What is Rhinoplasty and How is it Performed?

Rhinoplasty, also known as rhinoplasty surgery, is one of the most popular types of plastic surgery-cosmetic surgery. Rhinoplasty is a reshaping procedure to improve the appearance of the nose. The goal is to make the visible parts of the nose, in other words, the parts of the nose covered with skin, uniform. The ideal rhinoplasty aims to create a natural appearance of the nose in harmony with other facial elements.

Inside the nasal cavity, in the middle of both nostrils, we have a vertical and straight wall extending deep into the nasal cavity, which we call the septum. This wall grows and develops like the whole skeleton with the years passing during the growing age. During this process, blows to the nose cause this wall to gain curvatures. We call this crooked state of the wall a deviated septum. Since deviation is in bone and cartilage tissue, it is corrected only by surgery, not by treatments such as medication, cream, spray. The surgery to correct deviation is also called Deviation Surgery: Septoplasty. It can be performed together with rhinoplasty or separately. If septoplasty (i.e. deviation surgery) is also performed while rhinoplasty is performed, the deviation of the septum is corrected. In this way, while the shape of the nose is corrected, breathing comfort is also increased.

What is Rhinoplasty?

We call the part between the tip of the nose and our forehead the dorsum of the nose. The upper part of the dorsum of the nose consists of bone and the lower part of cartilage. We call the middle point where these two tissue types meet the rhinion. The suffix -plasty means to repair, to correct the structure. Since the deformations in the middle of the dorsum of the nose attract more attention than the other points of the nose, the term rhinoplasty, which refers to the correction of this area, was born. However, the range of meaning of rhinoplasty has expanded over the years because with developing techniques, diversifying and developing new approaches, we now use the term rhinoplasty in the sense of "surgery to change the entire shape and size of the nose", in summary, all the points and areas of your nose that are visible from the outside. In other words, rhinoplasty is a plastic surgery procedure that targets the entire visible part of the nose. The terms rhinoplasty, rhinoplasty, rhinoplasty, nasenkorrektur, aesthetic rhinoplasty, cosmetic rhinoplasty, nasoplasty all refer to the same procedure.

Who is Suitable for Rhinoplasty?

Those who have a deformed or asymmetrical appearance in any part of their nose, whether or not they have a memory of a nasal fracture;

If they are 17 years old and 18 years old
They do not have a blood or circulatory disease that makes general anesthesia risky, liver or kidney failure, or a respiratory disease that reduces lung capacity
They can undergo rhinoplasty surgery if they have received approval from the relevant branch doctors for other diseases that are already present and being treated.

Types of Rhinoplasty and Different Surgical Approaches

There are two main rhinoplasty procedures:

Open: Open rhinoplasty is a reshaping procedure that gives control over the entire nose. The surgeon lifts the patient's nasal skin to the eyebrow level by making thin and delicate cuts between the nasal lips, reveals the entire nose without skin, and makes the incisions he deems necessary on the bones and cartilages. In this way, the detailed anatomy of the nose is completely mastered.
Closed: Closed rhinoplasty is a reshaping procedure that offers a more limited working area but touches fewer points, fewer points can be changed but offers a faster healing process. In order to perform the necessary procedures, the surgeon makes incisions to separate the patient's skin from the bone and cartilage by approaching through the nostrils and works through a tunnel-like cavity.

Additional types of rhinoplasty include:

Non-surgical rhinoplasty (filler rhinoplasty): This is a type of cosmetic rhinoplasty that uses dermal fillers to temporarily fill hollows and irregularities in the patient's nose. It can lift a drooping nasal tip or correct a small hump.
Revision Rhinoplasty: Secondary rhinoplasty: Revises or corrects problems that arose after the initial rhinoplasty surgery.

What are the Advantages of Rhinoplasty?

The advantages of a rhinoplasty procedure include

Changing the shape and size of the nose.
To improve facial appearance.
Correcting structural abnormalities of the nose, such as a deviated septum.
Improve the level of nasal breathing.

What are the Risks of Rhinoplasty?

