The aim of this surgical procedure, called rhinoplasty, is to correct the deformity of the nose. If there are bone curvatures in the nose that prevent breathing or flesh growth, which we call turbinate hypertrophy, these problems can be resolved in the same surgery, in which case the name of the operation is septorhinoplasty.
WHICH DOCTORS DO RHINOPLASTY
Rhinoplasty surgery can be performed by an otolaryngologist who is specialized in this field and has enough experience. This surgery is within the head of facial plastic surgery. In this context, there are both otolaryngology and plastic surgery specialists. It is not necessary for every otolaryngologist to do or be able to perform rhinoplasty surgery. Again, not every plastic surgeon can perform rhinoplasty. The issue that our patients should pay attention to here is that whether the doctor performing the surgery is an ENT specialist or a plastic surgeon, there should be a doctor who has experience in rhinoplasty surgery and specializes in this subject.
I would like to remind our patients that if they have both functional and Aesthetic complaint or severe septal deviation, recommend them to choose an otolaryngologist who has full knowledge of the internal and external anatomical features of the nose. However, the right to choose their doctor always belongs to our patients.
PREOPERATIVE MEETING WİTH THE DOCTOR
Our patients should make the best use of the doctor's consultation and express their expectations well after the surgery. Your doctor will note these expectations and will tell you before the surgery which of them can be realized at what rate. In this way, both the doctor and the patient will be more conscious and comfortable after the surgery.
Our patients should identify their problems well before meeting with their doctor and share all of them during the meeting. For example, if a patient who will undergo rhinoplasty surgery has signs of allergic rhinitis such as runny nose, sneezing, nasal congestion and nasal itching, they should talk about these. Again, they should talk about the diseases they had before and the drugs they are constantly using, and they should tell the doctor in full. For example, if those who use blood thinners such as aspirin do not talk about this situation, the risk of nosebleeds will increase both during and after the operation.
As a result, we, the physicians, take a detailed anamnesis about our patient's nose, as well as his general health status and the drugs he is using, during the patient interview. For the benefit of our patients, it is necessary for the patients to share all the details about their nose and their general health status with their physicians during the interview.
We generally do not perform rhinoplasty before the age of 16 if our patient does not have breathing problems. Patients between the ages of 16-18 will be evaluated by the physician when they apply with the support of their parents, and if it is concluded that they have completed their craniofacial development, they will be able to undergo surgery with parental consent. Our patients over the age of 18 are adults and can make their own decisions. In terms of development, it is assumed that facial development is completed in patients over the age of 18.
WHO CAN NOT HAVE RHINOPLASTY
As I mentioned above, children under the age of 16 who do not have nasal breathing problems are not suitable for rhinoplasty. However, if the patient has serious difficulty in breathing through the nose and this affects the quality of life and academic performance, necessary surgery to relieve nasal congestion should be performed regardless of age.
It is not recommended for patients with serious health problems such as heart failure, kidney failure, liver failure, uncontrolled diabetes and hypertension to undergo surgery for rhinoplasty unless they are treated and stabilized. However, patients with severe nasal congestion and breathing difficulties can be operated on, taking into account the risks.
Patients who are using blood thinners such as aspirin and coumadin should be stopped for 20 days, 10 days before and 10 days after the surgery, in consultation with their physicians. Patients who are inconvenient to discontinue these drugs should be aware of the high risk of bleeding during and after surgery.
LIMITATIONS IN RHINOPLASTY
The aim of rhinoplasty surgery is to obtain a more beautiful and better breathing nose suitable for the patient's face. The host factor is very important in achieving this result. For example, when thick skin is laid on a beautiful nose skeleton made on a patient with thick skin, it may not fully reflect this beauty. Or, in a patient with facial asymmetry, it may be difficult to bring the nose to the midline during surgery. Even if it is brought to the midline, the nose may incline to its old side again due to the asymmetrical face after the surgery. Another factor that negatively affects the result of rhinoplasty is radix fullness. Here, the transition angle from forehead to nose approached may be about 180 degrees. Although this area is reduced a little with bone rasps, the ideal level may not be achieved.
