Nose is at the most prominent part of the face due to its position, and is the primary element that determines the visual quality of the face. Nose which is also a functional organ in addition its aesthetic effect has become one of the most commonly operated parts as the rhinoplasty evolves. Aesthetic nose operation called as “Rhinoplasty” is the reshaping of the nose by surgical intervention. This operation can be used to remove any deformations, crookedness, irregularities, or in nose reduction, enlargement, tip pointing-out, tip lifting, or nostril reduction.
Besides visual dissatisfaction, another complaint of the patients is functional incompetence. Most patients suffer from breath obstructions, nasal concha formations, nose wing collapses, or sleeping with an open mouth and associated teeth/gum problems. Such problems can be easily eliminated without any additional discomfort due to certain attempts to be applied during rhinoplasty operation. “Septoplasty” is used to remove any cartilage curvatures formed inside of the nose while concha-related complaints can be eliminated using radiofrequency techniques during the same phase. The association of “aesthetical and functional” interventions which constitute an integral part of rhinoplasty operations is called “Septorinoplasty”, and patients have a nose which is both aesthetical and ensures easy breathing at a time.
Although the concept of an aesthetical nose has been long attempted to be defined by figures or angles over years in parallel with the developments in the plastic surgery, the main concern is to apply those figures and angles correctly on the face of a person. In this context, requests of the patient is the main determinant while the primary purpose of a surgeon is to fulfill those requests in the most prudent and natural way possible.
A successful nose operation is the one that results in a unexaggerated and functional nose which fits the face of the patient and ensures unrestricted freedom of breathing.
Rhinoplasty begins when a patient decides to have the operation. In this phase, stability of the emotional situation of the patient is important. Upon making this decision, first interview will be made with the patient. The first interview is the first contact between the patient and the surgeon and is to query the general health condition of the patient in detail in addition to the nose examination. A chronic condition history, medications regularly used, herbal treatments, smoking, vitamin supplements, and probability of pregnancy are important since they can change the course of the operation, and should not be ignored. Nose examination is carried out to examine visual deformities, crookedness, any breath-obstructing narrowing, concha formations, and understand what the patient expects from this operation. Expectations of the patient will be reviewed based on experience of the surgeon, and the patient will be informed if their expectations can be fulfilled, and whether the outcome desired will fit the appearance of the face. Following this detailed information exchange to take place in the light of the above, technical details related to the operation will be explained to the patient, and questions arisen regarding the application will be answered. The first interview will end upon taking photos and scheduling the potential operation date.
The second pre-operation interview will take place preferably a few days before the operation. This interview is to query whether any new health problem or medication has arisen within the time from the first interview, and any new questions of the patients regarding the operation will be answered. Work on the photos taken in the first interview and related images will be presented to the patient, and the image that the patient wishes to have will be determined. Details regarding the course of the operation will be provided to the patient based on such image, and tests will be conducted to evaluate patient’s eligibility for the operation. Operation for patients who are found to be eligible for receiving anesthesia as the results of tests conducted will be finalized.
A patient who is scheduled to have operation the next day should not consume water or food as of 24:00. The patient who needs to come to the hospital with an empty stomach will be accepted to their room and then visited to plan the operation. The patient who is to be re-evaluated by an anesthesiologist in the next phase will be informed in detail about the anesthesia and a tranquilizer will be injected. This injection is to eliminate any feelings of stress, nervousness, or excitement.
Rhinoplasty is an operation performed under operating room conditions. The most preferred method is to perform the operation under general anesthesia although it can also be performed under local anesthesia where only the nose area is anesthetized. The patient will be fully in sleep under general anesthesia. This method is more comfortable for the patient, and also comfortable and safe for the surgeon.
Rhinoplasty can be performed in two ways including open or closed as their commonly known. The main difference between these two methods is that, in the open technique, the link called columella between the nostrils is cut. Today there are many different views on which technique is superior without any consensus. In this context, the surgeon will decide the operation type considering operations to be performed, severity of the deformity, and past operation history. Both techniques are commonly used, and it is important for the patient to trust the physician in determination of the technique.
Cuts made during the rhinoplasty will reveal the cartilage and bone structures forming the nose body. If the nose has a crooked structure, cartilage and bone structures forming it will be removed while in case of a sunken nose bridge, additions will be made to that area. Bone structures on the sides of the nose will be freed using special tools if needed, and the nose bridge will be closed to form a roof. Wide or narrow or saggy parts on tip of the nose will also be brought to the desired level by interventions in the cartilage bone. If there is any nasal deviation and the patient suffers from breathing problems, those problems will be eliminated by septoplasty. In case of concha, radiofrequency ablation will be applied. In case of any asymmetry or excess part identified in nostrils, such parts will be intervened in to achieve optimal results. Rhinoplasty will end upon application of silicone packings with air-passage channels inside and splint on the nose bridge. Unlike past approaches and common fears, there will be no obstruction to breathe and patients sometimes wake up with an easier breath than in the pre-operation period.
Upon waking up from anesthesia, the patient will be taken to a room until their general condition gets normal. In this phase the pain will be kept under control by the help of various painkillers and cold compress will be applied to prevent any bruising around the eyes. The patient can start moving and eating a few hours after the operation under the supervision of the doctor. Antibiotics treatment will be prescribed to mitigate any potential infection risk and the patient will be discharged 1 day after the operation. A control visit will be scheduled on the day suggested by the surgeon and silicone packings inside of the nose will be removed in the first control visit. The patient will have no pain in this phase. Bruises around the eyes will begin to vanish on the 3rd day while mostly disappear at the end of the 1st week. Within this 1st week, it is important for the patient to avoid heavy exercises, stress, leaning the head forward, or sports activities etc. to prevent any risk of bleeding due to increase of blood pressure. There are no medical obstructions to get back to work at the end of that week for most patients.
The surgeon will call the patient for the 2nd control visit at the end of the first week, and you will see your new nose for the first time upon removal of the splint on the nose bridge. Here it should be noted that the nose will look much more swollen and bigger due to edema than it will look in future. The nose might be fixed using a new splint or bandages in this week if deemed necessary by the physician.
The final look of the nose can extend up to 1 year in parallel with recovery potential of a patient. Therefore, you should not be worried about any swellings seen in early periods and massages recommended by the physician must be applied if needed.
It is quite natural after certain rhinoplasty operations that there will be some people who will tell you that your nose does not look very different than before. It is not a failure but on the contrary, if it looks better and natural, it should be considered the success of the surgery. Eventually, an aesthetical nose is not a nose that draws all the attention but complements the general features of the face.