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Rhinoplasty

Rhinoplasty can be performed due to various deformities of the nose, which is the most important organ on the face for facial expression. It can be performed due to such reasons as congenital curvature of the nose, larger noses and droopy nasal tip while it can also be done to correct deformities after traumas. It is very important what we understand from rhinoplasty. You should decide on the nose type with a specialist that will best fit to your face, because the most important factor of patient satisfaction and operation success is the pre-operative planning.

 

Before Rhinoplasty

You will experience a smooth recovery period and achieve a beautiful nose if the surgery is performed after making face analysis of the patient and considering skin quality, skin thickness, strength of cartilages and airway opening in order not to cause any breathing problems after the surgery. A nose shape that will fit to your face should be determined to get successful results. Golden ratio is considered while determining the ideal nose shape for the patient.

In order to achieve the golden ratio, nose should be photographed at all angles and post-operative image should be prepared in digital environment.

In rhinoplasty surgery, you should talk to your doctor about your expectations and wishes and decide on the details discussing together. Please remember that you will achieve a natural-looking nose after a rhinoplasty surgery that is performed proportional to your facial contours. After patient’s expectations and complaints are learnt during pre-operative consultation, a detailed physical examination is performed. During this examination, patient’s nose is evaluated both for aesthetic terms and breathing problems. Because, if the patient has breathing problems, it can be eliminated in the same surgery by plastic surgeons. Patient’s photos are taken, detailed face analysis is done and then the ideal nose shape is determined.

 

 

 

How Is Rhinoplasty Performed?

It should be performed by a specialist physician under operating room conditions. During this surgery, patient’s nose structure is intervened. It is worked on bones, cartilage structures and the skin, and the nose is brought to the ideal size and shape.

Are Intranasal Buffers Placed in Rhinoplasty?

Nasal buffers are used in the recovery period after rhinoplasty. However, the buffers that were used in the past used to cause difficulties in breathing and pain at removal; therefore, they are not preferred today. But silicone and plastic plates are used now instead of these buffers. Therefore, patients can easily breathe. There is also no pain during removal. Thus, recovery period is experienced smoothly. Buffers are removed after 3-6 days on average. The aim is to protect the shape of nose and prevent complications such as bleeding.

When Are Patients Discharged After Rhinoplasty?

People would like to learn many things about this operation. One of them is about after how many days patients can be discharged. People normally want to learn when they can return to their normal lives and prepare themselves accordingly. If the patient’s general health condition is well and there is no complication, they can be discharged after one night. However, it is very important to follow control appointments and pay attention to the recommendations during recovery period at home.

The role of piezo surgery in rhinoplasty;

The pain at rhinoplasty surgeries varies depending on the technique to be chosen and the level of deformity. The conventional method that is used in many places now is performed by cutting the nasal bone and shaping the bones creates difficulties for surgeons. When the bone is cut with a chisel or hammer, bruising and swellings occur on the patient’s face after surgery. Because the vessels on the relevant region are damaged and intra-tissue bleeding occurs during this cutting process. Head area is affected severely and the vessels on inner part of the bone cause bleeding. In Piezo Surgery, nasal bone is shaped with ultrasonic sound waves, so that vascular structures on the bone, cartilage tissues adjacent to the bone, and the skin are not damaged by ultrasonic knives. Swelling and bruising do not occur. Moreover, the contours can be cut at desired angles.

