Nose - Rhinoplasty

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What is it?

Rhinoplasty is a surgical procedure used to reshape the nose and fix deformities. Sometimes, it also involves repositioning of the nasal septum, to fix problems in nasal breathing.

Rhinoplasty is one of the most challenging and delicate cosmetic surgeries. The effectiveness of the procedure depends upon the extent of the surgical incisions required, and more importantly the ability of the skin to adapt itself to its new form, which in turn depends on its elasticity.  

It is important to ensure that the nose blends harmoniously with the rest of the patient’s face and general character. Moreover, there are limits to how much of the fundamental structure of the nose can and should be changed. This is why the general analysis of the patient’s face becomes an important part of the pre-surgical routine.

Rhinoplasty aims at fixing the defects in the shape of the nose, while essentially maintaining its original character. Suitably customized techniques will be used to match the patient’s requirements of course, but it is important to note that the effectiveness of the treatment is limited by factors like the thickness and elasticity of the skin.

During pre-surgical consultation, the proposed surgical procedure will be explained to the patient in full detail, with the help of digital images. The patient will also be able to see pictures and images of previous cases of similar nature, which helps them visualize the results for themselves.

Target areas of treatment

The following are some of the treatment areas of Rhinoplasty against some of the deformities and problems that they fix.

    The bridge of the nose:
o    Nose reduction can correct a bumpy nose with an overly prominent bridge.
o    A wide nose can be fixed by pinching the two sides of the bridge, so as to bring them closer together
o    A flat nose requires an augmentation, and this means extra material is either supplied by the patient via cartilage/bone grafting or by implants. The nose is then given a natural edge, and reshaped.
o    A nose-lift usually follows a collapse, caused by a nose injury (more commonly called the boxer’s nose).

   The tip of the nose:
o    A sagging or a hook nose, requiring a lift or refinement.
o    An overly long nose requiring reduction.
o    A square or wide nose tip requiring refinements.
o    Other general cases requiring a more drastic procedure with a combination approach of excision, restructuring or placements. All these techniques can be targeted on very specific areas, without any impact whatsoever on the rest of the nose.

   The nostrils:
o    Wide or thick nostrils requiring a reduction. (Achieved with very minimal scarring).

    Deviation:
o    An off-center nose requiring restructuring, and restoration of symmetry.

    The Septum:
o    A nose with a deviated septum, causing breathing problems, requiring fixing of the whole septum,
o    A chronically stuffy nose, allergic rhinitis, sinusitis and such functional defects, requiring fixing of the septum. Surgery on the septum requires a thorough pre-surgical consultation with an ENT specialist. This is not a purely cosmetic procedure and usually requires a parallel medical treatment as well to be effective.

At what age?

It is safe to perform Rhinoplasty on patients from a minimum age of 16 years. By this time, the patient’s nose is fully developed. However, it may be advisable to wait for another couple of years, until the patient is 18-20 years of age, except in cases of post-adolescent emergency. On the other end of the range, Rhinoplasty is very effective when performed in patients younger than 65-70 years of age.

Anesthesia

Most procedures of Rhinoplasty are performed under general anesthesia. However, it is sometimes carried out under a deep sedation (neuroleptanalgesia) along with local anesthesia. In most cases requiring very minor and localized changes (for example, refinement of the tip), local anesthesia is considered sufficient.

Recovery

All the procedures require a short period of hospitalization of about 24-48 hours. Recovery is virtually painless. Upon awakening, the patient will have mini-sponges plugged into the nostrils, but these will be removed within 48 hours.

In cases where the procedure involves the septum, mini silicone plates will be in place, and these will be removed along with the dressing plaster on the eight day after the surgery.

There may be a mild swelling and bruising (blue) of the lower eyelids and upper cheeks. Salt water rinsing, and oily nasal drops will be administered twice a day during the recovery period.

Scars

The only visible signs of the procedures are sutures made of absorbable mucous membranes, which are mostly concealed within the nose.

It is possible to ensure that the scars from the surgery are totally concealed within the nostrils, especially if the nostrils are wide enough.

In some difficult cases with some complications, or in cases requiring a revision surgery, it may be necessary to make a very discreet incision of about 3 mm, at the base of the nose, in between the two nostrils.

Results

It may take about 6-12 months for the nose to fully heal. However, just after the initial 2 months, the nose more or less achieves the final intended appearance. In general, the nose is in pretty solid shape after the first 2 months, but the finer contours and details, like the tip of the nose, develop gradually over time. Exposure to sun is to be strictly avoided for a month.

In case of minor irregularities, like a mild asymmetry of the nose tip etc., an additional revision surgery is recommended after the first year, under local anesthesia.

Conclusion

Rhinoplasty is now a well codified and established procedural technique in the realm of cosmetic surgery. The procedures are carried out in controlled and well-planned environments and the state-of-the-art techniques used for these procedures help achieve a near-perfect reconstruction of the nose.

Gone are the days when a nose procedure was clearly visible for all to see. Nowadays, an excellent surgeon, with the help of modern surgical techniques, can easily achieve a completely natural look, with the nose totally blending in with the patient’s face and personality.

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Docteur Dany GZAÏEL - Cosmetic & Aesthetic Surgery

Doctor Dany GZAÏEL - Cosmetic & Aesthetic Surgery 

18, Rue de Magdebourg
 75116  PARIS - FRANCE
Tél : +33 1 45 05 26 16

Fax : +33 1 46 21 85 42-docteurgzaiel@free.fr