AESTHETIC NOSE SURGERY(RHINOPLASTY)

WHAT IS AESTHETIC NOSE SURGERY(RHINOPLASTY)? WHO IS SUITABLE FOR THE SURGERY? WHO CANNOT BE OPERATED ON?

Aesthetic nose surgery is a surgical operation to reshape the nose by making changes to the bone and cartilage structure inside it.
Aesthetic nose surgery, also called nasoplasty or rhinoplasty is one of the most frequently performed aesthetic operations.
If the rhinoplasty is planned because of cosmetic concerns only, the operation is postponed until the patient’s nose cartilage fully develops. The limit age for the development of this cartilage is 15 for women but the development can take a little longer for men. If the patient has a problem with their breathing, the age limit may be moved backward.
These are the conditions where rhinoplasty should be avoided:

• Body Dysmorphic Disorder (The condition that makes the patient obsess over their appearance)
• Obstructive Sleep Apnea (Repeated respiratory pauses during sleep)
• Bleeding Disorders (Heavy or prolonged bleeding due to the lack of clotting factors) 

How is the Structure of the Nose?

The nose is our respiratory organ with an upper part consisting of bones and a lower part composed of cartilage.

What Are Some Reasons to Have Aesthetic Nose Surgery?

• Fixing a deformity after an injury.
• Changing the physical appearance of the nose.
• Correcting the deformities which create respiratory problems and make breathing easier.

No matter the reason why rhinoplasty is performed, the primary goal should be constructing the nose in a way that allows for the most comfortable breathing for the patient. The surgery can be performed by the complete reconstruction or partial correction of the nose.

What Kind of Changes Can be Made With The Aesthetic Nose Surgery?

• Reshaping the nose tip.
• Changing the nose size.
• Correcting the nostrils.
• Changing the nose angle
• Straightening the nose bridge
• Fixing the droopy nose
• Fixing the nasofrontal(nose/forehead) and nasolabial(nose/lip) angles. 
• Correcting the nose width
• Fixing the asymmetrical nose

What is the Aesthetic Nose Tip Surgery?

One of the parts that most prominently affect how the nose looks is the nose tip.  Some of the common deformities in this area are:

• Droopy nose tip
• Sharp nose tip
• Wide nose tip
• Nose tip with a pinched appearance
• Asymmetrical nostrils
• Upturned nose

The surgery is performed on the cartilage and the soft tissue parts at the tip of the nose without touching the bone part of the nose. For this reason, these operations are easier and shorter procedures than rhinoplasty. The surgery usually ends within 30-60 minutes and the patient is discharged the same day. The recovery time is also quicker than the rhinoplasty surgery.

How To Prepare For The Aesthetic Nose Operation?

The patient should stop taking some medications 2 weeks before the aesthetic nose operation because specific types of medicine (such as non-steroidal anti-inflammatory drugs like aspirin, ibuprofen) may increase bleeding. The use of supplementary, herbal products should also stop during this time. The patient needs to either smoke less or take a break from cigarettes because smoking decreases the blood flow to the area which slows down the recovery process.

How Is The Aesthetic Nose Surgery Performed?

It is possible to make changes to the bone, cartilage tissue, the skin layer, or all three of them with aesthetic nose surgery.

While planning the operation, your doctor is going to present you a personalized surgery plan which is suitable for you by considering the proportional qualities of your face, the skin structure of your nose, and the type of change you want from the surgery.

The first time you meet, your doctor will want to learn about your medical history,illnesses and the medications you use. Your doctor will want to know your purpose regarding the surgery and will explain how close the reachable results are to your goals realistically. After that, the doctor will ask you for the relevant blood tests, conduct your physical inspection which consists of an examination of your facial features, inside and outside of your nose, and your skin structure. Your doctor may want to take some photographs of your nose to show you the possible surgical interventions that can be performed and the possible results that can be achieved with them on a computer. Your doctor might talk to you about the need for another surgery to enlargen your chin if you have a small one since having a small chin can create the illusion of a bigger nose. Having a chin surgery is not a requirement but it can create a better balance with the overall appearance of the face.

Aesthetic nose surgery is usually performed under general anesthesia. However, your doctor might prefer local anesthesia for operations that require very small touches. The surgery lasts 2 hours on average. If the wall between the nostrils(septum) has deviated, this wall may also be straightened to improve breathing. This operation is called septoplasty.

