Rhinoplasty operation with the increasing popularity day by day, is the 4th in the world and the most common aesthetic operation performed in Turkey according to the “ISAPS Global Survey 2020”. It is possible to find information about this surgery in many websites. Therefore, instead of giving general information or talking about a technique, I will talk about my concept.
As Dr. Mert Ersan, what is my goal in nose surgery?
Being aware of the importance of function as well as shape, to increase your self-confidence as much as possible by obtaining a nose which breathes superbly, using techniques that cause minimal trauma with minimal damage to the existing anatomy, obtaining a new nose shape without disturbing the natural which will suit your face in the most beautiful way.
Which technique is used in nose surgery? Open rhinoplasty or closed rhinoplasty? Preservation rhinoplasty, structural rhinoplasty, or ultrasonic rhinoplasty?
Before making an explanation, I would like to give a brief information. While reconstructive repairs of the nose date back to the 6th century, the first modern rhinoplasty operation was performed in 1887. Studies have been carried out on this surgery for centuries, so the method and technique are constantly changing and developing. While the answer to this question is highly technical, there is no single answer. In my opinion, there shouldn’t be a single answer though. A good rhinoplasty surgeon should be familiar with most techniques used in the world, should follow the current literature and new developments, and know the advantages and disadvantages of each technique, instead of being tied to one technique. In addition, a good rhinoplasty surgeon should be able to discuss the advantages and disadvantages with the patient and decide on the most appropriate technique for the patient. So, patient-based planning is very important.
Is only the shape corrected in nose surgeries? Will the breathing problem get better? Should I do both together or separately? Can the breathing problem be corrected without changing the shape of the nose?
Aesthetic and function are highly related. To call an organ “beautiful”, that organ must be doing its function quite well. Therefore, a well-breathing nose is beautiful. With the patient’s complaints, history, physical examination, and imaging modalities; conditions that prevent good breathing, such as septal deviation, conchae hypertrophy, internal and external nasal valve insufficiency, are also detected preoperatively. It is recommended to correct this situation in the same session. In this way, you will not need to receive a second anesthesia, and also, we will use the parts that we remove which restrict breathing, to reshape your nose when necessary. In cases where it is not desired to change the shape of the nose, an intervention called “septoplasty” can be performed to correct the breathing problem by preserving the shape of the nose.
Can some rasp and nose tip correction be done instead of total rhinoplasty?
First of all, we should not forget that all of these are operations and should be approached with the same seriousness. The other point is the importance of considering the nose and face as “a whole”, which needs a holistic approach. In the consultation, we identify the existing deformities and talk about treatment options. When we perform a limited operation, we need to have a very clear understanding about the possible result, advantages, and disadvantages of the process. Therefore, correct planning and communication are very important.
Will there be bruising under the eyes after rhinoplasty? If so, what is the significance?
This situation varies according to the genetics of the patient, structural factors, current condition, bleeding problems, the procedure and technique. If there are bruises, it is extremely wrong to think that the operation went bad. On the contrary, if there is no bruising, it doesn’t mean that the operation was perfect. In summary, the bruises do not give you information about how the surgery went, and they do not provide you any idea about the result. The bruises, – if they occur – increase gradually up to postoperative 3rd day, then gradually decrease and disappear after 1 week.
Will there be pain after rhinoplasty?
Rhinoplasty operations are not typically pain-expected operations. There will certainly be minor tingles, but all of them respond tremendously to normal painkillers and disappear quickly.
How long does the nose surgery take?
It’s one of the questions that I can not answer exactly. Until this time, I have never said, “Come on, let’s finish the operation because it has been already 3 hours” or I didn’t say, it’s finished in 1 hour, it shouldn’t be that short, let’s do a little more”. Previous traumas, concomitant breathing problem, structure of bones and cartilages, skin quality, techniques used are important in this estimated duration. Instead of this, when we believe that we have made the most beautiful and most functional nose which can be obtained from your existing nose, when the surgical team and I are happy with the result, and when we reach the point which we planned preoperatively in the surgery, we will end that surgery. Let’s say 1.5-2 hours on average.
Do patients stay in the hospital after the operation?
You will not have an excessive pain after the operation, but it should not be forgotten that nose surgeries are operations performed under general anesthesia. Even if they are not related to the rhinoplasty operation, symptoms such as fatigue, mild nausea and dizziness may occur due to the anesthesia. My general recommendation is to stay in the hospital on the day of the surgery. However, this is not an obligation. At our post-operative visit, we will look at your general condition, if you can convince me that you can go home, I can send you home.
