RHINOPLASTY

The nose is the central structure of a person’s face and pivotal to a person’s identity. So it is understandable that rhinoplasty (nasal cosmetic surgery) is the most frequent surgery performed in facial plastic surgery. Despite beyond the aesthetic component of the nose, it is important for essential functions, such as, breathing and smelling to be maintained or improved.

 

Which noses can be operated on? Can you improve function and aesthetics in the same surgery?

 

Each nose is unique. The nose may be long, short, deviated, flat, fallen, upturned, have thin skin or thick skin, be large or small. Virtually any change (large or small) can be made to the nose. However, this requires a very specific knowledge on anatomy and physiology of the nose as well as individual analysis. It should be reminded that the nose is part of the face and the final goal of facial plastic surgery is getting the most natural and harmonious nose possible, concordant with the persons face and identity. It is as much or more important to have a beautiful but also functioning nose.

Who performs rhinoplasties? The plastic surgeon or the ENT/ORL surgeon?

 

This question is controversial. Although specialties of medicine are usually dedicated to distinct areas, there are border areas where two or more specialties can perform the same type of surgery. In this case both plastic surgeons as well as ear, nose and throat (ENT) surgeons can perform rhinoplasties, as long as they master the nose as a whole. In most rhinoplasties it is necessary to master and correct the nasal septum to be able to correct the deviation. The deviated septum other than causing nasal obstruction will also affect the shape of the nose and may be necessary for grafts. Rhinoplasties are often called rhinoseptoplasties resulting from the union of the aesthetic and the functional component.

I have chronic rhinitis and/or sinusitis. Can I have a rhinoplasty and treat my sinusitis / rhinitis as well?

 

The answer is yes; sinusitis / rhinitis is usually the result of internal lateral nasal wall pathology which can be corrected in the same surgery. These types of functional disorders are the focus of the ENT surgeon and can be simultaneously treated with rhinoplasty.

I would like to have a rhinoplasty but I am afraid it might make my nose ugly

 

This is the greatest fear of people who want to have a rhinoplasty. This surgery is a huge challenge even for the most experienced of surgeons. No nose is like the other, which is why a very clear conversation between the doctor and the patient is important, to manage expectations and discuss the problem at hand. Often what the patient perceives is the issue is not the main problem but rather a consequence of another. Sometimes simulation programs (Photoshop ®) are an excellent tool helping bridge communication between the doctor and the patient. However, keep in mind, even after a detailed and individualized plan, an average of 10% of operated noses may need minor adjustments or retouching after one year.

How is the post-operative period? Is it very painful?

 

The operation is nearly painless and well tolerated by the patient. In almost every rhinoplasty it may be normal for some bruising or swelling to occur around the eyes and discomfort occurs in the first week, the latter related to the temporary nasal obstruction and nasal secretions/crusting. Generally, an external splint is used for protection during the first week. The final form of the nose can sometimes take years, but normally after two months most of the swelling subsides.

How is the surgery performed? Will I have any scars?

 

There are two approaches to rhinoplasty, the “closed” and “open” approach. In the closed rhinoplasty, no skin incisions are visible and the nasal structures are dissected from inside the nostril. In open rhinoplasty, a millimetric incision is made in the columella to expose the nasal structures. However, this heals beautifully, becoming unnoticeable after 15 days. Nowadays, the choice between which technique to choose is dependent on the accessibility to provide the most satisfactory result and on the surgeons’ preference.

Will I need general anesthesia?

 

Surgeries are usually performed under general anesthesia for the patients’ convenience, although surgery can also be performed under local anesthesia with sedation.

What is a functional rhinoplasty?

 

These are procedures that improve the nose appearance by changing its shape while also allowing for better breathing. These usually relate to the tension nose (very long nose with narrow nostrils), nose with lower alar cartilage malpositioned or narrowing of the nasal valve (nose that collapse with inspiration). These concepts reinforce the need to approach the nose functionally as well as aesthetically.

This procedure is complex and the previous issues answered here are some of the most frequently asked questions in a rhinoplasty consultation. If you have any more questions ask them directly to your doctor.

CLINICAL CASES