Previous rhinoplasty surgeries are also among the factors that negatively affect the success of the surgery. Sometimes, cartilage transfer may be required from rib or ear cartilage for repaire their noses in revision cases.
Another issue is the recovery performance of the patient. Some patients recover more quickly, while others may take longer to recover. Rhinoplasty surgery is also performed in patients with these restrictive conditions and their noses may become more beautiful than before, but perfect results may not be obtained in these noses.
If the patient breathes better and his nose looks better after rhinoplasty in these patients, the surgery is successful.
RHINOPLASTY SURGERY
Rhinoplasty operations are operations performed under general anesthesia. It takes between 1 and 4 hours depending on the problems of the nose. The length of the operation period increases in direct proportion to the aesthetic difficulties of the nose, respiratory problems, and previous nasal surgeries.
In rhinoplasty, there are generally two methods, open and closed approaches. These methods are related to the structure of the nose and the experience of the doctor you prefer. Generally, there is a tendency to use the closed method in patients with less problems, and the open method in patients with more problems. However, there are surgeons who exceptionally apply all kinds of closed or open methods.
It would be more appropriate for our patients to leave the technique-related choice to the surgeons and to apply the technique that the surgeon feels most comfortable with. Some patients may advise us to do it without breaking my nose. Of course, surgery can be performed without bone fracture in patients with minimal problems or only nasal tip problems. However, in crooked, severely humped or very large noses, bone fracture will be required to achieve aesthetic improvement.
At the end of the surgery, if significant corrective action has been taken in the septum, a silicone pad will be placed. The tampon is usually not used in those who do not have serious problems in the septum. Silicone tampons are more comfortable than the gauze tampons used in the past and allow breathing while wearing.
POSTOPERATIVE
Post-operative bruising and swelling are much less common than previous surgical techniques. When you wake up after the surgery, you will wake up with a tiny cast on the back of your nose. Post-surgery is usually not as painful as feared. This period will pass quite easily with simple painkillers. Perfect breathing may not be expected in the first week after surgery. In patients with tampons, the inside of the tampon can be clogged with clots, and in patients without tampons, nasal congestion can be expected from time to time in the first week due to the swelling of the nose.
It is recommended that you rest with your head slightly elevated or in a sitting position in a place that is not too hot or cold. You can take a shower with warm water the day after the surgery. You will need to wash your nose with saline or similar nasal sprays every three hours and apply cold to your face for 15 minutes every two hours. It is not recommended to go out and do strenuous activities for the first three days.
There may be swelling on your face, which increases in the first three days and decreases in the following days, which completely disappears up to 7-10 days. The amount of this swelling is mostly proportional to the wound healing performance and skin characteristics of the patient. The extent of swelling on the patient's face cannot be predicted before the surgery. However, regardless of the size of this swelling, it completely disappears within 7-10 days.
Your nose will be cover with cast for one week and after cast removal one week with tapes. So totally two weeks your nose will be cover. After your tapes are removed, you will meet your new nose. It may seem strange at first, as your nose, which you've lived with for years, has changed. However, you will get used to your new nose within days.
Depending on the plaster and plaster application, there may be some skin reactions, acne and redness, especially in allergic patients. These heal completely over time. Our patient can do face and skin care from the 2nd week after the operation.
After rhinoplasty, every person you meet will make different comments to you. This is related to the fact that tastes are different, as well as your old nose is not well known. The interpretation of your nose can be made by the experts of this subject, considering your old nose. It will be the most appropriate way to follow the changes related to your nose with your doctor over time.
Avoid excessive physical activity after surgery. Avoid excessive facial movements and excessive laughing for a month. Do not touch your face and nose harshly for 3 weeks. Avoid excessive sunlight for 6 weeks following the operation. Excessive heat will cause swelling in your nose. Swimming in the sea or pool in the first month may carry the risk of infection. After a month, you can swim in the sea and pool and sunbathe. However, it would be better for the patient to protect his/her face with a hat or towel during early sunbathing. Sunglasses can be used after 2 months but it will be better to prefer light ones.
If you have questions about rhinoplasty that we haven't mentioned here, you can contact us directly by clicking the 'ask a question' button. I wish all our patients a day full of health and happiness.
