Rhinoplasty Rhinoplasty surgery, which means reshaping of the nose and giving an aesthetic appearance, is one of the most frequently performed surgeries. Also, some people for solving their nose problem apply for rhinoplasty. Having done the nose surgery by well experienced doctor can certainly guarantee an excellent result. The preoperative and postoperative caring and the […]
Rhinoplasty surgery, which means reshaping of the nose and giving an aesthetic appearance, is one of the most frequently performed surgeries. Also, some people for solving their nose problem apply for rhinoplasty.
Having done the nose surgery by well experienced doctor can certainly guarantee an excellent result. The preoperative and postoperative caring and the surgical success of the surgeon are the main factors on the outcome. The exact result is usually seen after one year, but sometimes it may not occur until a few years. The prolongation of this time depends mainly on personal factors but mainly depends on the thickness of the nasal tip skin and the factors that provide the nose-end projection.
Rhinoplasty surgery is not just an aesthetic surgery. The nose is a functional organ. It has functions such as breathing, cleaning and humidifying the air. Rhinoplasty surgery is also an operation with functional features. In rhinoplasty surgery, both the bone and the cartilage structure are reshaped, the structures that are too large are reduced, the structures that are missing or collapsed are expanded or enlarged by additional tissues. In the meantime, the structures that narrow the airway, especially the septum deviations (curvatures), and septum deficiencies or wing sediments are also corrected.
The nose contains many tissues. In addition to skin and subcutaneous tissue, there are issues such as bone, cartilage, muscle, connective tissue and inner lining. A red-pink moist texture mucosa that lining the inner face of the nose is called a mucosa. The inner side of the nasal cavity, septum and the mucosa covering the glands differ in part. At the level of the nostrils, there are bristles in the section about 1 cm wide inwards from the outward opening. The nasal skeleton consists of cartilage tissue in the lower half of the bone.
Nose structure is complex and consists of the skeleton, support structure, and soft tissue cover. In the soft tissue that covers the underlying roof, there are fascia and muscles with subcutaneous tissue as well as skin.
The skin may be thin or thick, light or dark. Those who are darker are usually thicker and have a subcutaneous tissue. Thicker skin is more difficult and less adaptable to changes at the bottom.
The thickness of the skin varies in different parts of the nose. The skin and subcutaneous tissue are the thickest in the supra type region. It is thinner towards the nasofrontal region and the thinner skin is present. Skin and subcutaneous tissue is the thinnest location where the nasal bone and the lateral cartilage meet.
There are three muscles in the nose related to rhinoplasty.
The most important of them is the depressor sept. If the muscle is hyperactive, it may cause a marked nasal tip loss during facial expressions. This appearance is due to the effect of the medial cartilage at the base. This problem can be prevented if the depressive septic island functions are restricted.
STANDARD LABORATORY AND RADIOLOGICAL EXAMINATIONS
Paranasal sinus radiography or paranasal sinuses and nasal cavity tomographic examination are performed if the patient has a complaint about the respiratory tract. Possible septum deviations, turbinates, and sinus cavities are evaluated.
If the patient has respiratory problems, intranasal examination, septum and turbinates are evaluated and rhinomanometry may be required if necessary. Nasal structures are displayed directly with the best individual system. After these stages, the general health status of the patient is reviewed. Previous illnesses, blood pressure, diabetes, smoking, and drug allergies are questioned.
The first procedure of aesthetic nose surgery is a comprehensive interview with the patient. Aesthetic nose surgery is usually performed at the age of 18 after the development of the face is completed. In some special cases, this limit can be changed. First, the patient’s wishes are heard. A nose examination is then performed. Evaluation of the nasal airways and septum examination are followed by the contribution of the nose hump, bone and cartilage structures to the deformity. The skeletal and soft tissues of past strokes damage are evaluated. Detailed information about previous surgeries are taken. Before going into the details of the nose structure, the patient facial structures are evaluated and the fit or non-conformity of the nose is examined.
When the patient is in contact, operation requests are determined and compared with the patient’s wishes. A computer can be used to help determine patient requests and help with surgical planning. Studies on the computer may be informative for the operation plan and the post, but it never guarantees it. This should be explained to the patient before this procedure. If the patient has respiratory problems, all the procedures to be performed and the possible outcome are explained and the operation is decided.
RINOPLASTY SURGERY: SURGICAL TECHNIQUE
It is done by techniques called open or closed methods. In close method there will not be any visible scar after the surgery.
It is best to correct the secondary deformities and complications that may develop after the surgery by one and a year and by the same surgeon.
Rhinoplasty can be performed under general or local anaesthesia. General anaesthesia is preferred but some surgeons prefer local anaesthesia with sedation.
Postoperative Care: Early and Late Period
The patient is kept under observation for 5 days. Blood from the nostrils and retro pharynx may be bleeding from the back. This bleeding normally takes no more than 12-24 hours. During the postoperative period, bleeding, hematoma and oedema control are performed by applying ice on the nose and eyelids. After the operation 4-5 hours, intermittent ice application is sufficient. Keeping the head elevated, makes the oedema to be limited. In the first 36-48 hours, the oedema reaches its maximum level, after which the swellings begin to descend. Depending on the situation, buffers are taken between 12-48 hours.