All surgical procedures, including rhinoplasty, carry risks.

Potential complications after rhinoplasty include:

A hole in the nasal septum (middle wall) (nasal septal perforation)
Infections
Nosebleeds
Prolonged wound healing or scars
Skin discoloration
Unsatisfactory appearance
Pain
Need for additional surgery

What is the Difference Between Rhinoplasty and Septoplasty?

Rhinoplasty is a procedure that improves the appearance and/or structure of the nose. Septoplasty, on the other hand, is a surgery to open the air corridor by correcting the protrusions of the wall that stands flat and upright like a board between the two nasal cavities and extends into the facial skeleton, narrowing the right or left airway.

If the aim is to improve both the appearance and function of your nose, rhinoplasty and septoplasty can be performed at the same time.

Rhinoplasty Procedure and Implementation

Rhinoplasty is performed under general anesthesia. The duration of the operation varies depending on the conditions, the number of points or areas to be intervened, the number and technique of the surgical maneuvers required, the presence of additional deformations, the tendency to bleed, the presence of the same or different previous operations and other factors. Since there are many factors, it is misleading to predict a general operation time, but statistically, the operation time is between 2 hours and 4 hours. In addition, the preoperative preparation of rhinoplasty and the preparation before leaving the operating room takes about an hour in total.

ENT surgeon during rhinoplasty:

He makes an all-round incision through the patient's nostrils (closed rhinoplasty) or, depending on the need, he can also make a transverse incision with special angles along the base of the nose (open rhinoplasty).
The skin covering the nasal bones and cartilage is lifted.

Subsequent phases;

The covering tissues of bone and cartilage are removed. Those with defective structures are separated from their connections with each other, the cartilages are cut from the deformed parts and sutured to give the correct angles and folds. The deformed parts of the bones are corrected by cutting or filing, angled and re-fixed.

It takes months for these reconstructed tissues to adhere to each other in their new shape and to be surrounded and bound by connective tissues. This is why special suture materials are used for these fixations, which take months to dissolve and disappear.

At the end of the operation, the incisions made in the skin are sewn one by one with millimetric care. Specially produced, millimetric and often dissolving sutures are used to ensure that the skin heals healthy and with zero/near-zero scarring.

Postoperative Process

The following processes take place after rhinoplasty surgery:

A small plastic splint is inserted to minimize swelling and maintain the new shape of the nose as it heals. The splint is shaped and solidified according to the nose while it is soft at the end of the surgery and can be worn for 5 - 14 days. When the splint is removed, the nasal skin is wiped and the healing speed is observed. What to do at this stage varies from patient to patient. The splint is not reapplied, but taping may be applied for 3-4 days, massage with (or without) cream may be advised, both of these may be required or none of them may be required.
A silicone support can be placed inside the nose. According to the surgeon's instructions, it can usually be removed 5 - 8 days after surgery. Nasal cleansing by spraying sea water spray and gently blowing the nose may be advised.
A small gauze bandage may be taped to the tip of the nose. It may need to be kept on for a few hours or a day to prevent secretions from the nose and light blood from going into the mouth.
Although not common, swelling and bruising around the nose and eyes may occur, which may take a few days to resolve. They usually dissipate without special treatment.
When the operation is over, anesthesia is terminated and the patient, who regains consciousness in a slow and controlled manner, is made ready to be sent to bed safely by the anesthesia team.
The patient is taken to bed and made to rest with the head elevated at 30 degrees. A slight feeling of heaviness in the head, feeling of pressure, nausea, drowsiness, grimacing may last until the effect of anesthesia is reset. There may be a slight burning sensation in the nose, but our patient does not have any pain and should not have any pain.
Ice gels can be placed around the nose with pressure-free contact. If necessary, it is planned to continue for a few hours - 1 day.
Our patient starts drinking water in the 1st hour and eating in the 2nd hour of admission. The first meal starts with watery and soft foods. He/she can eat whatever he/she wants in the following and other meals. Depending on weight, the patient is advised to drink 2 to 3 liters of water a day.
Our patient can go to the toilet in the 3rd hour accompanied by his/her nurse or relative, and in the 4th hour he/she is taken for a small walk in the hospital corridor. If he/she wishes, he/she can sit in the hospital cafeteria for a short time at the 5th hour. At the 6th hour, he/she can take a body shower under the supervision of a relative.
Most of our patients are sent home after 1 day. On the day of discharge, absolute bed rest is essential. However, the day after that, activities such as going out, meeting people, taking short and slow walks, taking short trips, driving are free.

