Aesthetic nose surgery (rhinoplasty) is the most common plastic surgery performed by both men and women in our country.
NOSE AESTHETIC SURGERY
The procedure performed in rhinoplasty is to reshape the nose by changing the structure of cartilage and bones. In order to create a more aesthetic nose shape, sometimes it is necessary to cut the bones and cartilage, and sometimes, on the contrary, to complete the missing parts and change their shape.
It would be very correct to accept rhinoplasty or aesthetic nose surgery as the most difficult and unknown surgery of plastic surgery.
WHY IS AESTHETIC NOSE SURGERY DIFFICULT
Aesthetic nose surgery is difficult because the nose is like a closed box and you have to do this surgery on only one side of this box. There are many unknowns in this surgery because the bones and cartilages that make up the structure of the nose exist independently of each other but as a whole and may behave differently during the recovery period. For this reason, this is the aesthetic surgery, which is followed by the most frequent revision, that is, a second correction surgery. It is considered normal for a world-class surgeon to have to make revisions to one out of every 10 cases.
On the other hand, this surgery gives very good results when done well.
OPERATION
Rhinoplasty surgery can be performed in two ways as open and closed technique.
In the closed technique, all cuts are made inside the nose. The surgeon completes the operation by working from the inside. In the open technique, a 3-4mm cut is made at the tip of the nose and the tip of the nose is opened.
The difference between the two techniques is about the surgeon’s command of the operation. The closed technique made from the tip of the nose is more like performing an operation in a bottle. If you are only planning to take something out of the bottle, there will be no problem, but if you want to make a model of the ship inside, your job will be difficult. In the open technique, the surgeon can see the structures in the anterior 2/3 of the nose in front of him.
Which technique is better is always a matter of debate among the doctors who perform this surgery, and no decision has been made on this issue.
As you can see from my descriptions above, my preference is mostly for the open technique. The most important reason for this is that I do not believe that the result of a fine work that is blinded and does not forgive mistakes can be good. It is something that even the advocates of the closed technique cannot object, that many surgical maneuvers are only possible with the open technique, and corrections that cannot be imagined with the closed technique are possible with the open technique. I believe that the possibility of revision decreases after open surgeries.
The biggest handicap of the open technique is the scar on the tip of the nose. But this scar is almost vague after a well-done surgery and remains under the nose. Many patients forget this scar after surgery.
However, consult your doctor about this and trust him. Every surgeon will get the best results with the methods he knows and believes best. The above are just my personal opinions.
I SEE VERY BAD SURGERY, WILL I HAVE IT TOO?
I also see “operated noses” that are unnatural, very small, with nostrils visible when viewed from the front. I explained on a separate page how you can understand a badly performed nose surgery. Remember that the outcome of the surgery depends entirely on the techniques used by the surgeon, his skills, and what he wants to do.
Giving an upturned nose shape by only making the nose smaller creates an unnatural result. In modern techniques, almost nothing is removed, only the locations, positions and shapes of the tissues are changed.
If you examine this figure, you can see one of the most common aesthetic mistakes. This is a method often used in old techniques. In the past, in order to show the nose upturned, the nose was shrunk and the starting point was taken as low as possible. Thus, an illusion was created as if the nose was up, but the result would not be natural. It is necessary to start the nose from where it should start, that is, almost at the level of the pupils, and give its entire shape accordingly.
HOW CAN I SEE WHAT I WILL HAVE AFTER SURGERY?
There are computer programs prepared for this purpose. Your doctor will likely give you an idea with one of these. However, a real operation planning and measurement cannot be made with these programs and they can only give a general idea.
If your doctor is using one of the new measurement-based techniques, he or she will want to take measurements on your pictures. For this, he will either hold a ruler in your hand while taking your photo and measure it accordingly, or he will print the picture he took in real size.
I calculate the golden ratios and the ideal face profile by making fine measurements before the surgery. As a result of my calculations, I draw a profile picture by hand. For detailed information on profiling, click here.
COMPLICATIONS AND PROBLEMS THAT MAY OCCUR:
The risk of bleeding in every surgery may be more serious in rhinoplasty. Especially if non-aesthetic procedures are to be performed in the nose to relieve nasal congestion, which must be done if necessary, the possibility of unwanted bleeding increases. It is an organ that contains medium-sized vessels in the nose. But this type of bleeding usually does not reach dangerous levels and can be stopped with simple tampons.
Adhesions called synechia may develop in your airways after surgery, and these can make it harder for you to breathe than before the surgery. This is usually easy to treat but may require a second surgery.
Very rarely, a hole may occur in the structure called the “septum”, which forms the middle of the nose. This is usually not a problem, but in rare cases it can cause a sound when breathing.
It is difficult to treat and requires reoperation.
Infection in the nose is almost impossible. This organ, which has a very strong blood supply, is very resistant to inflammation. If infection develops after this surgery, you can enter the medical literature.
