What is a nose surgery?
Rhinoplasty or nose aesthetic surgery is an intervention to restore the harmony of the nose and balance the proportions of the face to give it the desired morphology by remodeling the different structures that give shape to the nose.
- The goal is to get a natural looking nose, suitable for the patient's psychology and personality, while meeting their demands.
- The idea is to reshape the bone and cartilage that form the solid infrastructure of the nose and give it its particular shape. The skin covering the nose will be rehabilitated and redraped through its elasticity. This last point highlights the importance of the quality of the skin in obtaining the final result.
- If there is a nasal obstruction that affects the patient's breathing, it will be treated during the same operation, whether due to a deviated septum, turbinate hypertrophy (formations present in the nasal cavity), or a nasal valve problem.
- Other abnormalities in the position of cartilage may alter respiration and are corrected during the procedure.
- All these abnormalities should be identified during the examination of the nose at the consultation.
- Indeed, if they are not detected before and treated during the operation, the anomalies at risk for respiratory difficulty may decompensate after surgery and create significant difficulty breathing!
- It may be useful in some cases to associate a chin surgery (genioplasty) or forehead surgery (lipofilling) in order to rebalance the proportions of the nose with those of the face. This is called profiloplasty.
Good to know
Regarding the surgeon, he or she must be particularly well trained in rhinoplasty including in all the latest advances in rhinoplasty.
In fact, rhinoplasty remains the most delicate operations in cosmetic surgery, which requires excellent training to achieve the desired results. Many of the defaults that appear after a rhinoplasty result from an imperfect analysis of the nose before the operation or use of ancient techniques that generate their own set of imperfections. The peculiarity of rhinoplasty is that these defects can not be hidden! It is therefore absolutely critical to well choose your surgeon before rhinoplasty.
Regarding the skin, you should know that very thick skin does not provide all the desired finesse to showcase new landmarks of the modified nose. Conversely, thin skin allows a perfect definition of the operated nose, however any surface irregularity will be visible, and camouflage preventive methods are sometimes used.
Regarding cartilage, an analysis of their quality is important both before the operation and during the operation: the techniques to modify the shape of the nose must take into account this factor to avoid creating distortion.
Why have nose surgery?
- The nose is the first thing we see on a face. It is the keystone around which the whole harmony of the face revolves. If a nose is too big or too small, has a pronounced hump, a tip that is too large, a deviation of the nose, etc... it breaks that harmony and draws attention to the nose rather than to the rest of the face.
- The nose is involved in respiration, and deformation therefore can cause respiratory problems, sinusitis, and other functional disorders that can affect breathing.
There are different types of rhinoplasties : it is essential to analyze the characteristics of each nose, then the desires of each patient and finally lead to a common therapeutic project using computer simulations.
The most common requests in primary rhinoplasty include:
- The bumps on the back of the nose
- Tips that are too large
- Drooping tips
- Tips lacking finesse
- A nose that is too prominent
- A nose that is too wide
- Deviated or crooked nose
It is best to wait until the end of growth before performing rhinoplasty or usually be at least 15-16 years old. However, it is also important to ensure the psychological maturity of young patients who want rhinoplasty.
What happens during a consultation?
An aesthetic and functional analysis of the nose is a mandatory prerequisite to any rhinoplasty surgery.
- During a consultation, the doctor verifies if there are any respiratory problems. Additional tests are sometimes prescribed. The interior of the nose is examined to find any elements that may cause difficulty breathing (nasal septum deviation, hypertrophy of a turbinate, dysfunction of the nasal valves ...)
- Digital photos are taken and each part of the nose and face (forehead, chin ...) is analyzed to determine the improvements or the desired changes.
- Then computer simulations are performed in order to achieve a common project in line with the patient's wishes, tissue constraints and their facial harmony. These simulations represent a tool for dialogue between the patient and the surgeon.
- It will be determined whether it is necessary to simultaneously perform genioplasty (forward, back, chin augmentation), or forehead surgery.
- The most suitable type of rhinoplasty is then determined
Chronologically, based on the case, both a rhinoplasty and genioplasty are performed at the same operation, or we perform chin surgery at first (especially when orthodontic treatment is required).
What happens during a nose surgery?
- Duration of the operation: An hour and a half to 3 hours.
- Duration of hospitalization: 1 day and 1 night. Hospitalization takes place on the morning of surgery while fasting and in some cases the night before.
