Rhinoplasty

The typical rhinoplasty surgery is the most popular type of cosmetic surgery among Caucasians and especially Mediterranean people. Fastidious nose surgeons consider it the most difficult type of cosmetic surgery for justifiably demanding patients.

The correct diagnosis of the cosmetic problem of the nose constitutes a prerequisite for the right aesthetic result. This will determine the aim of the correction. Every deviation from the normal with regard to the aesthetic features (bridge, nasion, tip, septum, nostrils and labionasal corner) of the nose is recorded. The patient’s view of what is nice as well as any racial and local characteristics of their descent have to be taken into account when making the final decision for the surgical plan.

Respiration control has to be included in the diagnostic approach and the surgical anatomical problems (nasal scoliosis, hyperplasia of the nasal concha, nasal valve) should be located and corrected by the surgeon during the procedure.

The experience and surgical flair of the surgeon in executing the surgical plan are necessary for a successful rhinoplasty. The postoperative course is nearly always smooth, but it is imperative that all postoperative recommendations are followed for the first ten days.

A complete medical history has to be taken preoperatively, including any medication that the patient may be on.

The procedure is preferably performed with general anesthesia. Depending on the aesthetic and functional problem, the surgery may last between 45 minutes and 1.5 hour.

Upon awakening, patients will have a plastic splint and nasal packing in the nostrils. Often, they have to breathe from the mouth. Vision may be blurred for a short while due to the ophthalmic ointment applied during the procedure. The eyelids may be slightly swollen. Patients do not experience any pain either immediately or on the following days. They may be discharged in a few hours, and have to follow antibiotic treatment and use eye drops (collyrium).

On the first postoperative day, bruising will appear in the eyelids. On the second (or third day if the nasal diaphragm was also corrected) the nasal packing is removed by the surgeon at the surgery. This may probably be the only time the patient experiences discomfort. The full and uninhibited respiration, though, will compensate for that. The swelling of the eyelids will subside gradually and by the tenth day everything will be nearly completely normal. That is when the splint is removed and patients may enjoy their new look, bearing in mind that the swelling has not disappeared completely and they can look forward to an even more elegant nose in the days to come.

Revision Rhinoplasty

There is no such thing as a beautiful nose that does not suit a specific face. The correct assessment of the anatomical features that compose the construction of the nose will always bear a result that matches the surrounding aesthetic features. Since the visual image is usually comparative, correct rhinoplasty also enhances the image of the surrounding aesthetic features (the eyes and cheeks are accentuated and the upper lip is released if necessary). If the surgeon does not respect all these principles, the patient may have to undergo revision surgery, which implies financial cost, mental hardship and uncertainty regarding the result. In any case, correct rhinoplasty from the beginning is the best result than any revision.

Revision rhinoplasty is a more difficult case that requires special surgical flair and the right approach to the problem. In the case of revision, and provided it is necessary, the surgeon must not spare any of the surgical techniques that plastic surgery offers, even if the procedure develops into major surgery. Because of the previous procedure, the relationship of the anatomical features has been altered and scars may hinder the surgical preparation. A reasonable amount of time (eight to ten months) has to go by between the first and the second surgery, so that the scar may maturate. The medical process (medical history, diagnosis of the problem, surgical plan, surgical treatment) has to be followed to the letter. A rough diagnosis of the problem is performed (saddle nose, supratip deformity, open book bones, etc) and the course of the surgery is determined. The need to restore cartilage deficiency has to be evaluated and the source selected (diaphragm, era pinna or ribs). The same applies for restoring bone deficiencies, with the source being the external layer of the skull. On rare occasions, the original surgery is incomplete, in which case the revision surgery is simple and follows the steps of the typical rhinoplasty.