But if you experience aesthetic problems, deformities or don’t like the shape of your nose after this surgery, no one will be surprised. Therefore, the most common complication of this surgery is aesthetic.
FREQUENTLY ASKED QUESTIONS:
Should this surgery be performed by a plastic surgeon or an otolaryngologist (ENT)?
Your doctor may be a plastic surgeon or an otolaryngologist. I still recommend you to have surgery to a plastic surgeon, but I know that there are ENT specialists who do this surgery very well. However, do not forget that this is not an operation to say, “Let’s take that bone while we’re doing it”. Sometimes this kind of retouching done in good faith can be very difficult to fix. Discuss everything with your doctor in detail.
Are you breaking bones?
We don’t break bones. If we want to shape or take parts of it, we “cut” it. Thin chisels are used for this. Sometimes the bones are filed.
Can this surgery be done with local anesthesia?
If something is going to be done about the bones, which is mostly necessary, local anesthesia will not be appropriate. This is an operation that requires general anesthesia.
Is it necessary to put a tampon? Will it hurt a lot when the tampons come off?
It is not necessary to put a tampon. In fact, there is no need to put tampons after many surgeries. A tampon is only needed if serious work has been done inside the nose. Now, modern bumpers are not as long as they used to be. Pad removal can be a little tedious, but it’s no longer a painful procedure. Consult your doctor about this issue, find out if he will use tampons and what kind of tampon he thinks if he will.
Is the purpose of rhinoplasty to shrink the nose and “remove the bone”?
The answer to this question is unequivocally no. The aim of this surgery is to give the desired shape to the nose. Contrary to popular belief, this is usually achieved not by making the nose smaller, but by enlarging the nose. If there is a bone called “hump” (in fact, it is mostly cartilage) on the back of the nose, this will of course be removed, but many of these types of noses actually have a low nose tip and need to be raised. In the same way, although many nose tips look fat, the main problem is in the shape and reducing or thinning it only makes the problem bigger.
TIPS:
It would not be an exaggeration to say that rhinoplasty is the most difficult plastic surgery. It is a surgery that you will be very pleased with if done well, but difficult to correct if done poorly.
Contrary to popular belief, the slightly upturned European noses that we adore are not tiny but extremely high noses. Therefore, it is impossible for the noses, which are raised only by making them smaller, to stand naturally.
WHAT TO EXPECT YOU BEFORE AND AFTER THE SURGERY:
This is minor to medium plastic surgery. It is absolutely necessary to faint during the operation, I do not recommend you to have an operation with local anesthesia. The operation must be performed in a hospital, it does not have to be full-fledged or have an intensive care unit. I would not recommend you to have this surgery under the conditions of the office.
Your doctor may be a plastic surgeon or an ear, nose and throat (ENT) doctor. I still recommend you to have surgery to a plastic surgeon, but I know that there are ENT specialists who do this surgery very well. But do not forget that this is not an operation to say, “Let’s take that bone while we’re doing it”. Discuss everything with your doctor in detail.
After the surgery, you will have a cast on your nose. You may also have tampons in the nose. Pulling the new generation bumpers is now much more problem-free.
I can say that the bumpers taken by your friends for meters are a thing of the past.
Your first night will be relatively difficult. It will be difficult to breathe through your nose even without a tampon, you will have a headache, you need to apply ice constantly and it will be difficult to sleep. But the next morning you will feel much better.
How much swelling will be depends on the procedures performed in the surgery, your body and of course your doctor. In the second surgery, the swelling will be a little more. There will be a slight leak from the tip of your nose for the first 24 hours. This is also extremely normal.
If you vomit a blob of blood, fear not. Some patients may swallow blood during surgery and this may cause vomiting after surgery. Do not be afraid if the bleeding is not fresh and does not continue, but be sure to inform your doctor.
After the second day, you can return to your normal life, for example, to go to the cinema. After the plaster is removed, sticking a thin tape on the nose helps the swelling to pass early.
STORY OF THE SURGERY:
Anesthesia mode: General.
Where the surgery should be performed: In a hospital operating room.
Surgery time: 1.5 to 2.5 hours.
Length of hospital stay: You can be discharged on the same day.
Post-operative pain – distress: There may be a slight tingling for a few days. Usually, simple painkillers taken by mouth are sufficient.
Swelling, bruising: There may be severe bruising and swelling around the eyes for 3-7 days.
Dressing: Tampons, if any, are removed the next day. The plaster is removed on the fifth day.
Stitches: If open rhinoplasty is performed, the nasal tip sutures are removed together with the plaster on the fifth day.
When to return to work: 3–7 days.
Sports: Long walks after 2 weeks, normal sports after 3 weeks. It would be correct to start competitive sports, such as basketball and boxing, after 5 weeks at the earliest.
Final shape: Usually in the second week, a significant part of the swelling goes away. But the final shape appears at the earliest in the 6th month. Especially if there is swelling between the eyebrows towards the forehead, this will continue for up to a year.
