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Rhinoplasty

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, it is sometimes 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 perform this surgery from 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 are independent of each other but as a whole and can behave differently during the healing period. For this reason, this is the aesthetic surgery that is most frequently followed by revision, that is, a second correction surgery. In world standards, it is considered normal for a surgeon to have to perform revision in one out of every 10 cases.

On the other hand, this surgery gives very good results when done well.

How is the surgery performed?

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 surgery 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 related to the surgeon’s command of the surgery. The closed technique performed through the tip of the nose is more like performing surgery in a bottle. If you are only planning to remove something from inside the bottle, there will be no problem, but if you want to make a model of a ship inside, your job is difficult. In the open technique, the surgeon can see the structures in the front 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 understand 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 such a delicate work, which is done blindly and blindly and which does not forgive so many mistakes, can be good. The fact that many surgical maneuvers can only be possible with the open technique and that corrections that cannot even be imagined with the closed technique are possible with the open technique is something that even closed technique advocates cannot object to. I believe that the possibility of revision decreases after open surgeries.

The biggest handicap of the open technique is that it leaves a scar on the tip of the nose. But this scar is almost indistinct after a well-performed surgery and remains under the nose. Many patients forget this scar after surgery. Consult your doctor about this issue and trust him/her. Each surgeon will get the best result with the methods he knows and believes best. What I have described above are only my personal opinions.

I See Very Bad Surgeries, Will I Be Like That?

I also see “operated noses” that are unnatural, very small, with nostrils that are visible from the opposite side. I explained on a separate page how you can recognize a poorly performed nose surgery. Remember that the result of the surgery depends entirely on the techniques, skill and what the doctor who performs the surgery wants to do.

Giving an upturned nose shape by simply shrinking the nose creates an unnatural result. In modern techniques, almost nothing is removed, only the location, position and shape of the tissues are changed.

If you examine this shape, you can see one of the common aesthetic mistakes. This is a common method used in old techniques. In the past, in order to make the nose look upturned, the nose was made smaller and the starting point was taken as low as possible. Thus, an illusion was created as if the nose was upturned, but the result obtained was not natural. What should happen is to start the nose where it should start, that is, almost at the level of the pupils, and give its whole shape accordingly.

How can I see what kind of nose I will have after surgery?

There are computer programs for this purpose. Your doctor will probably give you an idea with one of them. However, these programs cannot be used for actual surgery planning and measurement and can only give you a general idea.

If your doctor is using one of the new measurement-based techniques, he or she will want to make measurements on your pictures. For this, he/she will either hold a ruler in your hand while taking your photo and make the measurement accordingly or he/she will print the picture in real size.

I calculate the golden ratios and the ideal facial profile by making fine measurements before surgery. As a result of my calculations, I draw a profile picture by hand. Click here for detailed information about the profile study.

What are the Complications and Problems that may arise?

The risk of blood in every surgery can be more serious in rhinoplasty. Especially if non-aesthetic procedures will be performed in the nose to relieve nasal congestion, which must be done if necessary, the possibility of unwanted bleeding increases. The nose is an organ that contains medium-sized vessels. However, such bleeding usually does not reach dangerous levels and can be stopped with simple tampons.

After surgery, adhesions called synechiae may develop in your airways and these may make breathing more difficult than before surgery. This is usually easy to treat but may require a second surgical intervention.

Very rarely, a hole may form in the structure called “septum” that forms the middle of the nose. This is usually not a problem, but it can rarely cause a sound when breathing. Treatment is difficult and reoperation is required.

Infection is almost non-existent in the nose. This organ with very strong blood supply is very resistant to inflammation. If infection develops after this surgery, you can enter the medical literature.

But no one will be surprised if you experience aesthetic problems, deformities or if you do not like your nose shape after this surgery. Therefore, the most common complication of this surgery is aesthetic.

What are the Frequently Asked Questions?

Should a plastic surgeon or an ear, nose and throat (ENT) specialist perform this surgery? *

Your doctor may be a plastic surgeon or an otolaryngologist. However, do not forget that this is not an operation to say “let’s get that bone while we’re at it”. Sometimes it can be very difficult to correct such touch-ups made with good intentions. Discuss everything in detail with your doctor.

