Rhinoplasty

Well the nose is positioned in the “center” of the face. The increasing power of social media has brought a new meaning visuality which expresses more than social identity. That’s why how we look, has become a phenomenon that affects our imagine in business life as well as our social identity more than ever. Therefore, the aesthetic flaws(of course, depending from one’s poitn of view to other) in the very center of the face have become sadly less tolerable both individually and socially. This is why the sense of “self-confidence” based on visuality has been more important recently and is a more vulnerable concept in one’s mind compared to the past. So, the questioning of one’s visual identity in our social, business and internal worlds and lacking self-confidence have made rhinoplasty surgery the top of the cosmetic surgeries list.

Perhaps the most difficult part of all is the “decision making” phase. Patients usually spend a long time wondering if they are the right candidates for rhinoplasty surgery, whether they will regret this in the post operative period and whether they will eventually have a “natural and beautiful” or “dream” nose they have been longing. Not every patient who dislikes their nose is an ideal nasal aesthetic patient. However, it would be best for patients who are uncomfortable with the appearance of their nose and who think about it very often and who lack self-confidence (do not look at their nose too often in the mirror, pose from the same angles mostly, applying filters to photos) to consult a specialist doctor.

In general, patients who cannot breathe adequately due to structural or previous traumatic reasons (accident, previous nose surgery etc), who have realistic aesthetic problems and who are seeking for a solution, who have completed their adolescence period, are the ideal rhinoplasty surgery patients.

The ideal nose is a personal concept which differentiates from one person to another. Briefly, if the nose that breathes well and meets certain proportional harmonies with other aesthetic units of the face looks more natural and beautiful to the eye. It is inevitable for the type of noses that are not in harmony with the other units of the face (forehead, chin, lip, eye) to look natural even if they are technically well structured.

One of the most difficult and perhaps the most important stage of decision making period is the choice of a your surgeon doctor after deciding to have a nose surgery. Today, as in almost every field, in plastic surgery, patients make their decisions mostly based on social media images with questionable reliability. Unfortunately, plastic surgery is brutally abused by social media. Of course, social media images can help you find your surgeon who has a similar point of view to the image in your head and make it easier for you to have an idea about the doctor you choose, but a patient can never %100 rely on social media because botched cases are never shown on there. The most objective way of evaluating the surgeon you choose is possible, (if possible) by obtaining information from the past patients who have been operated by this plastic surgeon. Your rhinoplasty journey can only come to a happy ending for both the surgeon and the patient, as long as it is based on a realistic, mutually understanding patient-doctor relationship and mutual trust. The surgeon should understand the patient, evaluate whether their requests are realistic, and explain the possible results and what will be done during the surgery. Also, it will be comforting for the patient, who trusts their surgeon, to let the surgeon to decide on the technical approach which he/she plans to apply.

Using some simulation programs with photos taken from certain angles before the operation is possible, but of course, if your requests are realistic, it can be combined with the professional opinion of your plastic surgeon and an after imagine before your nose surgery can be obtained. Although, this does not give any “guarantee” of the outcome of the surgery, this helps the aesthetic view of the surgeon and the patient’s expectations to become one. It should be noted that while the side aspect simulation image can be successfully presented to the patient, the view from the front angle might not as satisfactory. However these simulation imagines approximately help finding out about the aesthetic approach of the surgeon.

I do not find it right to categorize the result of the rhinoplasty surgery in these 2 different topics;  aesthetic and functional. Because the nose can only be whole with its aesthetic units and functional structure combined. I believe that a surgeon who performs a nose surgery should be in charge of both aesthetic and functional terms. For this reason, I do not support having an ENT surgeon to deal with patient’s breathing problems and a plastic surgeon for aesthetic issues, I believe this concept is very old fashioned. The reason is that, most patients who would like to correct their ‘aesthetical’ deformities also have structural disorders that affect the breathing quality. Therefore, in our preoperative examination, we perform a detailed evaluation and inform the patient if we see a structural disorder that affects breathing such as concha hypertrophy, nasal septum deviation, nasal valve insufficiency, we will perform maneuvers that will correct these issues or make them better.

