Rhinoplasty Rhinoplasty surgery, which involves reshaping the nose and giving it an aesthetic appearance, is one of the most commonly performed surgeries. In addition, some people turn to the solution of their nasal problem for rhinoplasty. Performing nose surgery by an experienced doctor can certainly guarantee excellent results. The preoperative and postoperative care as well […]
Rhinoplasty surgery, which involves reshaping the nose and giving it an aesthetic appearance, is one of the most commonly performed surgeries. In addition, some people turn to the solution of their nasal problem for rhinoplasty.
Performing nose surgery by an experienced doctor can certainly guarantee excellent results. The preoperative and postoperative care as well as the surgical success of the surgeon are the main factors for the result. The exact result is usually seen after one year, but sometimes it can only be seen after a few years. Prolongation of this time depends mainly on personal factors, but is mainly dependent on the thickness of the nasal tip skin and the factors responsible for nasal endprojection.
Rhinoplasty surgery is not just an aesthetic operation.
The nose is a functional organ.
It has functions such as breathing, purifying and humidifying the air. Rhinoplasty surgery is also an operation with functional features. In rhinoplasty, both the bone and the cartilage structure are reshaped, the structures that are too large are reduced, the missing or collapsed structures are widened or enlarged by additional tissue. In the meantime, the structures narrowing the respiratory tract, in particular the septum deviations (curvatures) and septal deficiency or wing sediments, are being corrected.
The nose contains many tissues. In addition to skin and subcutaneous tissue, there are problems such as bone, cartilage, muscle, connective tissue and lining. A red-pink moist texture lining that lines the inner face of the nose is called mucous membrane. The inside of the nasal cavity, the septum and the mucous membrane covering the glands are sometimes different. At the level of the nostrils there are bristles in the section which is about 1 cm wide from the outward opening. The nasal skeleton consists of cartilage tissue in the lower half of the bone.
The nose structure is complex and consists of the skeleton, the supporting structure and the soft tissue cover. The soft tissue covering the underlying roof contains fascia and subcutaneous tissue and skin.
The skin may be thin or thick, light or dark. Those that are darker are usually thicker and have subcutaneous tissue. Thicker skin is more difficult and less adaptable at the bottom. The thickness of the skin varies in different parts of the nose.
The skin and subcutaneous tissue are strongest in the supra type. It is thinner to the nasofrontal region and the thinner skin is present. Skin and subcutaneous tissue are the thinnest points where the nasal bone and 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, there may be a significant loss of nasal tip during facial expression. This phenomenon is due to the action of the medial cartilage at the base. This problem can be prevented if the functions of the depressive septic island are limited.
STANDARD LABORATORY AND RADIOLOGICAL STUDIES
Sinus radiography or sinus and nasal cavity tomography examination is performed when the patient has a respiratory complaint. Possible septum deviations, turbines and sinus cavities are evaluated.
If the patient has respiratory problems, the intranasal examination, septum, and turbinates are examined, and if necessary, rhinomanometry may be required. Nasal structures are displayed directly with the best individual system. After these stages, the general state of health of the patient is checked. Pre-existing conditions, blood pressure, diabetes, smoking and drug allergies are questioned.
The first procedure of aesthetic nose surgery is a detailed interview with the patient. After completion of facial development, esthetic nasal surgery is usually performed at the age of 18 years. In some special cases this limit can be changed. First, the wishes of the patient are heard. Then a nasal examination is performed. After evaluation of nasal airway and septum examination, the contribution of nasal tuberosity, bone and cartilage structures to deformity is contributed. The skeletal and soft tissues of previous strokes are evaluated. Detailed information about the previous operations will be taken over. Before going into details of the nasal structure, the patient’s facial features are evaluated and the fit or mismatch of the nose is examined.
When the patient is in touch, operation requirements are determined and compared with the patient’s wishes. A computer can be used to identify patient requests and facilitate operation planning. Studies on the computer can be meaningful to the surgical plan and site, but are never guaranteed. This should be explained to the patient before this procedure. If the patient has breathing problems, all procedures to be performed and the possible outcome are explained and the operation is determined.
RINOPLASTIC SURGERY: SURGICAL TECHNIQUE
Dies geschieht mit Techniken, die als offene oder geschlossene Methoden bezeichnet werden. Bei der Nahmethode tritt nach der Operation keine sichtbare Narbe auf.
It is best to correct the secondary deformities and complications that may develop after surgery, at one and one year and by the same surgeon.
The rhinoplasty can be performed under general or local anesthesia. General anesthesia is preferred, but some surgeons prefer local anesthesia with sedation.
Postoperative care: Early and late phases
The patient is monitored for 5 days.
Blood from the nostrils and retro pharynx may bleed from the back. This bleeding usually does not last longer than 12-24 hours. During the postoperative period, bleeding, hematomas and edema controls are performed by applying ice to the nose and eyelids. After 4-5 hours, intermittent ice application is sufficient. Keeping your head high will limit the edema. In the first 36 to 48 hours, the edema reaches its maximum level, whereupon the swelling descend. Buffers are consumed between 12 and 48 hours, depending on the situation.
