Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose. Rhinoplasty is one of the most popular surgeries worldwide. Rhinoplasty is not exclusively a cosmetic procedure. This surgery also aims to improve breathing or both. For example, to maintain nasal function or improve it. This can be necessary when the patient has reduced airflow due to an obstructive process. Airflow obstruction adds to the complexity of the operation. The surgeon must modify internal nasal structures to correct functional issues.
John Roe described the first Rhinoplasty procedure in 1887. Rhinoplasty has much evolved since then. Rhinoplasty’s long evolutive process is both technical as well as philosophical. The reduction-only concept in nasal surgery evolved into a more proportional approach. Using a combination of careful reduction and grafting gives superior results and consistency. Such advancements were possible mainly due to a better understanding of the anatomical structures and by the works of great surgeons like Joseph and Sheen. They described a number of techniques that we still use today.
Rhinoplasty remains one of the most complex surgical procedures in Plastic Surgery. It also is one of the most popular. More than 200.000 such operations were performed in 2018 in the United States. This makes Rhinoplasty the third most conducted plastic surgery in the USA.
Rhinoplasty can be important in psychological health. The nose is a central landmark of the face. Nasal proportions and symmetry are directly linked to facial beauty. Rhinoplasty encompasses a wide range of different techniques. Achieving consistent results can be challenging even for very experienced surgeons. The choice of an experienced surgeon is paramount.
The noses anatomical variations contribute to the difficulty of making “the same nose in every patient.” Furthermore, there’s no such thing as an “ideal nose”. A nasal configuration that may suit one patient’s face might be very different for another.
All of these factors combined can explain why rhinoplasty is also such a rewarding surgery. It can improve both psychological and physical health. This leads to highly favorable outcomes.
The malformation of the nose has many possible causes. An important part are inherited (familial) traits. Also racial traits (more or less visible in people of a particular region). Other reasons include previous traumas. Examples are traffic accidents, sports accidents, work accidents, etc. Further causes include congenital diseases (cleft lip and palate, facial asymmetries etc.), infectious diseases, and with the most important reasons being mouth, teeth and biting disorders.
With the establishment of adult teeth at age 12, facial development progresses to a new stage. Like all units in the face, the nose continues to develop in the 18-23 age range. If the teeth alignment in the upper and lower jaws is good, the jaw inclusions and the irregularity are smooth, the face and nose development will be more balanced and better. For example, it is common for an underdeveloped person to have a longer and arched nose. A less developed lower jaw can only be compensated with a larger nose in terms of the skeletal balance of the face. Likewise, a more pronounced lower jaw can find a facial balance with a smaller, flattened nose. Just as in the whole body’s skeletal system, all of the units in the face have a biomechanical balance between them and their development is in accordance with this balance. If a permanent tooth that has been pulled at an early age has left an empty space, there is greatly increased possibility that the jaw is distorted as a result of this, creating deformations in the face. For this reason, it is very important to have a good alignment of the teeth between the ages of 12 and 18. If there is a problem, help is available from orthodontists) for face and nose aesthetics.
General Examination in Cosmetic Nose Surgeries
As in all surgeries, the age, general physical health and psychological status of a person are very important for aesthetic purposes. Because development hasn’t been completed in young adults under the age of 17-18 years of age, Rhinoplasty operations are not appropriate in this age group unless there’s a particular reason. Nose surgery cannot be performed if there are important systemic diseases such as (heart, lung diseases, anemia, diabetes, excessive use of cigarettes, use of certain medicines, infections, tumor diseases, psychiatric diseases etc.). For this reason, the patient must inform the physician and the patient should be evaluated in detail by the physician. The fact that an operation is for an aesthetic purpose does not mean that it is easier or simpler to technically evaluate it than other operations. One of the most important issues to be evaluated in nose surgery is the psychological condition of the person. It is very important for the surgeon to have enough time to examine this issue, how long it has been since the patient has wanted cosmetic nose surgery, and the recent changes in their social life (marriage, divorce, death, sudden decisions, deep sorrows, depression etc.). Another issue that needs to be addressed is the motivation of the person and the expectation from the operation. The result that can be obtained in a cosmetic nose surgery will naturally vary from person to person, from nose to nose. Because there is no standard surgical technique, everything is implemented according to the surgeon’s experience and surgical prognosis. Therefore, researching the relevance of the expectation of the person who needs cosmetic nose surgery will reduce problems with patient expectations, which can arise after the operation.