Thick-skinned noses are more noticeable with their fleshy nose wings and porous structures. Imagine a ball under a thick blanket and another ball under a thin silk cover, it will be more difficult to spot the ball under the blanket as its fabric structure is thicker, right? So, skeletal changes made on a thick-skinned nose will show itself less than a thin-skinned nose. And, thick-skinned noses tend to swell more after surgery due to the excess amount of soft tissue they contain. Especially, this edema at the tip of the nose takes longer to pass compared to the thin-skinned nose. Therefore, it will take longer for the final shape of the nose of a thick-skinned patient to settle. It is important to explain this anatomical issue to the patient as it will make it easier for the patient to be more calm during the early stages of healing. On the other hand, a thick-skinned nose case is more advantageous when it comes to hiding the roughness and surface irregularities on the bone structure than a thin skinned rhinoplasty case.

There are two different approaches in rhinoplasty surgery; open and closed. Each nose contains unique structural problems that need to be fixed specific to that case. So, the technique applied to that specific nose should be tailor made. But in general, in the closed technique, the incisions are applied only on the inner border of the nostrils, and the nose tip is less swelled or no post-operative edema is occured, little or no numbness, and a softer nose rather than a stiff nose tip due to the protective approach of the intranasal ligaments is achieved, this type of technique has become widespread in recent years. In the open technique, in addition to the incisions performed in the closed technique, there is another small incision performed in the columella (the bridge between the nose tip and the lip) that will not be visible in the long term. The skin of the nose is lifted over the nasal cartilage and bone skeleton and the operation area becomes accessible. The advantage here is that, it is easier to control the nose tip and bridge. However, after the surgery, especially the swelling at the tip of the nose takes longer time to fade. However, temporary numbness can be observed in almost every case, the severity of the numbness depends from case to case. In primary rhinoplasty cases, I generally prefer a closed, protective approach depending on the severity of deformity. If I am planning a revision nose surgery and if there is a severe deformity at the tip of the nose that I needs to be corrected, the open approach is my first choice.

Nose surgeries are performed under general anesthesia. Patients must meet certain health criterias in order to be operated under general anesthesia. This is provided by the pre-operative tests and their evaluation by the anesthesiologist. Nose surgery witholds a very low risk for patients who are suitable to have rhinoplasty surgery. The most common risk of nose surgery is postoperative functional issues or aesthetic dissatisfaction. At this point on, the experience of the doctor you decide to have surgery, aesthetic view and the realisticity of your expectations comes in first. It should be considered that the frequency of revision after nose surgery varies between 5-15% in the world.

Rhinoplasty surgery takes between 1.5 to 4 hours.

First of all, your tests will be evaluated by the anesthesiologist and you will be examined in terms of suitability for the operation. You should stop eating and drinking completely 8 hours before the operation. On the morning of the rhinoplasty surgery, your final preparations are made by the nurses. Your pictures would have been taken before the surgery and you will have read and signed the consent forms of the rhinoplasty surgery.

When you enter the operating theatre, you will be greeted by an anesthesiology technician, an anesthesiologist and a plastic surgeon.

After you are put to sleep, your surgery will be begin and once it is completed, you will be taken to the re-animation room. You will be taken to your bed after the last checks of the anesthesia team. While you are just beginning to wake up, a little nausea might occur. Within a few hours, full sobering is achieved and you will start to communicate with your companions comfortably.

If inner nasal splints are not used in your surgery, it means you will have a more comfortable night. If tampons are used, you might feel clogged. On this first night of the surgery, not much pain complaints are seen. The most common complaint is the inability to breathe and difficulty in sleeping due to these reasons.

One night hospital stay is sufficient after nose surgery. The next day, the necessary medications are prescribed and then you are discharged.

