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RHINOPLASTY (NOSE JOB)

ρινοπλαστικη


The nose plays an important role when it comes to the face’s aesthetic appeal, being one of its central features. As such, improving the shape of the nose can go a long way to towards improving the aesthetic appeal of the face as a whole. Often, an improved nose can create the impression that the entire face has been improved.

Rhinoplasty (otherwise known as a nose job) is a procedure that aims at improving the nose’s shape and aesthetically reviving it. This is an entirely cosmetic procedure, rather than functional. If the nose is not functioning properly, it is recommended the patient undergo septoplasty, which can be performed in tandem with rhinoplasty.

Septoplasty focuses on repairing the outer features of the nose, in order to facilitate a smooth flow of air through it, and allow for easier breathing.

ALL NOSES SHOULD NOT BE THE SAME

The operations a plastic surgeon may be perform upon the bones of the nose may differ greatly from patient to patient, as no nose is exactly the same as any other. Perhaps there is no other type of operation that is affected to such a degree by individualization.

The plastic surgeon will have to study the existing problems carefully and decide on a solution that fits those problems exactly. Otherwise, there is a serious danger of verifying the frequently heard accusation that all noses constructed by a plastic surgeon are identical. Even worse, the surgeon may produce a nose where it is evident that it has been operated upon.

Before the operation, the plastic surgeon should explain the entire procedure to the patient, and, using a computer, show them the estimated result following the operation.






The computer’s aid (Computer Imaging in Rhinoplasty) is essential in this case, in order for the surgeon to better comprehend the patient’s wishes, and for the patient to understand what the surgeon can offer.

It is very important for you to have decided upon exactly what it is you desire for your nose, and to ask your plastic surgeon to show you the estimated result on the computer. Of course, the computer itself has no surgical knowledge and cannot take the particulars of each patient into account. Therefore, the simulation you will see will not be exactly the same as the results of the operation, but a very close approximation.

HOW RHINOPLASTY IS PERFORMED

Rhinoplasty involves the plastic surgeon repairing the nose’s underlying structure, which is mainly composed of cartilage and bone. These materials are balanced in a fairly complex construction which gives the nose its three-dimensional shape.

As the balance between materials is quite fragile, the rhinoplastician will have to be very familiar with the nose’s anatomy, its functions, and also how to alter the balance between its materials in order to achieve the aesthetic result he or she is aiming for.






The operation is usually performed within the nostrils, and in most cases does not require external incisions. Even in the event that external incisions are required, these tend to be placed very discreetly, and as such do not pose a cosmetic problem.

After the nose’s structure has been amended, some sutures are made upon the incisions within the nostrils. The underlying structure is then covered with skin, which naturally follows the new shape of the structure.




Afterwards, the surgeon places a few small strips of gauze inside the nostrils, and places a splint over the nose. The splint will hold the nose steady while it heals and settles into its new shape and position. The gauze can usually be removed from the nostrils after two days; the splint can be removed after one week.

AFTER RHINOPLASTY

In most cases, patients are surprised to find that there is no pain following a rhinoplasty. After the procedure there will be some bruising around this eyes which, while they do not impair vision, are a cosmetic problem. In theory, a rhinoplasty patient should be able to return to work and generally return to their daily activities on the very next day. However, in most cases this is not achievable, as the patient is not quite presentable yet due to the edema and bruising around their face. These flaws tend to recede after 10-15 days. However, patients whose occupation does not require them to presentable tend to return to work on the next day. Sporting activities can be resumed after two months, unless there is a serious danger of injuring the nose, in which case it is best to postpone this for a few more months.


METHODS OF RHIMOPLASTY

There are two main methods employed in rhinoplasty worldwide. These are open and closed rhinoplasty; their naming describes the degree to which the nose is exposed during surgery.

1.    CLOSED RHINOPLASTY:
This method requires the incisions to be limited to the interior of the nostrils; the skin is then detached from the nose’s structure, and the bone and cartilage are rearranged into their new shape. This method has fairly low visibility, and the plastic surgeon will have to work mostly using touch rather than sight.

2.    OPEN RHINOPLASTY:
This method again requires incisions to be made in the nostrils, but also a smaller incision in the septum, i.e. the part of the nose located between the two nostrils. This incision, while external, will heal very well in time, and as such is very discreet to the point of being indiscernible most of the time. This method allows the plastic surgeon to expose the nose’s underlying structure to a greater degree, thus granting him or her full visibility.

COMPARING OPEN AND CLOSED RHINOPLASTY

Neither method is better or worse. Each of the two offers its pros and cons. Closed rhinoplasty has the advantage that it does not interrupt the flow of blood through the septum, for example, allowing the edema and swelling to heal quicker. Open rhinoplasty, on the other hand, offer the advantage that the plastic surgeon has a better view of the nose’s structure during surgery, and as such will be able to make the incisions and place the sutures with greater accuracy. The results of open rhinoplasty tend to be closer to the predicted outcome.


COMBINING RHINOPLASTY AND SEPTOPLASTY

Rhinoplasty can be combined with other operations. The operation it is most frequently combined with is septoplasty, which aims at improving respiration. The procedure involves the otolaryngologist straightening the nasal septum, which may have deviated into other cavities, in order to restore it to its original state, wherein respiration was unhindered. There have been cases wherein the septum has not deviated at all but still impedes respiration, due to an excess in mucosal lining, cartilage or scar tissue.

