The nose is one of the most important parts of our face. Aesthetic changes to the nose are difficult to disguise, making it a relatively common procedure in cosmetic surgery consultations.
Rhinoplasty is a surgery aimed at changing the shape of the nose to improve its appearance or correct congenital and traumatic alterations. It is undoubtedly a surgery of great responsibility for the surgeon. Any mistake will always be very evident, so the surgery must be well planned.
The patient must be aware that absolute perfection does not exist, and before surgery, they should clear all doubts with the surgeon.
SURGICAL PROCEDURE
There are two basic types of surgery:
1. Open rhinoplasty: an incision is made in the nasal columella to revert the tip, thus exposing the nasal septum and tip.
2. Closed rhinoplasty: small incisions are made inside the nostrils. This approach is usually used in simple primary rhinoplasties. The main areas to be treated are the nasal dorsum, tip, and nostrils. All aspects must be considered: bones, cartilage, and skin. The surgeon must be conservative and remove material little by little until the desired shape is achieved. At the end, a plaster or plastic dressing is applied, and nasal packing is placed inside the nostrils.
ANESTHESIA AND DURATION OF SURGERY
The surgery can be performed under local anesthesia, local anesthesia with sedation, or general anesthesia. The choice of technique depends on the experience of the medical team and the complexity of the operation. In our experience, the procedure lasts between 90 to 120 minutes. There are two basic types of surgery.
RESULT
To achieve a good result, you must follow your doctor’s instructions correctly. In facial surgeries, it is normal to experience slight depression in the days following the surgery due to the appearance in the first few days. The final result may take several months.
To achieve the desired result or to correct a small imperfection, a second procedure may be necessary. This can be done after 5-6 months.
POST-OPERATIVE CARE
During the first few days, there is slight swelling. Hematoma can be reduced if infiltration is done before surgery. Usually, the nose returns to normal within 2 weeks. In the first few hours, slight serosanguineous drainage may also occur. In our clinic, we place packing, which we remove after 24 hours. After 7-10 days, the sutures and plaster or plastic dressing are removed. Most activities can be resumed within a few days.
WHAT ARE THE MOST COMMON PROBLEMS THAT CAN OCCUR WITH RHINOPLASTY?
Complications are infrequent but can happen, and it is the doctor’s duty to inform about them: infection, nasal bleeding, reactions to anesthesia. Over time, telangiectasia (small red vessels) can appear on the nostrils. Laser correction is usually easy. In severe cases, major deformities may occur, such as septal loss or noses that are too small or disproportionate. These cases are usually related to the surgeon’s inexperience.
Whatever the type of complication, it is important to remain calm and understanding, trusting the doctor to solve the problem. Comments with friends or family, besides not helping, may create anxiety and disbelief. The occurrence of any of the problems mentioned above is part of the so-called “calculated risk,” which applies to all types of surgery. Fortunately, its occurrence is not frequent and does not usually permanently affect the results.
WHAT SHOULD YOU ASK THE DOCTOR?
It is very important to know the surgeon’s experience, to find out whether they use the open or closed technique, what complications they have had (don’t believe anyone who says they have never had complications), and how they were resolved. Ask to see pictures of noses similar to yours, and try to get an idea, even if approximate, of how it will look.
1. What are the advantages of the open technique?
It provides better visibility of the operative field and, therefore, more secure results. It should be used for more complicated noses and re-operations.
2. What are the disadvantages of the open technique?
It leaves a small scar on the columella, although barely visible.
3. What are the advantages of the closed technique?
It leaves no scars and should be reserved for simpler surgical interventions.
4. What are the disadvantages of the closed technique?
It provides a more distorted view of the operative field.
