaking them and due to these fractures, some amount of purple spots and swelling occurs in around the eyes after the surgery. These edema and swellings disappear within 7-12 days completely. In the application of “hilotherapy” that has started to be used recently, 15-18 degrees cold is applied around the eyes with the help of a special mask. With this application that keeps the lymph and blood circulation active, swelling and discolorations around the eyes may be prevented after the surgery to a large extent.

Since the placement of compresses is not necessary except for some special situations, operation can be performed in most of the patients without compresses.

Apart from that, the bandage and plastic cast that is applied outside the nose is renewed in the first week after the surgery and are removed in the 10th-14th days.

Since the nose is structure that can not move, severe pain is not experienced after the surgery and simple painkiller are generally sufficient.

During the operation, if a surgical intervention other than cauterization, radiofrequency or microdebrider that do not lead to bleeding is performed to minimize the concha, then in order to reduce the risk of bleeding after the surgery, compress may have to be placed in the nose. This compress has the structure of a soft sponge and do not cause a serious problem other than congestion and is removed on the second day following the operation.

After the surgery, resting in an environment that is not too hot is recommended with the head slightly elevated.
Cold application on the eyes in intervals for the first 24-36 hours is useful in order not to have the swellings and purple spots increased and also for rapid recovery.
For rind formation and congestions that may occur inside the nose in the first week, patients may have to go back for a control.

After rhinoplasty surgery, recovery takes time and complete recovery may last for 6-12 months according to the type of the surgery. During this process, the desired result is achieved quickly within the first weeks and then slowly in the following weeks. Therefore, it is natural for the appearance of the nose not to be as desired during the early period following the surgery, as edema decreases and the skin attains its normal thickness, the shape of the nose will change as desired. Similarly, though differences may be present due to the used technique and the performed process, the observation of the desired result exactly in the early period following the operation, should bring the possibility of the formation of a different result to the mind.
It will be appropriate to follow the changes in the shape of the nose that form in time, with the doctor performing the operation.




POINTS TO CONSIDER AFTER RHINOPLASTY

  1. The cast on your nose will stay for 10-14 days. It should not be wetted. If you stay in very hot or steamy placed, the cast may be loosen or fall off due to sweating.
  2. During the first 24-36 hours, cold application on your eyes should be performed in intervals (5-10 minutes on the hour).
  3. After the surgery, you have to avoid physical activities as much as possible and should rest as you head elevated.
  4. Avoid excessive facial mimics and laughing for a week.
  5. If open technique is used, then sutures on the tip of your nose will be removed by your doctor after 5-7 days.
  6. After your nose surgery, swellings may form under your eyes and on your face. These swellings and discolorations will completely disappear within 1-2 weeks.
  7. After your nose is opened, you can clean your nose gently with liquid soap or with special lotions. After the bandage is removed, you can apply make up.
  8. It is appropriate not to wear turtleneck sweater or clothes with narrow necks that increase the risk of impact to the nose within three weeks following the surgery.
  9. You should not touch your nose harshly and avoid activities that have the possibility of impact for the first 6 weeks.
  10. It is recommended tat you should not wear eyeglasses for 6 weeks and after this period; you should wear eyeglasses with light frames.
  11. You should protect your nose skin from the sunlight and avoid sunburn for the following 6 months.
  12. Since extremely hot environments may lead to swelling in your nose, you are recommended not to stay in these environments.
  13. You must not take medications other than the ones prescribed by your doctor.


COST OF THE SURGERY

Rhinoplasty surgeries are performed by using different techniques, instruments and materials in different styles. The extent of the problem in your nose, previous nose surgeries, the necessity to obtain cartilage pieces from the ear or the ribs and concha hypertrophy, accompanying problems like sinusitis that require intervention during the same operation affects the cost of the surgery.

Another factor that has impact on the cost is the hospital in which the operation will be performed. Operations performed in Group A hospital (like Amerikan Hastanesi, Acıbadem Hastanesi), though the cost of surgery is the same, since other costs (room, usage of the operation room, materials, anesthesia, examination) are relatively high, he cost increases compared to smaller hospitals.

Rhinoplasty is a surgery that health insurances do not cover just like other aesthetic operations. Therefore, the cost of the operation is usually given as a package price. That is, the price that you will pay is determined at the beginning of the surgery, the price of the materials that will be used are not calculated individually, but determined as a fixed price. The experience, training surgical skills of the surgeon who will perform the operation are the most important factors on the success of the aesthetic intervention that will be performed on a conspicuous, critical anatomical structure that is located at the center of your face, however, the quality of the instruments and materials used during the surgery also have an important role. For example, instead of using expensive surgical sutures that completely dissolves within 4-6 months, using comparatively cheaper sutures that do not dissolve spontaneously while fixing the cartilage structures may lead to problems like foreign substance reaction, infection in time.

Similar situations may be effective in many different factors from the quality of the other materials and equipments to the sterilization, that is, decrease in the cost usually means making concessions on the quality.

As a consequence, when you decide to undergo rhinoplasty which is a complex surgery, the price that you will pay is certainly an important criterion; however, it should not be the top priority. The first surgery is the one that has the highest success rate. The success rate of the following corrective operations and the rate of yielding functional results gradually decrease. For an operation that gives final result within a period of 6-12 months, the experience of the surgeon and the number of the cases are the most important factors that have influence on the result. Therefore, correct selection of the surgeon who will perform your operation must be your top priority.

The cost of the surgery varies within a very wide range according to the parameters that are mentioned above. The correct approach is having a complete aesthetic and functional nose evaluation after deciding on your surgeon, and to decide on the interventions that have to be performed. In order for your operation to be successful in respect to aesthetic and identically important functions of the nose, the necessity for additional interventions like adenoid or sinus surgery may effect the cost and also the selection of the hospital.

The price of your surgery may only be determined realistically after all these stages.



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