Piezo rhinoplasty allows nasal bones to be shaped precisely with the help of ultrasonic oscillations. Being a revolutionary technique in rhinoplasty operations, piezo rhinoplasty is an innovative technology that enables precise work on the nose and facial bones. Piezo electric instruments use ultrasonic vibrations to shape bone and does not damage soft tissues such as cartilages and skin. Thanks to ultrasonic vibrations, the nasal bone is shaped by preserving the surrounding soft tissue. Moreover, it also provides advanced sensitivity. Asymmetrical and structural deformities on the nose can be precisely corrected with piezo rhinoplasty method. It carefully transforms and changes the nasal cartilage during the surgery in order to support the nose skin adequately. Ultrasonic rhinoplasty is a little different than a conventional rhinoplasty operation, the device can only be used in open rhinoplasty procedures. If it is required to change the shape and width of the bone during the reshaping of nasal bone, sensitive tools are used that allow to intervene without damaging other soft tissues of the nose with ultrasound technology. Piezo rhinoplasty is a different method; nasal bones are shaped with a great sensitivity like an artist doing his job. The risk of mistakes is lower in this method. Unlike conventional devices, piezo technology allows shaping the bone without any risk for damaging the soft tissue accidentally. It is a great technology that can be adapted to many different areas of use.

This method, which has been used in dentistry for years, was later provided with a series of special microchips that are adjusted for the requirements of rhinoplasty operation, which is one of the most common aesthetic operations in the world. Piezo rhinoplasty provides several benefits compared to classical rhinoplasty surgeries, such as extremely precise shaping of the nasal bone, preserving soft tissue, causing less edema and bruising, ensuring rapid recovery, causing less post-operative pain and ensuring an effortless and reliable operation.

Ultrasonic rhinoplasty is a new motorized device that uses sound waves to contour the nose. Nose is reshaped and humps are eliminated. Unlike the old rhinoplasty methods, ultrasonic rhinoplasty only affects the bones and does not cause additional damage on other tissues. It causes less trauma on the nose and there less bruising and swelling are observed. This method also provides less complication during tissue and bone recovery.

Piezo rhinoplasty is usually performed in open operations. It provides highly successful results in relation to the desired nasal change. The bone is precisely shaped and positioned during the operation. Piezo electricity devices replace traditional instruments. The aim of these operations and the aim of classical rhinoplasty operations is the same; only the method, technique and instruments are different. Nasal hump can be reduced and nose can be shaped without any mistakes in piezo rhinoplasty operations. The entire operation is performed with high precision, under control and within full visibility area. Patients recover rapidly and more precise results are achieved. Its new form allows to monitor the nose fully and closely observe the bone weakness. As piezo affects only the bones, it provides a comfortable and reliable operation because it is already known that this procedure does not damage soft tissues, the skin or mucosa membranes on the operation area.

In order to prevent swelling and bruising, cold application can be recommended after rhinoplasty operation. In general, mild bruising and swelling disappears after a few days. Some patients may even not experience any pain, bruising or swelling. The used technique and some individual factors determine this factor.

Who Can Get Rhinoplasty?

People with the problems of nose curvature, deviation, deformity and droopy nasal tip can undergo rhinoplasty operation after a physician examination. However, it is waited until the age of 18 when nasal structure is fully developed. In case of a traumatic situation or breathing difficulty, operation can be performed regardless of the age.

After Rhinoplasty Surgery

Following the necessary precautions after the surgery ensures a faster and smoother recovery period. Post-operative recovery period varies depending on the surgery technique. It is inevitable to face a scar, even not noticeable, on the lower part of the nose after an operation with open technique. It can be hardly noticed from the outside due to its location. But after piezo surgery, recovery period becomes faster and more comfortable.

 

Secondary Rhinoplasty

Secondary Rhinoplasty is performed when the problems of patients who previously underwent nose surgery for breathing difficulty or aesthetic concerns are not eliminated or when deformities occurred secondarily to the first operation.

The relevant problems include; ongoing breathing difficulty or emergence of a new breathing problem, failure to shape nasal arch or excessive curvature of the nasal ridge, problems in the shaping or angling of nasal tip, saddle nose and  inverted V deformity.

If necessary, cartilages can be taken from the ribs or ears in order to correct these problems. Even though it is more successful to shape the nose in the first operation, it should be known that such deformities can definitely be resolved and corrected.

Does rhinoplasty provide successful results in one session?

