Rhinoplasty is surgery aimed at changing the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, its function, or both.
Rhinoplasty is one of the most performed procedures of plastic surgery and is surely the most complex. To perform a rhinoplasty successfully the surgeon must have a very clear concept of nasal aesthetics, must be able to predict the changes that will result from the alteration of each anatomical element and must also be able to perform the operation with the maximum guarantees.
The ultimate goal should be to contribute to the well-being and happiness of the person who wants to be operated.
The decision to perform a rhinoplasty involves a great responsibility. The objectives of the operation are not only to achieve a good aesthetic and functional result but also a satisfied patient. It is very important not only to recognize the technical limitations that occur in some cases but also the expectations of the patient. In this last section it is very important to assess the emotional stability of the patient. Sometimes we find patients with minimal or non-existent problems that magnify their situation or patients who expect the rhinoplasty intervention to radically modify their way of being or acting.
Now we will try to solve the doubts that logically are presented to any person who considers performing a rhinoplasty for aesthetic or reconstructive reasons.
When planning rhinoplasty, the surgeon considers your characteristics, the skin of your nose, and what you would like to change. The upper part of the structure of the nose is bone, and the lower part is cartilage. Rhinoplasty can adjust bone, cartilage, skin, or all three.
Directions:
Rhinoplasty can change the size, shape, or proportions of the nose. It may be done to repair deformities from an injury, correct a birth defect, or improve some breathing difficulties.
Preparation:
Before scheduling rhinoplasty, you should have a visit with your surgeon to discuss the important factors that determine whether the surgery is likely to work well for you. In the medical consultation we will assess:
- Your medical history including a history of nasal obstruction, surgeries, and medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
- A physical exam. Your doctor performs a complete physical exam, including lab tests, such as blood tests. We will also inspect your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and what your physical characteristics are – for example, the thickness of the skin or the strength of the cartilage at the tip of your nose – can affect your results. The physical exam is also critical in determining the impact of rhinoplasty on your breathing.
- Photographs. Your doctor uses these photos for before and after evaluations, reference during surgery and long-term checkups. Most importantly, the photos allow for a specific discussion about the goals of the surgery.
- A discussion of your expectations. You and your doctor should talk about your motivations and expectations.
Before rhinoplasty, it may also be necessary to avoid certain medications. Avoid medicines containing aspirin or ibuprofen for two weeks before and after surgery. These medicines can increase bleeding. Take only medications approved or prescribed by your surgeon.
We also recommend stopping taking infusions and natural remedies that could affect increasing intraoperative bleeding.
If you smoke, quit. Smoking slows the healing process after surgery and can make you more likely to get an infection.
Surgery:
Rhinoplasty is a unique and individualized procedure for each patient. In each patient the execution will be different because always the start is different as well as what each patient wants to obtain.
Rhinoplasty can be performed through an incision inside the nose (closed rhinoplasty) or through a small external incision at the base of the nose, between the nostrils (open rhinoplasty).
Your surgeon will likely readjust the bone and cartilage under the skin. We can increase or decrease the bone or nasal cartilage in a variety of ways. In the case of augmentation rhinoplasties we can use septal cartilage, rib material or we can use external materials that integrate perfectly.
Rhinoplasty is usually performed under general anesthesia, although in some patients it can be performed under local anesthesia or with local anesthesia and sedation.
When in surgery in addition to performing a treatment on the shape of the nose we act on the septum because it has a deviation we talk about rhinoseptoplasty.
Ultrasonic rhinoplasty:
We currently perform most rhinoplasties helped by piezoelectric surgery equipment.
Equipment for piezoelectric surgery or ultrasonic rhinoplasty allows us to:
- Progressively file the bone minimizing trauma to the bone and adjacent tissues.
- Practice osteotomies in the nose (cutting the bone of the nose) using ultrasonic micro vibrations which involves cutting bone only cleanly and precisely without damaging the soft tissue.
- Selective cuts to protect soft tissues such as nerves, blood vessels and mucous membranes.
- It also helps plastic surgeons to have a blood-free field and that allows us to improve the accuracy of the surgery.
- Having less swelling after surgery.
- Decreases postoperative bleeding and bruising.
- Faster and less traumatic postoperative recovery.
Conservative or preservation rhinoplasty:
For a few years rhinoplasty has evolved and there is a new way of approaching the treatment of the nose that has forced us to make an effort to plastic surgeons to achieve better results, minimal aggression to the tissues and faster recovery. In conservative or preservation rhinoplasty there are many differences with traditional rhinoplasty but the three pillars or basic principles are the preservation of the skin covering (including in it the ligaments that anchor it to the deep structure), the back and the wing cartilages.
Principles of the technique:
- Elevation of coverage in a subperichondric – subperiostatic plane.
- Preservation of the osteocartilaginous back.
- Maintenance of the wing cartilages with minimal excision and achieving the desired shape through sutures.
- Subperichondric plane – subperiosteal. For many years and even today many plastic surgeons separate the covering to work the back and cartilage in a sub-smas plane. This plane implies greater trauma and bleeding which would lead us to a worse postoperative period with more unpredictable results, possibility of chronic inflammation and greater bleeding. On the contrary, a subperichondric-subperiosteal plane minimizes bleeding and injury to structures obtaining a result with less bleeding and inflammation and more predictable.
- Back. In most rhinoplasties, the osteocartilaginous back is removed, leaving an “open roof” that requires breaking the bone at the lateral level to close the defect. In contrast, dorsal preservation consists of lowering the height of the back without altering the roof (that is, sectioning the bone at the lateral level and the septum at the central level).
- Wing cartilage. The wing cartilages are the cartilages that define the shape of the nasal tip. Traditionally what has been done is the radical section of the cartilage and placement of grafts to define the shape of the tip. Currently we perform remodeling of the cartilages achieving a harmonious shape without destruction of these. This action not only achieves better results, but also facilitates secondary rhinoplasties if necessary.
Recommendations:
- In the first postoperative days avoid intense exercise.
- During the shower prevent the splint from getting wet.
- Do not blow your nose.
- Avoid over-laughing for the first few days.
- Wash your teeth gently to limit the movement of your upper lip.
- Wear clothing that is fastened in front to avoid the possibility of manipulation of the splint when removing clothing.
- It is necessary to avoid the placement of glasses during the first 4 weeks to avoid compression in the nasal bridge.
- It is necessary to use extreme sun protection on the nose during the first postoperative month when you are outside.
- Use SPF 30 sunscreen when you’re out, especially on your nose. Too much sun can cause permanent irregular discoloration on the skin of the nose.
- Limit salt in the diet to help bloating go away faster.
Although it is true that rhinoplasty improves with the months and that to have a definitive result you have to wait almost a year with the new techniques you can see your result much earlier.
In cases where old techniques are used especially in the separation of skin coverage the result is not only more difficult to predict, but also much slower in its recovery.