Eye tears will continue for 2 days. Bruising around the eye occurs during this period and will eventually regress at the end of the second-third week. 60-70% of the nose, nose and face oedema occur in the first 3 weeks, and approximately 80% in the first 2 months. It takes about 1 year for the withdrawal of the remaining oedema and the full shape of the nose. During this period, sometimes massage and physiotherapy can be done to accelerate the stroke of the oedema and to protect the nose. All patients should protect their noses from sunlight for at least 2 months. Swelling and nasal skin hyperpigmentation may occur.
No routine use of antibiotics in routine rhinoplasty is necessary for infection. If the buffers are left for more than half a day or if alloplastic material or cartilage graft is placed, antibiotics are administered. If the patient has cardiac valve disease, acne on the face or folliculitis around the nose, antibiotics are used.
The most common complication after nasal surgery is epistaxis. The incidence of this is parallel to the prolongation of the operation time.
POSSIBLE EARLY COMPLICATIONS AFTER RHINOPLASTY
Dorsal swelling, nasal skin oedema and changes in the nasal tip skin are quite common in the early period.
The bruise around the nose and around the eyes continues for the first 10 to 15 days after surgery. It is a common complication rarely seen for a few months.
Nasal mucosal swelling is very common in the first month after surgery. This is more common in patients with allergic rhinitis or vasomotor disease.
Nasal mucosa dryness is very common after rhinoplasty. Especially in winter, when the indoor humidity is low or in dry environmental conditions, it is more common. Therefore, all patients should be given moisturizing solution after the surgery (physiological drops such as Serum, Steri-Mar spray, Tonimer gel).
Hematoma Postoperative hematoma (bleeding into the nasal tissues) is a rare occurrence.
Infection after rhinoplasty can sometimes be seen in different ways. The most common form of infection is the subcutaneous tissues and the vestibulitis that holds the mucosa. This infection is treated in a short time with sensitive antibiotics against streptococci.
Toxic shock syndrome is a potentially fatal complication. It starts with high fever and fatigue in the postoperative period. At the beginning of the treatment, the resulting buffers are removed. Intensive IV fluid replacement and Beta-lactamase antibiotic IV are given.
Graft infection, rejection or possible extrusion may be seen within the first week after surgery. Sometimes it can be seen years after surgery.
Epistaxis: This complication has decreased considerably in recent years. If the bleeding site is seen directly, it is cauterized with silver nitrate or electrocautery. Clot formation is stimulated by a nasal buffer with a biodegradable hemostatic material.
Mucoperikondrium defects may develop as a result of rupture of the mucosa during surgery. As a general rule, if the rupture is unilateral, it does not result in rupture perforation. If the mucoccerondrial rupture is bilateral, septum perforation may occur. These post-operative perforations can be treated with intranasal humidification.
Lacrimal system injury is very rare. If there is injury, this usually takes a short time and does not leave serious side effect.
It is quite common for the olfactory sensation to be altered or even to complete smell. The olfactory region is not directly damaged by nose surgery. The risk of interventions in the septum is higher. Mucosal oedema, nasal congestion caused by blood clots, drug reactions can cause temporary smell power loss.
Depressive reaction: The most serious complication is seen in a patient who does not like the appearance change after rhinoplasty surgery is depressive reaction and rejection. To avoid this problem, the patient’s expectations and the findings of the surgeon on the appearance problem in the patient should be discussed thoroughly. This problem can manifest itself as soon as the dressings are opened. The patient cannot be convinced by his friends or surgeons, even if the result is successful. These patients are not willing to change the face of their personal image. Such patients need psychiatric support and need to do treatment in the preoperative period. In order to solve this problem, the surgeon, patient and psychiatrist should work together. In addition, it should be kept in mind that it will take time for each patient to have a new nasal shape after surgery.
POSSIBLE COMPLICATIONS AFTER RHINOPLASTY
Supratip deformity (poly beak deformity): Is one of the most common complications after rhinoplasty surgery. Supra type deformity is a deformity that manifests itself at the weakest point where the hard and soft hump at the tip of the nose meets. Even in the most experienced hands, an error that cannot be calculated can result.
Saddle nose deformity: One of the most common nasal deformities. It may be congenital or acquired, or maybe syphilitic, or traumatic. The most common reason is the loss of septal support.
Stenosis of the nostrils, Airway insufficiency Problems: As a rule, the nasal cavity is sufficiently free and wide but both vestibules are narrow, thus causing respiratory distress. It is very difficult to correct vestibular strictures after surgery. It immediately relapses after inadequate adjustments.
Re-twisting the dorsum of the nose: Recurrence and skewing of the nasal dorsum and upper structures after surgery is one of the most common complications and occurs after the operations of the extremely curved noses.
Unsatisfied with the patient: The operation is performed with the correct indication and technique, and the patient may not please even if the result is successful by the surgeon. One of the most important reasons for the lack of satisfaction of the patient is the failure to fully understand the patient’s expectations and the purpose of the patient in the pre-operative interview. For this reason, it is essential to take pre-operative photographs of the patients.