I would like to first mention how rhinoplasty operation is decided. First of all, the person should be complaining about any part of his nose. It may be due to nasal hump, size of the nose, deformity of nasal tip, nasal curvature and so on.  Then, these complaints must be evaluated by a plastic surgeon and determined whether the complaints are real and a more beautiful nose can be achieved by correcting these deformities. This is actually the most important step for rhinoplasty because patients sometimes realize after the physician examination that the things which they call defects are actually not real problems and not significant at all.

All the problems are recorded and operation is planned. At this point, all these problems are corrected in the first operation and a second operation is usually not required for a lifetime. However, there are very important facts that should be remembered every time. So what are these?

Each nose is different from each other and undergoes different operations. Applying the same procedure to each patient is not enough to achieve the same results. Nasal cartilages are developed in a certain form and their curvatures may be in different shapes such as C shape or S shape. Cartilage has also a memory and may tend to return to its former shape after the operation. Nose is an organ consisting of the skin, subcutaneous tissue, cartilage structure and bone structure, and all of these elements have an important place both for the dynamics and aesthetic appearance of the nose. After these findings, I must say that interventions to these live structures will require a recovery period and it is essential for the success of this operation.

It is expected to achieve a successful operation by 90% with the right and appropriate interventions. To explain this, nine out of ten patients should recover from their problems in the first operation and will not need any other operation throughout their lives. It is a standard and scientific rate, but there might be changes depending on personal experiences. Besides all these details, I would like to give information about how the process takes place and what interventions are done to help these patients in 10% group who have previously undergone an operation but could not achieve desired results. In secondary rhinoplasty operation, it is possible to make appropriate interventions that can be applied on these patients who could not achieve the desired result at the end of first operation or even after the 3rd and 4th operations.

The problems of patients who have previously undergone a rhinoplasty operation for respiratory problems or aesthetic concerns can be listed as; collapse on nasal dorsum, bulging and squaring on nose tip, excessive asymmetry in nasal wings, a flattened nose as if it was punched, development of a curvature that was not existing before, differences in lateral nose bones, whistling sound while breathing and collapse in nasal wings while breathing.

In these patients, it is possible to eliminate the deformities with various methods from a small scale to a large scale. Small irregularities and asymmetries can be corrected with a slight rasping. If more serious problems have occurred after the first operation, cartilage tissues are extracted from the patient himself in order to correct these deformities. The cartilage to be extracted from the person’s own body can be obtained from ear cartilage or rib cage depending on the severity of deformity and the procedure to be applied. These extracted cartilages are used to reshape and support the nose.

Such operations which are known as cartilage graft and during which cartilages are shaped and used for supporting the required areas, can be performed with either open or closed rhinoplasty techniques.

The important thing here is the surgeon’s experience and his choice for the requirements.

Secondary operations are more troublesome than the first operations but it is possible to achieve successful results by making the right choices. Nose tip can be angled, given a triangle shape and nasal ridge can be made smooth and well-shaped.

 

 

 

Septorhinoplasty– Revision Rhinoplasty

A very nice-looking nose? A very well breathing nose? Or both? Would we be happy if we had a beautiful nose but cannot breathe properly?

The nose, which is one of the most valuable and determinant element of our face in terms of its aesthetic appearance, has also a very important place in functionality with the support it provides to the respiratory system. People may face chronic headache, under eye circles, dry mouth, snoring, chronic upper respiratory tract problems and chronic fatigue respirations due to an improperly breathing nose. For this reason, if an aesthetically nice-looking nose is achieved but respiratory problems cannot be eliminated or new respiratory problems occur after aesthetic rhinoplasty operation, this operation is not accepted to be successful.

The aesthetic beauty of the nose may differ among people. You may have a nose that everyone finds beautiful but you may be uncomfortable with its certain parts and you can make it corrected or you may have a structurally unaesthetic nose but it may be characteristic to your face and you may not want it to be intervened.

However, everyone wants to a have a nose through which they can breathe healthily. Therefore, it is wrong to consider the nose surgery only for aesthetic purposes. If we examine the nose anatomically, bone structure is composed of nasal bones and vomer cartilage is composed of upper lateral cartilages, lower lateral cartilages and septum.