When septoplasty is performed in tandem with rhinoplasty, it does not usually require additional incisions. Both procedures are performed using the same incisions within the nostrils.







COMBINING RHINOPLASTY WITH OTHER PLASTIC SURGICAL PROCEDURES

Rhinoplasty can be combined with other plastic surgical procedures, such genioplasty (otherwise known as mentoplasty or chin augmentation), i.e. a corrective procedure upon the area of the chin. Often, a small chin may be accompanied by a hawk nose, as well as a dewlap. When these problems occur together, their simultaneous correction can yield impressive results.

In addition, rhinoplasty can be combined with any form of plastic surgery or laser operation which aims to improve the shape or general appearance of the face.

RHINOPLASTY: PLASTIC SURGEON OR OTOLARYNGOLOGIST?

Many people wonder if they should seek out a plastic surgeon or an otolaryngologist to have their nose operated upon. Since each of these specializes in a different field, the ideal solution is to have a plastic surgeon co-operate with an otolaryngologist, so that each of them can contribute in their own way (the plastic surgeon handles the cosmetic aspect, whereas the otolaryngologist handles the operational aspect of the reconstruction) towards the best possible result.

Particular care is needed when selecting a surgeon and one must always be aware that the relevant specializations officially recognized by the Ministry of Health are ‘Plastic Surgeon’ and ‘Otolaryngologist’. Specializations such as ‘facial plastic surgeon’, ‘rhinoplastic surgeon’, and various others are not officially recognized.

As the nose is an essential cosmetic feature of the face, its correction bestows an important improvement on the overall appearance of the face, and can have a very positive effect on the patient’s outlook and confidence.


AUGMENTED RHINOPLASTY

WHAT IS AUGMENTED RHINOPLASTY

Augmented rhinoplasty is a particular type of rhinoplasty that is performed upon those noses that, in order to acquire an aesthetically pleasing shape, require bulk to be added rather than removed.

It is usual when dealing with malformed noses for there to be an excess of bulk in some place, particularly the ridge (hawk nose). Every misshapen nose does not, however, necessarily require bulk to be removed in order to correct it. A misshapen nose is not necessarily a large nose.

Of course, the cases where rhinoplasty must be augmentative rather than reductive are few. However, it is important that the plastic surgeon be very familiar with augmentive rhinoplasty as well, so that he or she is able to perform it successfully where the conditions demand.

This type of operation is much more difficult than standard rhinoplasty, and requires particularly advanced knowledge of the subject. In several cases, in fact, even when dealing with reductive rhinoplasty, some features of the nose may require augmentation, and therefore the plastic surgeon will need to be able to exercise the techniques of augmented rhinoplasty even when performing a standard rhinoplasty to reduce the bulk of the nose.

Precisely because augmented rhinoplasty requires a much more complete knowledge of the subject, a trend can be noticed in several cases wherein, when dealing with a small nose that also happens to be misshapen, in order to correct an irregularity, additional bulk is removed. This, of course, is done because it is easier to remove bulk than to add it. However, in such cases, a patient with a small, misshapen nose will end up with an even smaller nose that does not fit well with the rest of their face.






WHEN AND HOW AUGMENTED RHINOPLASTY IS PERFORMED

The cases wherein augmented rhinoplasty is required are the following:

1.    Small noses that have been misshapen from birth.
2.    Noses that have had their bone structure destroyed by injury.
3.    Cases that have undergone rhinoplasty with excessive removal of the bone structure.

As far as preparing the surgery is concerned, as well informing the patient and the procedure in general, the same process is followed as with standard rhinoplasty (see the chapter on Rhinoplasty). In augmented rhinoplasty, however, the bone structure of the nose is reconstructed.

Cartilage is most frequently used as material to reconstruct the bone. This cartilage is obtained from the diaphragm of the nose itself (this being the preferred donor area); if there is not a sufficient quantity there, it can obtained from the ear or even the ribs.

This cartilage is shaped into little section, each of which are positioned so as to form a bone structure that will be able to support the skin of the nose. Cartilage is the preferred material because it does not cause the organism to react and reject it, nor does it cause inflammations.

In order to construct the bone, additional, artificial materials can also be used. The problem with these is that they often cause infection or are rejected by the organism. For this reason, they are used quite rarely and only when there is no other option. These materials tend to be silicone implants, porous materials (porex), etc.

To conclude, a material that can be used easily and securely is hyaluronic acid. This material is injectable, is not rejected by the organism, and can be administered with great ease.

However, the disadvantage is that not all noses can be corrected using hyaluronic acid. Therefore, a correct and thorough evaluation must be made by the rhinoplastic surgeon, and provided the nose can be corrected with hyaluronic acid, then we can proceed to the operation itself, which is easy and secure. Of course, hyaluronic acid is not a permanent material, and the procedure will need to be repeated from time to time. However, these repetitions are not very frequent.

When using cartilage in augmented rhinoplasty, the duration of the operation is of course longer than that of standard rhinoplasty.

The method most frequently employed is open rhinoplasty, as this allows a greater degree of exposure for the bone, so that it can be better operated on. Therefore, the incisions are made in the nostrils and the septum (the wall dividing the nostrils).

The recuperation period following this operation is equivalent to that required after standard rhinoplasty (see the chapter on Rhinoplasty). The only difference is that the nose requires attention and care for a longer period of time, as the bone structure is more fragile and as such requires a longer time to stabilize.