Rhinoplasty is the fifth most demanded cosmetic surgery according to
SECPRE, the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery.
. With this surgery we manage to reshape the nose improving its proportions and harmony in the face as a whole. Although not always responds to aesthetic needs, rhinoplasty can also help us to correct secondary respiratory or ventilatory alterations, due to hereditary causes, accidents or sequelae of other previous surgeries.
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What aspects of the nose can be corrected with rhinoplasty?
- The size of the nose in relation to the rest of the facial structures.
- The width of the nasal bridge.
- The size and position of the nostrils, (either because they are excessively large, wide, asymmetrical, or malpositioned).
- The nasal profile, which sometimes instead of being straight, presents humps, irregularities, or depressions at the level of the nasal bridge.
- The tip, either because it is large, bulbous, drooping, upturned or hooked.
- Nasal asymmetries. It is important to keep in mind that any person’s face presents a certain degree of asymmetry, and that the results may not achieve perfect symmetry, although a harmonious and proportionate result is always achievable.
Deviated nasal septum and rhinoplasty
On many occasions, rhinoplasty is more than a cosmetic surgery that improves the appearance of our nose as it achieves functional functional improvements. Rhinoplasty improves airway obstructionseither by rectifying the nasal septum, treating turbinate hypertrophy, etc.
When rhinoplasty is performed to improve an airway obstruction, the nasal structures that will influence both airflow and ventilation must be carefully evaluated. Generally, a deviation of the nasal septum, constitutes one of the most common causes of respiratory alteration, and its correction is achieved by adjusting the different nasal structures to achieve a better alignment.Its correction is achieved by adjusting the different nasal structures until a better alignment is achieved.
The surgical procedure in a nose job
Rhinoplasty surgery includes the following steps:
Anesthesia
Anesthetic medication is administered to maintain the patient's well-being during the surgical procedure. Options include intravenous sedation or general anesthesia. The surgeon will recommend the best option for your specific case.
Incision
Rhinoplasty can be performed using the closed procedure (incisions are hidden inside the nose) or the open procedure (an incision is made through the columella, the thin band of tissue that separates the two nostrils). Through these incisions, the soft tissues that cover the nose are gently separated, allowing access to the structural elements of the nose that will be the target of our reshaping.
Remodeling of the nasal structure.
Depending on the particular case, reduction or augmentation of nasal structures may be required. In a larger than usual nose, reduction maneuvers will be performed by removing bone or cartilage from the structure, while in the opposite case, augmentation techniques may be needed by adding cartilage grafts from other parts of the body. In general, the cartilage comes from the septum or nasal septum, although sometimes it may be necessary to take cartilage from the ear, or more rarely costal cartilage. On the other hand, it may be necessary to perform small fractures in the nasal bones (external osteotomies) in order to reduce the width at the level of the nasal bridge. Sometimes it is necessary to place a support at the level of the columella (cartilage post or strut), and sometimes it is necessary to place two cartilages parallel to the septum to keep the internal valve open in spite of the healing process (spreader graft).
Correction of septal deviation
If the septum is deviated, it can be straightened, thus reducing projections into the nose to improve breathing.
Incision closure
Once the underlying structures of the nose are reshaped to the desired shape, the skin and nasal tissues are rearranged, and the incisions are closed. Additional incisions can be made at the level of the natural ridges above the alars to modify the size of the nostrils.
Postoperative splint
At the end of the operation, a gauze packing and a thermoplastic splint are placed to maintain and support the new nasal structure while the tissues begin to heal. The tamponade is maintained for 48 hours, and the splint for 1-2 weeks.
At Dr. Villaverde we will help you define the best changes for your nasal profile, so that the rhinoplasty results are satisfactory and natural. During your first consultation with Dr. Villaverde we will discuss:
- Surgical goals, expectations and desired outcome.
- Medical history, diseases and allergies, both to medications and other components.
- The use of medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
- Previous surgeries.
- The patient’s general health status and existing risk factors will be evaluated.
- Photographs will be taken for the clinical history.
- Facial anthropometric examination and relationship between the different structures.
- The different rhinoplasty options or techniques will be analyzed, and a treatment will be recommended to achieve the patient’s goals.
- Other surgical and non-surgical alternatives will also be discussed, as well as the expected results of rhinoplasty, and the potential risks and complications.
It is important that in the first consultation with Dr. Villaverde you ask questions about any doubts that may have arisen. We recommend that you prepare a list of questions and bring it with you to the consultation.. Understanding all aspects of the procedure is essential for a successful rhinoplasty.