These cartilage and bone structures constitute internal and external valve structures to provide respiratory support. Moreover, the turbines provided by nasal conchae have an important role in the healthy transmission of the air to the lungs. Congenital or acquired impairments (trauma, surgical intervention, medications) in any of these anatomical structures will lead to serious respiratory problems.

Respiratory problems that are mostly caused by septum deviation can be corrected by septoplasty surgeries without making an aesthetic intervention or by septorhinoplasty surgeries combined with aesthetic interventions of the nose.

The curvatures of septum from the midline disrupts the entire physiological respiration process of the nose, causing problems in other structures over time. If there is hypertrophy in nasal conchae, it should also be intervened.

In septoplasty operations, the curved part of the septum is reached by opening the mucosa on both sides of the septum. The curved part is removed without damaging the cartilaginous roof, or this curvature can be corrected by reshaping the septum with different methods.

If an aesthetic intervention has also been planned for the nose, septoplasty operation is combined with rhinoplasty operation and the changes that were previously determined with the patient can be applied by making changes in the size of nose, nasal hump, nasal tip, nasal nostrils and wings and correction of the angle between the nasal tip and upper lip.

Septoplasty operations take about 2-2.5 hours and are mostly performed under general anaesthesia. If there are breathing problems that we mentioned, special silicone buffers -allowing you to breathe- are placed at the end of surgery. Bruising is reduced with per-operative precautions but the resulting bruises will have been significantly regressed 5 days after the operation.

The splint placed on the nose is removed 1 week after the operation. During the following period of 1.5 months, the nose should be protected from traumas. With the regression of oedema, you will have a new and beautiful nose but it will take a year to see the final shape of your nose.

If you have decided to have rhinoplasty operation, do not forget to mention your breathing complaints during the consultation with your doctor. Keep in mind  that even though everything goes perfect and your operation gets successful, there may be minor deformities due to wound healing during the recovery period. Scientific data indicate that such minor revisions are required in one out of ten surgeries.

Aesthetic nose surgery takes the most important place among aesthetic surgeries because it is located in the middle of the face and creates a significant change in the person. Before this operation, you should examine your nose thoroughly and have decided whether you are ready for these changes. You should clearly identify which parts of your nose you are bothered with and talk to your doctor very clearly.

Taking the decision of operation right after the first interview and examination would be a very hasty decision for such an important operation. Patient should be given enough time to take his final decision. I do not recommend undecided people to undergo this operation because they are likely to be unhappy in the later period. If the person is undecided about having nose operation, appointment should be given for examination again for a later period and it should be waited for him to make his decision.

 

Tipplasty – Nasal Tip Aesthetics

All structures of the nose should be evaluated in rhinoplasty. When the bone, cartilage, skin and mucosa structures of the nose are evaluated together, the problems can be solved by performing on-site interventions in the deformities that disrupt the integrity. In order to correct the deformities of nasal tip, the operation called tipplasty is performed. Tipplasty is actually applied routinely during the classical rhinoplasty procedure, in order to change the angle of nose tip and correct the deformities. However, there is only nasal tip deformity in the nose, this procedure can be applied alone.

Nasal tip deformities include droopy nasal tip, non-prominent nasal tip, split nasal tip, wide nasal wings, weak support of nasal wings or bulbous or square-looking nasal tip.

During the procedure, the excess tissues on cartilages causing deformity can be removed or cartilage tissues can be added to the deformity areas and weak parts, so that the nasal tip can be shaped.

In order for the nasal tip to appear uniformly, nose tip cartilages are shaped with special stitch techniques.

If the nasal wings are large and disproportionate to the face, nasal wings are reduced by hiding the scars inside the nose or tried to be thinned with thinning needles.

After nasal tip surgery, the patient will spend the night at home. Compared to classical rhinoplasty, there is no bruising and swelling occurs only at the tip of nose but disappears quickly. Bandage is applied on the nose tip with small tapes for the first week and removed after 5-7 days.

Nose tip surgery is a comfortable and painless procedure and provides a more proportional and nice-looking nose.