- Type of anesthesia: most of the time general, or local potentialized
- Preparations before surgery: Certain medications should not be taken during the 10 days prior to the surgery: aspirin, anti-inflammatory, anti-coagulants, etc…
- End of the operation: A splint made of resin is generally placed on the nose at end of the procedure: it must be kept for six days. Dr. Gerbault and Dr Makhoul use a suturing technique of the nasal mucosa, which eliminates the need for nasal packing. So there is usually no nasal packing after rhinoplasty. In some cases, however, including some secondary rhinoplasty, silicone splints are put in the end of the procedure: they are usually removed during the inspection after days.
What happens following a rhinoplasty?
- The intervention is almost always painless. In very exceptional cases of pain, analgesics are then given to relieve the pain.
- Sometimes there is bruising and swelling around the nose and eyelids that decrease quickly. The use of ultrasonic rhinosculpture technique significantly reduces blue bruises after surgery.
- The first few days, it is best to sleep with your head elevated to reduce the swelling. Cold wet compresses should be placed on the eyelids on the first night to limit postoperative edema. Specific drugs are given after surgery to minimize postoperative swelling, and specific compressive bandages are used at night in the following 3 months.
- The stitches and the splint are removed 6 days after the surgery.
- A certain respiratory discomfort due to the edema of the nasal mucosa may occure during the month following the operation: nasal sprays reduce this discomfort. It is necessary to clean the nose with cotton swabs during the first few days to avoid the risk of bleeding due to the pressure from nose blowing.
- It is better to return to work after the removal of the splint, ie after a week of rest. Usually, a 7 day work stoppage is prescribed.
- Intense efforts should be avoided during the month following the intervention.
- Wearing glasses is not recommended during the six weeks following the operation in case of osteotomies unless the support of glasses on the nasal pyramid is avoided by different methods.
- However, with the advent of ultrasound rhinosculpture, it is increasingly unnecessary to fracture the bones to narrow the nasal pyramid: thus, the glasses can then be delivered the day after the operation.
The risks of rhinoplasty
We must distinguish the complications related to surgery and those related to anesthesia.
In regards to the surgical procedure:
Choosing a qualified plastic surgeon limits these risks to the maximum, but does not remove them completely. In practice, the vast majority of operations go without any problems and patients are fully satisfied with their result. However, despite their rarity, you should be aware of possible complications:
- Bleeding from the nose the early hours is possible but usually remain very moderate. Exceptionnaly, a nasal packing may be used to stop the bleeding.
- An infection is exceptional despite the natural presence of germs in the nasal cavity. It may require the prescription of antibiotics.
- A result that does not correspond to the desired nose is a risk that must be reduced to the minimum by careful preoperative consultations, including thorough computer simulations before surgery.
- Persistent respiratory discomfort after the procedure should be avoided by a pre-operative screening for all malposition of internal nasal structures that must be corrected during the operation.
In regards to anesthesia:
During the consultation, the anesthetist informs the patient of the risks of anesthesia. You should know that technical anesthetics and monitoring methods have improved immensely over the last twenty years, providing optimum safety.
The scars of a rhinoplasty
The scars of a rhinoplasty are barely visible.
- Most of the time they are tiny and located on the columella (space between the two nostrils).
- In certain cases the scars are located inside the nose.
- Dans quelques cas où les ailes du nez sont épatées, elles se situent également dans le creux situé autour de l’aile du nez.
- They can also be located behind the ear, in the crease under the breast or in the chest, in the scalp, when grafts are needed.
This is very rare in primary rhinoplasty, but more frequent in secondary rhinoplasty.
After rhinoplasty surgery
- The final shape of the nose can not be judged until after 3 months for the upper part of the nose, 6 months for the middle portion and 12 months for the tip and base of the nose. Thus, the final appearance cannot be determined until a year or more in case of thick skin.
- Immediately after the removal of the plaster, the nose remains very swollen and its form will not correspond to the final result, even if significant changes are already noticed.
- When ultrasonic rhinosculpture is used, the postoperative course is simple and quick: the result after removing the splint is closer to the final result.
- The results of the intervention persist "for life"; since it acts on the osteochondral architecture of the nose that is reshaped to the desired shape. However, the facial aging is also active in the nose, and with time, the shape of the nose may change a little, as is the case with non-operated subjects.