Do you break the bones?

We do not break the bones. If we want to shape them or remove parts of them, we “cut” them. We use fine chisels for this. Sometimes the bones are filed.

Can this surgery be performed under local anesthesia?

If something has to do with the bones, which is most likely, local anesthesia is not appropriate. This is an operation that requires general anesthesia.

Is it necessary to put a tampon?

Tampons are not necessary. In fact, there is no need to put a tampon after many surgeries. A tampon is only needed if serious work has been done in the nose. Modern tampons are no longer meters long and endlessly long as they used to be described in the past.

Will it hurt a lot when the tampons come out?

Removing a tampon can be a little tingly, but it is no longer a painful procedure. Consult your doctor about this, find out if he/she will use tampons, and if so, what kind of tampon he/she thinks.

Is the aim of rhinoplasty to make the nose smaller and “remove bone”?

The answer to this question is definitely no. The aim of this surgery is to give the desired shape to the nose. Contrary to popular belief, this is usually done by enlarging the nose, not reducing it. If there is an excess bone called “hump” on the back of the nose (in fact, this is mostly cartilage), this will of course be removed, but in many such noses, there is actually a low nose tip and it needs to be raised. Likewise, although many nasal tips look fat, the real problem is the shape, and reducing or thinning it only magnifies the problem.

Tips

It is not an exaggeration to say that rhinoplasty is the most difficult plastic surgery. If it is done well, you will be very satisfied, but if it is done badly, it is a surgery that is difficult to correct.

Contrary to popular belief, the slightly upturned European noses that we aspire to are not tiny but extremely high noses. Therefore, it is impossible for noses that are lifted only by reducing them to look natural.

What awaits you before and after the surgery?

This is a minor to moderate plastic surgery. You must faint during the surgery, I would not recommend you to have surgery with local anesthesia. The surgery must be performed in a hospital, it does not necessarily have to be full-fledged and have intensive care. I would also not recommend you to have this surgery under office conditions.

Your doctor can be a plastic surgeon or an ear, nose and throat (ENT) doctor. I would still recommend you to have surgery with 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 get this bone while we have it inside”. Talk to your doctor about everything in detail.

After the surgery, there will be a plaster cast on your nose. You may also have tampons in the nose. The withdrawal of new generation tampons is now much more problem-free. I can say that the meters of tampons that your friends told you about are a thing of the past.

Your first night will be relatively difficult. It will be difficult for you to breathe through your nose even without a tampon, you will have a headache, you will need constant ice application and it will be difficult for you to sleep. However, you will feel much better the next morning.

How much swelling you will have depends on the procedures performed during the surgery, your body and of course your doctor. Swelling will be a little more in the second surgeries. There is a slight leakage from the tip of your nose for the first 24 hours. This is also very normal.

Do not be afraid if you vomit a clump of blood. 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 you can go to the movies. After the plaster casts are removed, a thin bandage on the nose will help to relieve the swelling early.

Scorecard of the surgery:

Type of anesthesia: General.

Where the operation should take place: In a hospital operating room.

Duration of surgery: 1.5 to 2.5 hours.

Length of hospitalization: Can be discharged on the same day.

Postoperative pain – discomfort: There may be a slight tingling for a few days. Simple oral painkillers are usually sufficient.

Swelling, bruising: Between 3-7 days, sometimes there may be severe bruising and swelling around the eye.

Dressing: Tampons, if any, are removed the next day. The cast is removed on the fifth day.

Stitches: If open rhinoplasty is performed, the nasal tip sutures are removed on the fifth day together with the cast.

When you can return to work: 3-7 days.

Sports: Long walks after 2 weeks, normal sports after 3 weeks. It is best to start body-to-body competitive sports such as basketball and boxing after 5 weeks at the earliest.

Final shape: Usually, a significant part of the swelling disappears in the second week. But the final shape appears in the 6th month at the earliest. Especially if there is swelling between the eyebrows towards the forehead, this will continue for up to a year.

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