Facial examinations in Cosmetic Nose Surgeries
The nose is the most important aesthetic unit in the middle of the face and is in functional and aesthetic interaction with other anatomical units. A flat or bumpy forehead structure, a small or large lower jaw, and a distinctive or barely there cheek structure can lead to a different perception of the nose. In about thirty percent of people there exits an asymmetry with the face, arm-leg and body. That is, the two parts are not equal to each other. This is not a illness. However, when the asymmetry is somewhat obvious, sometimes the nose may be bent to one side. A significant portion of people who think that their nose is curved have facial asymmetry. Although asymmetry in the face doesn’t usually require treatment, taking the crookedness of the nose into account, during cosmetic nose surgery special techniques are used to try to align the nose to the middle of the face. In addition, the profile of the face and the nose should be evaluated in detail. In certain cases a better aesthetic appearance of the nose can be achieved by eliminating existing problems of the lower jaw or the forehead.
Formal examination of the nose during cosmetic nose surgery
The nose firstly is evaluated in terms of its dimensions (in terms of its width-height-length ratios), and the skin structure is examined. The thinness-thickness of the skin, scars, excessive tension or looseness are important factors. Then the nose is divided into three anatomic regions and evaluated in detail.
Region 1 is the upper bone region. The characteristics of the bone, its thickness-thinness, the presence-absence of a belt, the width, the axe, curvature problem, differences between the two sides are taken into account and noted.
Region 2 is the central region of the nose. Here, there are middle cartilages and upper lateral cartilages, which we call septum. These are building blocks in a dynamic system that sets the aesthetic lines of the backbone of the nose, as well as the velocity of entry into the air. The narrowness of this region, any weakness and instability of the cartilages, will affect air entry and will act as one of the possible causes of various heart diseases in older ages.
Region 3 is the tip of the nose. This region is formed of the septum and lower lateral cartilages. The size, deformity, irregularity, asymmetry, lip-to-nose angle, etc. of this region is assessed in detail. Cosmetic nose surgery; which is noted in the patient’s examination and shared with the patient, is decided to correct the shape of the nose and breathing problems in line with a plan. According to the experience of the surgeon, if different techniques are available, the ideal choice is the appropriate surgical technique required for the nose. The most commonly used surgical techniques are delivery techniques, which we call open, closed or semi-open. We cannot argue which method is better. Because achieving the same results with different means is in the nature of science. Each technique has its advantages and disadvantages or different advantages in its details. Instead of defending the superiority of a basic technique, it’s better to gain enough experience to dominate all techniques and provide the patient with the most suitable treatment.
The operation is performed under general anesthesia. We start by injecting a special liquid with the aim of reducing bleeding. Bone and cartilage structures are revealed through the tip or inside of the nose. First, the middle cartilage segment, which we call the septum, is corrected and the cartilage tissue from which it will be needed is removed. Then the excess bone and cartilage on the back of the nose is removed by grinding or cutting it. The nasal bones are narrowed down with the help of small cutters from the sides. Upper cartilages located in the middle of the nose and serving as a valve for breathing are corrected. If necessary, cartilages taken from the septum are used here. For the tip of the nose, the lower wing cartilages and the lower part of the septum are straightened together and the cartilage taken from the septum is used for this. The most important aspect for the aesthetic appearance is the face structure of the person. The most natural appearance must be given without disrupting the function of the nose.
The surgery lasts about 2 hours on average and a plastic splint is placed on the nose at the end of the operation. We place a few small stitches at the tip of the nose. A silicone plug is placed according to the process performed in the nose. Their removal is on Day 7 and is a painless process. Recovery is about 7-10 days. It takes three months to 1 year to see the final state of the nose.