Despite the advanced protective nose surgery techniques, bruising and swelling may occur. We ask our patients to begin cold press application and continue for the first 3 days in order to minimize postoperative swelling. Swelling generally tends to increase in the first 48 hours, but begins to decrease after the 3rd day. If there is under skin bleeding, this creates bruising under eyes but this disappears within 10 days. Bruising and swelling are not only related to the surgical technique but also related to the skin thickness and anatomy of the patient.

Silicone inner splints are used in rhinoplasty surgeries. Although the patient is not very comfortable with these splints, they can breathe due to their canals. The use of tampons supports the cartilage and bone tissue in the midline and prevents blood accumulation as well. Except for some revision rhinoplasty cases where these splints might need to be kept there longer, these silicone tampons are removed on the 3rd post op day after your operation. Since these splints do not stick to the nasal mucosa (inner skin), you will not feel pain when removing them. When the splints are taken out, you will start to breathe much more easily. If procedures for better breathing were performed in your surgery, day by day your breathing will become better due to the decrease of your swelling each day. The use of sea water spray for the following 3 months after your tampons are removed is a method that keeps your airway open, softens and accelerates healing.

Tapes and plastic cast that protect your nose from external factors and keep the swelling under control are used after the surgery. On the 7th day after the operation, your nasal cast is removed and the following 3 days, you will continue to have a tape over the nose for edema control. Once the tapes are removed and gentle massages are recommended if necessary. When the nasal cast is removed, the swelling between the tip of the nose and the eyebrows will occur which is normal, most of the swelling will fade within 6 weeks.

However, if your surgery was performed through an open rhinoplasty technique, then your stitches at the columella will be removed, and it is recommended to protect this area agains sun exposure for the following 6 months.

Especially in the first 3 months, it is necessary protected the nose from outer factors. I do not think it is appropriate to wear glasses for the first 2 months. Although light exercises are started 4 weeks after the operation, it will be more appropriate to wait 2 months for normal to heavy cardio exercises. Patients can apply make-up gently 2 weeks after surgery(without applying pressure to nose area. It will be best to avoid activities such as swimming for the first month after the operation and sauna and Turkish bath for 2 months.

In the first 6 weeks after the nose surgery, most of the swelling will be disappear, but the swelling will continue to decrease in the first 6-8 months gradually and it takes about 1 year for the nose to take its final shape. For this reason, it is especially important to be patient and calm during the acute stage of healing(1st month after surgery).

This is the type of operation planned to eliminate the patient’s aesthetic and functional dissatisfaction after one or more nose surgeries. This can be related to breathing or the nose shape. Revision surgeries can also be performed due to trauma occured in the early postoperative period. Revision rates vary between 5 and 15% globally. Since it will take at least 1 year for the nose to take its final shape after the first surgery, the ideal time to perform a revision rhinoplasty surgery should not be at least before 1 year is completed. Revision rhinoplasty surgeries tend to be a more complex procedure compared to primary rhinoplasty. This requires patients to find a sufficiently qualified and experienced surgeon. Revision rhinoplasty may vary from minor to major cases depending on the case. Minor revision operations take around 45 minutes. Major revision operations can take up to 5-6 hours. The revision rhinoplasty procedure can feel more challenging compared to primary rhinoplasty period. It requires a very good planning. For this reason, the communication between the patient and the doctor should be transparent and planning should be made in a realistic way. Due to the intervention and deformation in former rhinoplasty surgery, cartilages in the nose may not be sufficient in most cases. So, it might be necessary to take spare cartilage from the back of the ear or the rib. This might extend the healing process compared to primary rhinoplasty cases. Therefore, revision nose surgery requires good planning, patience, care and mutual understanding for the surgeon and the patient together.

Rhinoplasty surgery prices may vary, depending on the severity of the deformity, the duration of the surgery, the techniques to be used, the hospital, and whether if this a is the primary nose surgery case. That is why, we would like to welcome you to our clinic for a detailed examination and your questions.