When are internal and external splints removed?
I don’t always use internal or external splints. Instead of this, I make patient-based decisions. But generally, my preference is as follows. I find the application of the internal silicone splint which allows you to breathe after the operation and thermoplastic external splint useful. With using them, I believe that we provide better support to the changes we make both inside and outside of the nose, and we prevent the nose from being traumatized. Although it varies according to the person and the procedure, I remove the internal splint on the postoperative 3rd day on average, I remove the external splint in the 1st week and apply a special tape instead. I also describe nasal massage depending on the procedure and the patient.
It varies depending on the technique and the patient. Some patients want to continue their jobs before the external splint removal, and they are usually not bothered. My personal opinion is that you should have 7-10 days after the operation in which you can rest well. Women are little luckier in this regard, the use of foundation creams can cover the bruises, which have already decreased. However, I do not recommend any heavy physical activity in first 2 weeks.
What are other procedures that can be combined with nose surgery?
It is very important to consider the face “holistically”. The relationship of the nose not only with itself, but also with other organs on the face is very important. Fat injection to the forehead and chin in appropriate indications can increase the effect of the rhinoplasty operation on the profile very well. The fat can also be used for depressed areas on the lower eyelid (See Fat Injection (Lipofilling) Section). At the same time, since the incision used in open rhinoplasty surgery is similar in shape and region to the incision used in lip-lift operation, a combination of rhinoplasty and lip-lift can be performed in individuals with a wide upper lip-nose distance (See Lip Lift Section).
Would every nose be perfect? Is symmetry 100% guaranteed?
The answer is very clear. Perfection does not exist. In addition, bone and cartilage nature, memories of the structures, skin thickness and healing pattern differ from person to person. The aim of nose surgery is not to make a perfection to your nose. The human body and face are also not 100% symmetrical. If you are looking for perfection and 100% symmetry in nose surgery, I would not recommend you that surgery. The realistic expectation is that the appearance of your nose will visibly improve after the operation, and you will have a nose that suits your face and on you and you can breathe much better. If your expectation is in this direction, you will probably be one of my hundreds of patients who are very satisfied with the result and you will say that “I am very pleased to have known you and I’m glad that I was operated by you”.
Can you show me on the computer what kind of nose I will have after the operation?
This is a request that I am receiving very often lately. I think that this demand is partially justified. Because, considering the developing technology, social media, and advertising policies, it seems almost mandatory to do this. But real life, unfortunately, is not like that. Of course, through some applications, we can show the changes we have planned together on your nose before the surgery. This situation guides us both before the operation and during the operation. However, it should not be forgotten that these tools are 2- or 3-dimensional imaging devices. The reality is the situation encountered during the surgery. As I said before, each person’s skin, bony and cartilage structures and healing patterns are different from each other.
What if everything doesn’t go well?
A very valid fear and a valid question. This possibility is always there. Of course, I will try to achieve the best possible result for you with your current anatomy, but it should not be forgotten that nose surgery is an operation that has been discussed for hundreds of years and requires constant changes and innovations. This surgery is a very complex operation that can not make any rhinoplasty surgeon say, “All my noses are perfect, my revision rate is 0 (zero)”. The result of this operation cannot be predicted 100%.” The communication between us does not end after performing the surgery. We have many more controls in the post-operative period. Most of the things that patients worry about usually disappear in this process. However, in rare cases that do not go away, a second intervention may be required to correct these problems. We do this intervention after 6 months-1st year to allow the nose to heal. In addition, in cases where revision is required, the procedure we usually need is a very small procedure compared to your first operation, and it usually does not force you and your social life as much as in the first operation.
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Summary
Rhinoplasty operation is a surgery that we do very often, where patients are usually very happy with the results, which provides aesthetic and functional outcomes, and makes patients say, “I’m very glad that I had this surgery”. Pre-operative history, physical examination, imaging methods, understanding mutual demands and requests, evaluating whether expectations are realistic and meeting on a common point are very important. However, it should be noted that the surgical intervention and recovery process depend on many variables and therefore cannot be predicted exactly. If your realistic expectation is not “perfection and 100% symmetry”, but if you expect that “your nose will visibly improve after the operation, you will have a nose that suits your face and on you and you can breathe much better” you will probably be one of my hundreds of patients who are very satisfied with the result, have achieved their goal, and say that “I am very pleased to have known you and I’m glad that I was operated by you”. Best regards
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