What is rhinoplasty?
The nose is located in the center of the face and affects the entire facial appearance. Its function in breathing is also very important. Perhaps it is one of the organs “whose perfection is most desired”. This may explain why rhinoplasty and septoplasty surgeries are among the most common surgical procedures.
What should you expect from nose surgery?
Rhinoplasty surgery is not a monotonous surgery where the same path is always followed and the same procedure is always performed. Many techniques have been described for rhinoplasty surgery, all aimed at correcting a different problem. During surgery, the techniques that are necessary for the patient are selected and applied. With these defined techniques; the nose can be reduced or enlarged; the dorsum of the nose can be corrected; the tip of the nose can be thinned or thickened; the length of the nose can be shortened or lengthened; the width of the nose can be increased or decreased; changes can be made to the tip of the nose. In addition, structures such as cartilage or mucosa that block the airway can be removed to allow the patient to breathe more comfortably, or vice versa, cartilage grafts can be added to expand the airway and provide support to the nasal structure.
It is possible to make many changes in the nose during rhinoplasty surgery. These changes are shaped by the patient’s wishes and the doctor’s opinions. Therefore, the doctor-patient consultation before surgery is of great importance. For both the patient and the doctor, it is essential to create a healthy interview environment and to take the time to do so.
How is it done?
The skeleton of the nose resembles a pyramid of cartilage and bone structures. This bone and cartilage tissue is in delicate balance with each other and with the skin tissue that covers them. The slightest change in any component of this pyramid will affect the other components without exception. In fact, the secret of success in nose surgeries depends on the preservation of this balance after the changes made in the nose.
On or off?
If you are doing research on aesthetic nose surgeries, you will often come across comparisons between open and closed rhinoplasty techniques. Both techniques have ardent advocates. The constant comparison of these two techniques inevitably creates the idea that there are two different ways of performing aesthetic nose surgeries. While this may seem a bit confusing, the situation is actually not that dire.
There are basically five incisions in rhinoplasty, all made to reach different parts of the nose. Four of these incisions are made inside the nostrils and are not visible from the outside, while only one – the trancholumellar incision – is made below the tip of the nose. Rhinoplasty surgeries using this incision are defined as “open rhinoplasty”. The scar left by this incision is visible from the outside. It usually fades over time, becoming barely noticeable.
In fact, whether open or closed technique is used, the interventions to the cartilage and bone structure in rhinoplasty operations are similar. However, the trancholumellar incision made in the open technique significantly facilitates some procedures, especially for the tip of the nose.
In my own approach, I believe that a thorough preoperative analysis should be performed and that an open rhinoplasty incision is unnecessary unless there is a clear benefit. However, I believe that we should not avoid it if it leads to better results. I do not agree with the view that every nose surgery should be performed with open technique because it clearly reveals the structure of the nose. The skeletal and cartilaginous structure of the nose – if the patient has not had previous surgery – can be revealed to a large extent in the preoperative evaluation only by examination. Therefore, I am in favor of the idea that there is no need to completely remove the skin of the nose, unless an intervention is planned that will require the open rhinoplasty technique.
In addition, the skeletal structure of the nose should not be considered separately from the skin on it. In my opinion, one of the most important disadvantages of the open rhinoplasty technique is that the relationship between the nasal skin and the skeletal structure is disrupted during surgery. This makes it difficult to predict how the skeletal structure shaped during surgery will look when the nasal skin is placed on it. In addition, complete separation of the skin from the skeletal structure may slow down the postoperative healing period and prolong the resolution of edema.
However, there are cases where it is very appropriate and even essential to use the open rhinoplasty technique. A considerable number of the procedures applied in rhinoplasty surgeries, especially the interventions performed on the tip of the nose and the methods used in excessive septum curvatures, are performed more comfortably with the open technique. If these procedures are deemed necessary, the open rhinoplasty technique should not be avoided. The fact that the patient has had previous nose surgery may be a reason to prefer the open technique, as it is easier to evaluate the procedures applied in previous surgeries.
After the surgery, patient 2. On the day, he/she is called for a follow-up visit to remove the tampons. In the other control 6-7 days later, the plaster on the nose is removed.
Patients can stand up within a few hours after surgery and can do their daily work. It is recommended to wait until the plaster has been removed to start work.
After nose surgeries, it may take a certain period of time for the edema to disappear and the shape to settle. This takes a relatively shorter time after closed technique surgeries. Sometimes massage may be recommended to the patient to facilitate the resolution of postoperative edema.