Every person recovers differently after rhinoplasty surgery. The amount of swelling and skin structure may be different for everyone. Although the time for the nose to take its final shape may vary, it is usually one year.

After the surgery, follow Op. Dr. Kemal Demir's treatment plan and keep follow-up appointments to ensure that your nose heals properly.

What is Asymmetric Healing After Rhinoplasty?

It is not surprising that your body reacts to surgery in different ways, such as asymmetrical healing. Asymmetric healing is swelling that affects one side of the nose more than the other. This makes your nose look crooked when you look carefully and can be worrying. This is not a permanent condition. The reason is that the skin; so to speak, is used to the old shape of the nose, the concave and convexities have changed, the skin parts that correspond to the old protruding areas are now loose to that point, the nose has shrunk most of the time but the skin has remained the same (for now) and each point of the nose requires a different intervention. The healing tissues in the more intervened areas call for more repair cells, the skin covering these areas swells more and these swellings deflate later. Asymmetric healing is one way your body heals after surgery. You may experience this for a few months after surgery. But the skin eventually adjusts to the new size and shape, most often by the end of the 1st year.

Pain after Rhinoplasty

There should be no pain in the routine after rhinoplasty surgery.

Return to Normal Life After Rhinoplasty Surgery

After rhinoplasty surgery, follow Op. Dr. Kemal Demir's advice on when you can return to your daily life or resume your normal activities.

You will have to be much more - I repeat, much more - meticulous than the people around you to ensure that no small or large blow to your nose is received. You should know that this period of vigilance will not be shorter than 6 months. You should remember that your nose can be harmed by people's hand-arm movements, babies and small children, the main owner of our world, our animal friends who are the color of life, doors that open towards you, automatic sliding doors, lids whose backs cannot be seen, clothes that cannot be worn without rubbing against the nose, any sudden movement where you can bring your hand to your face.

Although there are exceptions, we have restrictive rules regarding the use of glasses. We do not allow you to wear glasses until the 3rd month, after the 3rd month you can wear them for 2-3 hours a day and after the 4th month you can wear them as much as you wish.

Within 5 - 10 days you should be able to return to work, study or other occupation. By the 2nd week you can start light-moderate sports activities and by the 3rd week you can start any kind of physical activity.

A Note from Op. Dr. Kemal Demir

If you are uncomfortable with the appearance of your nose, you can visit our clinic to discuss whether you are a good candidate for rhinoplasty. Rhinoplasty can improve your appearance, but you need to have realistic expectations about your results. Visible results appear immediately after surgery, with the nose getting closer to its final shape every week. By the end of the 4th month, the final shape is about 75%. However, since this process slows down as the months pass, it always takes a year to see the final shape.

Surgery is a complex and important action aimed at health. The surgeon who will perform it aims for the best on behalf of the patient, thinking on behalf of the patient, and determines the course of the technical part of his methodology. However, for a surgery such as rhinoplasty, which aims to achieve both health and good appearance, this process is different.

On the way to restoring the correct anatomy to the nose and ensuring the correct and healthy functioning of the nose, the wishes of the person regarding the new appearance of the nose should be understood correctly by the physician and these wishes should be understood correctly by the physician;

how appropriate,
how possible,
and even how much it fits the face

that he or she has a clear view of what is going on.

This is not enough, it is necessary to continue the mutual exchange of views and to reach a consensus. Therefore, the prerequisite for the decision to have a rhinoplasty is that the person and the physician have a mutual, healthy communication.