Rhinoplasty preoperative
In preparation for nasal reshaping surgery, or rhinoplasty, they may be necessary:
- Perform a laboratory test or medical evaluation.
- Stop taking certain medications or adjust your current medications.
- Smoking cessation.
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements, as they may increase the risk of bleeding.
You will receive specific instructions about:
- What to do the night before and the morning of surgery; the type of anesthesia used during rhinoplasty, postoperative care and follow-up.
- The place where the intervention is performed.
- It is recommended that someone accompany you to the procedure, stay with you the first night after the procedure and drive you home, as you will not be able to drive.
Rhinoplasty postoperative period
Although the initial swelling subsides within a few weeks, the reabsorption of all the edema and the healing of the nasal tissues take months or even a year, which is why sometimes the definitive nasal contour and shape will not be visible until one year postoperatively. During this period there are gradual changes in the appearance of the nose, until a more permanent result takes shape; the swelling may be fluctuating and even worse in the morning. This process will also be marked by the patient’s characteristics, depending on whether the patient has thin skin (in which less fluid or edema will accumulate) or thick skin (in which a large amount of fluid accumulates and the changes will take longer to be observed). Once the one-year period has passed, the results are almost always permanent, although on rare occasions, the cartilage may continue to change shape and alter the surrounding tissues, affecting the final result over time.
During the immediate postoperative period you will be explained how to take care of the operated area, the treatment and indications to follow, what factors you should take into account in relation to the operated area and in relation to your health in general, and when to return to the office for revision and the following visits. Once back home, if you experience any abnormal symptoms (severe pain, fever, breathing difficulties, extreme tiredness, unusual heartbeat or chest pain), contact your surgeon immediately.
It is important to follow the surgeon’s instructions at all times regarding the care of your surgical wounds; this is the key to the success of the operation. The incisions made should not be exposed to excessive forces, pulling, abrasions or movements during the healing period in order to promote the most favorable healing possible and avoid alterations at this level.
Normally you will have to wear a nasal splint for 1-2 weeks, depending on the type of rhinoplasty and intervention the surgeon will recommend one management or another specifically. In the case of nasal packing, it is usually removed in 1-2 days, and in the case of stitches it is usually removed in 5-7 days.
Normal life activities can be resumed in 1-2 weeks, also depending on the technique used and the individual needs of each patient.
Candidates for rhinoplasty
In general, a good candidate for this surgery is one who:
- He is in good physical health.
- He wishes to improve the shape of his nose as it causes him discomfort and concern.
- Has realistic expectations of what can be achieved with the intervention.
- He does not smoke or at least will stop smoking when instructed to do so by the surgeon.
- The growth of his face and facial structures has been completed.
Rhinoplasty, as well as any other cosmetic surgery procedure, is a personal choice, so the person who is thinking of undergoing this intervention, must make the decision for himself, not to satisfy the desires of another person, or to try to adapt to a stereotype of ideal image. It is the person himself who has to assess whether the benefits to be achieved match his expectations, as well as to know the risks and possible complications of rhinoplasty.
Rhinoplasty risks and safety information.
The decision to undergo cosmetic surgery is an extremely personal one. Each person must decide whether the expected benefits meet his or her expectations, and whether the risks and potential complications are acceptable. The plastic surgeon will explain in detail the risks associated with the surgery, and the patient will be asked to sign an informed consent form to ensure that he or she fully understands the procedure and any potential risks or complications.
Among the risks of rhinoplasty are the following: risk of anesthetic complications, bleeding or hematoma due to rupture of small vessels of the nose, infection, abnormalities in healing, surgical wound dehiscence, alterations in sensitivity (pain, numbness…..), perforation of the nasal septum (although this is a rare complication, it is possible, and would require a new surgical intervention to repair the septum, although sometimes the defect is permanent), alterations in breathing, an unsatisfactory nasal appearance, nasal asymmetry, swelling, nasal edema and alterations in coloration, irregularities in the contour of the skin, extrusion of sutures through the skin in such a way that they are visible or cause irritation, possibility of revision surgery. In surgeries of a long duration, cardiac and/or pulmonary complications could arise, which could be due to the formation of blood clots in the venous system (venous thrombosis).
All these risks must be discussed before signing the informed consent, so it is important that the patient asks the plastic surgeon all the questions he/she deems necessary.
The practice of medicine and surgery is not an exact science, since even if good results are anticipated, there are no guarantees. In some cases, it is not possible to obtain optimal results with a single surgery and another intervention may be required to achieve the desired aesthetic result.
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