There Are 2 Different Aesthetic Nose Surgery Techniques:

1)During an open rhinoplasty a small incision is made on the vertical tissue band between the nostrils. (columella) Through this incision, the doctor’s field of vision gets wider. This technique is preferred with complicated cases with advanced nose deformities or patients who had aesthetic nose surgery before. The most important advantage of this technique is the wide field of vision. However, the recovery takes longer and problems that arise after the procedure like edemas and bruising are more common with this technique.

2)As for the closed rhinoplasty, the surgery scar is not visible on the outside because the incisions are made inside the nose. While the doctor has a less field of vision to work with during the closed rhinoplasty, the recovery time is shorter compared to open rhinoplasty. This technique is more frequently used to correct small deformities.

For the smaller changes,the doctor can use the cartilage taken from the deeper parts of your nose, or the cartilage that is taken from your ear. As for the bigger changes, the doctor can use the cartilage taken from the ribs.

Lastly, the skin is placed back on the constructed roof of the nose, the incisions are sutured back and this concludes the procedure. A cast will be applied outside of the nose to preserve its new shape. In addition, tampons or soft plastic splints can be put inside the nose to stabilize the wall that separates the nostrils. (septum) These tampons can be removed after 1-2 days, the cast outside the nose can be removed 1 week later. The patient might have nasal congestion because of swelling or splints. Light bleeding or bloody mucus discharge is a common condition after removing the tampons. A small gauze bandage can be taped under the nose to absorb the discharge but it should not be too tight.

It is possible to leave the hospital the same day after a smooth operation. However, it is recommended that the patient has someone to help them around since the anesthesia can cause temporary side effects for the first couple of days such as slower reaction times, difficulty on making decisions, or temporary memory loss. The patient can usually get up and walk around within 4-6 hours and eat if there is no sign of nausea after 6 hours. Sometimes the patient is kept under observation for 1 night and is discharged the next day.

What Are Some of The Complications That Might Emerge After The Aesthetic Nose Surgery?

There is always the risk of infection and bleeding after the operation like every other surgery. Moreover, although they are rare, there are risks specific to rhinoplasty as well. These risks are listed below:

• Difficulty breathing from the nose
• Pain
• Discoloration or swelling
• Septum perforation
• Numb nose and numbness around the nose 
• Nose with an asymmetric appearance 
• Requirement of an additional surgical intervention 

How Is The Process After The Aesthetic Nose Surgery?

1. There is usually pain after the operation, this is why the painkillers are administered preemptively without waiting for the anesthesia to wear off. The medicine your doctor recommends should be used.
2. To minimize the bleeding and swelling, the patient needs to rest in bed with a position in which the head is elevated higher than the chest.
3. Physically tiring activities such as aerobics or running should be avoided.
4. A shower where the water is pouring down from above should be avoided if there is a bandage on the nose.
5. The patient should not blow their nose during the first 15 days after the surgery.
6. Since straining during a bowel movement would pressure the surgery area, the patient should strive to avoid constipation.
7. Expressions such as smiling or laughing should also be avoided, the teeth should only be brushed softly to lessen the upper lip movement.
8. Wearing t-shirts or turtlenecks should be avoided, clothes with a front opening such as a shirt should be worn instead.
9. Glasses or sunglasses should not directly stand on top of the nose for at least 4 weeks. 
10. Sunlight can cause permanent discoloration on the skin, a sunscreen with at least 30 SPF (sun protection factor) should be applied on the nose when going outside.
11. A temporary swelling or black/blue discoloration might occur on the eyelids which can last 2-3 weeks. On other hand, the swelling of the nose might take longer to heal. As for nutrition, staying away from sodium helps to recover faster from the swelling.
12. Things like ice or icepacks should not be applied to the nose.
13. The nose should be protected against bumps or impacts for 8 weeks.

How Long Is The Recovery Time Of The Aesthetic Nose Surgery?

The patient can get back to work usually within 1 week - 10 days if there is no sign of any complications. Swelling and bruising are normal after the operation, these symptoms diminish in intensity with time and they recover to the point that the patient can cover them up with makeup in 1 week - 10 days. One month after the operation, 75-80% of the edema formed disappears. The desired nose shape is reached completely after a full recovery period of 1 year. This process can differ from person to person depending on the factors such as the scale of the operation or the structure of the nose tissue. Still, it is normal to see edemas form in the morning and disappear later in the day during this period. After the operation, some of the patients might require small adjustments to reach the exact nose structure they desire. 1 out of every 10 cases might need a second operation. If the need for a second operation arises, it is recommended to wait for at least 1 year. This corrective second operation is usually a simpler surgery.