The tears occur for 2 days. Bruises around the eye occur during this time and will go back at the end of the second to third week. Nose and facial edema occur in the first 3 weeks to 60-70% and in the first two months to about 80%. It takes about 1 year for the remaining edema to be withdrawn and the nasal shape to be complete. During this time, sometimes massages and physiotherapy can be performed to accelerate the ointment and protect the nose. All patients should protect their noses from sunlight for at least 2 months. Swelling and hyperpigmentation of the nose skin may occur.
Infections do not require the routine use of antibiotics in routine rhinoplasty. If the buffers remain for more than half a day or if alloplastic material or cartilage graft is used, antibiotics are administered. If the patient has heart valve disease, facial acne, or folliculitis around the nose, antibiotics are used.
The most common complication after nasal surgery is nosebleeds. The incidence of this is parallel to the extension of the operating time.
POSSIBLE EARLY COMPLICATIONS TO RHINOPLASTY
Back swelling, nasal membrane edema and changes in the nasal tip skin are quite common in the early stages.
The bruising around the nose and around the eyes lasts 10 to 15 days after surgery. It is a common complication that has rarely been seen for several months.
Nasal swelling is very common in the first month after surgery. This is more common in patients with allergic rhinitis or vasomotor disease.
Dryness of the nasal mucosa occurs very frequently after rhinoplasty. Especially in winter, when the humidity in the room is low or in dry conditions, this is more common. Therefore, all patients should receive a moisturizing solution after the operation (physiological drops such as serum, Steri-Mar spray, Tonimer gel).
Haematomas Postoperative haematomas (bleeding into the nasal tissue) are rare.
An infection after a rhinoplasty can sometimes be seen in several ways. The most common form of infection is the subcutaneous tissue and vestibulitis that holds the mucosa. This infection will be treated in a short time with sensitive antibiotics against streptococci.
The 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. An intensive IV fluid replacement and beta-lactamase antibiotic IV are given.
A graft infection, rejection or possible extrusion can be seen within the first week after surgery. Sometimes it can be seen years after surgery.
Epistaxis: This complication has decreased significantly in recent years. If the bleeding site is seen directly, it is destroyed with silver nitrate or electrocautery. Clot formation is stimulated by a nasal buffer containing a biodegradable hemostatic material.
Mucoperikondrium defects may develop as a result of a tear of the mucosa during surgery. If the fracture is unilateral, this does not usually result in a perforation fracture site. If the mucoccerondrial rupture is bilateral, perforation of the septum may occur. These postoperative perforations can be treated with intranasal moisturization.
Injuries to the lacrimal system are very rare. In the case of injuries, this usually takes a short time and does not cause any serious side effects.
It is quite common that the olfactory sensation is altered or even completes the odor. The olfactory area is not directly damaged by nasal surgery. The risk of surgery in the septum is higher. Mucosal edema, stuffy nose, blood clots, drug reactions can lead to temporary loss of odor.
Depressive reaction: The most serious complication is seen in a patient who does not like the appearance of rhinoplasty: depressive reaction and rejection. To avoid this problem, the patient’s expectations and surgeon’s outcomes regarding the patient’s appearance problem should be thoroughly discussed. This problem can manifest itself as soon as the bandages are opened. The patient can not be persuaded by his friends or surgeons, even if the result is successful. These patients are not ready to change the face of their personal image. Such patients require psychiatric support and must be treated in the preoperative phase. To solve this problem, surgeon, patient and psychiatrist should work together. In addition, it should be kept in mind that it takes time for each patient to get a new nose shape after surgery.
POSSIBLE COMPLICATIONS TO RHINOPLASTY
Supratip deformity (poly-beak-deformity): is one of the most common complications after rhinoplasty. Supra-type deformity is a deformity that manifests itself at the weakest point where the hard and soft hump meets the tip of the nose. Even in the most experienced hands, an error can occur that can not be calculated.
Saddle nose deformation: One of the most common nose deformities. It may be innate or acquired, or possibly syphilitic or traumatic. The most common reason is the loss of septum support.
Stenosis of the nostrils, respiratory insufficiency Problems: As a rule, the nasal cavity is sufficiently free and wide, but both vestibuli are tight and cause respiratory distress. It is very difficult to correct the vestibular constrictions after surgery. In case of insufficient adjustments, it falls back immediately.
Twisting the Nasal Ridge: Recurrence and twisting of the nasal bridge and upper structures after surgery is one of the most common complications and occurs after the operations of the extremely curved nose.
Dissatisfied with the patient: The surgery is performed with the correct indication and technique, and the patient can not be satisfied, even if the surgeon’s result is successful. One of the main reasons for the patient’s lack of satisfaction is that he does not fully understand the patient’s expectations and the purpose of the patient in the preoperative interview. For this reason, it is essential to photograph patients before surgery.