RHINOPLASTY : COSMETIC NOSE SURGERY

DEFINITION, AIMS AND PRINCIPLES

This procedure aims to modify the shape of the nasal pyramid (either partially or completely) and can also if necessary correct nasal breathing problems.
The result should be a nose in harmony with the facial features, and which corresponds to the personality and expectations of the patient.
The technique uses incisions hidden inside the nostrils and remodels the bone and cartilage which give each nose its distinctive shape. The skin covering these elements will be redraped and will adapt to the new nose.
This procedure carried out both for men and women, can be done from the age of 16, when growth is complete.

BEFORE THE OPERATION

The motivation and expectations of the patient will have been analysed.
Prior to the operation a thorough examination of the nasal pyramid and its harmony with the other features of the face will have been carried with an endo-nasal examination.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anesthesia

This operation is usually performed under general anesthesia or local anesthesia with intravenous
sedation (twilight anesthesia).

Hospital stay

Rhinoplasty is usually carried out in an ambulatory facility, you arrive early at the hospital and are discharged the same day after a few hours under observation.

THE PROCEDURE

Incisions

As a rule they are invisible, hidden inside the nostrils there are therefore no visible scars.
It can be necessary to use an external incision concealed at the base of the nose wings if reducing the nostrils, or across the columna, between the nostrils in order to perform an ‘open’ rhinoplasty (giving access to the internal structure of the nose. This can be used when repairing serious deformations or for touch-up surgery.

Reshaping the nose

The osteocartilaginous structure will then be reshaped as planned.
The nose may be made smaller or straightened, a bump removed, the tip may be redefined, the septum may be straightened or the nasal concha reduced in size. In some cases a cartilage or bone graft will be used to fill a hollow zone, to support part of the nose
or redefine the tip.

Dressings and splints

The nostrils are packed with wadding. An external dressing of tape is applied then a splint of plaster, plastic or metal is molded and fixed to the nose.

The operation can take between 45 minutes and 2 hours.

AFTER THE OPERATION

There is rarely actual pain, it is rather the fact that the wadding makes it impossible to breathe through the nose which is a problem for the first few days.
Swelling can be observed around the eyelids with bruising which is variable in degree and duration for each patient.
During the first few days rest is advised, with no physical strain.
The wadding is removed 1 to 3 days after the procedure. The splint is removed 5 to 8 days after surgery, to be replaced by a smaller splint for a few more days.
The nose will appear bigger because of swelling and it will still be difficult to breathe because of swelling of the lining of the nose and possible scabs in the nostrils.
The visible signs of the operation will disappear gradually and a return to normal social and professional life is possible after 10 to 20 days.
Sport and strenuous exercise should be avoided for 3 months.

THE RESULT

Two to three months are necessary before the final result becomes appreciable, and it will only be after 6 months to one year that the final aspect will become apparent after a slow and subtle healing process.

DISAPPOINTING RESULT

These can result from a misunderstanding concerning what can reasonably be achieved, or be caused by unusual scarring phenomena or unexpected tissue reactions such as poor healing and retractile fibrosis.
These imperfections can be remedied by corrective surgery if necessary, usually under local anesthesia from the 6th month following surgery. It is necessary to wait until the healing and scar tissue are stabilised. This touch-up surgery is more simple than the first procedure both regarding the technique used and the postoperative care.

POSSIBLE COMPLICATIONS

A rhinoplasty, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here.

• Bleeding : this can occur in the first few hours after surgery but is usually moderate. If bleeding persists more wadding should be added, or a return to the operating room may be necessary.
• Hematoma : these must be drained if too painful or too large.
• Infection : in spite of the natural presence of germs in the nostrils this is very rare.
• Abnormal scarring : this can only concern external scars (if any) and is rarely a problem to the point of requiring a second procedure.