Rhinoplasty

The nose is a prominent feature of the face. Its modification can significantly affect the overall appearance of a person. Therefore, any nose reshaping is considered an aesthetic procedure – an act of cosmetic surgery. The goal of nose surgery, known as rhinoplasty, is to reshape the outward appearance of the nose to match the patient’s expectations. Today, there are no alternative methods that effectively reshape the nose. In some cases, the deviation of the nasal septum is also corrected, which is beneficial for better breathing and drainage of the surrounding nasal cavities.

Appearance and aesthetics play a role

Rhinoplasty is a plastic surgery procedure that reshapes the nose and/or improves its functionality. Some people are interested in so-called aesthetic (cosmetic) rhinoplasty for a more beautiful appearance of the nose. They want to change its shape, size, profile, tip, or other characteristics, which will ultimately affect the appearance of the entire face.

Rhinoplasty and its most common aesthetic reasons:

• enhancement of a nose that is “like an onion”, hooked, droopy, etc.
• reduction of the nose (in some cases even enlargement) to make the face proportionally balanced
• getting rid of bumps on the bridge of the nose, or other irregularities
• improving the appearance of the nose due to previous injury/fracture of the nose
• fixing the appearance of nostrils that are too wide, small, large, etc.

However, there are many people who have to undergo what is called a functional rhinoplasty, which improves breathing and nasal function.

Rhinoplasty and its most common medical reasons:

• correction of a congenital abnormality (e.g. cleft lip)
• repair of blocked nasal passages (deviated septum)
• restoring breathing function after illness, cancer treatment, traumatic injuries or burns,
• repair of deviated septum.

Rhinoplasty is a surgical procedure that modifies a part of the body. The resulting effect will last a lifetime. Therefore, it is important for patients to be realistic about the expected results and have realistic ideas about how rhinoplasty will affect their lives.

The main positive aspects of this plastic surgery include:

• improvement of breathing through the nose
• improvement in facial appearance, leading to increased self-esteem, more socialization, reduction of stress and anxiety about self-perception and self-complexity
• correction of any structural abnormalities of the nose

Rhinoplasty is one of the most complex operations in the field of plastic surgery and requires a high degree of imagination, skill and experience on the part of the surgeon, especially since some adjustments are made without direct visual guidance. Nose shape abnormalities can be congenital or the result of trauma, and some can lead to respiratory problems caused by poor patency of the nasal passages. Before proceeding with surgery, it is important to consider a number of factors – such as functional and aesthetic status – for proper indication of the procedure.

The most commonly problems leading a patient to rhinoplasty include:

• bump on the nose
• nose that is too wide
• wide tip
• deviated septum
• saddle nose and others.

Before surgery, it is essential to carefully consider all details, including tissue quality and other individual factors, and tailor the surgical plan according to the diagnosed findings. As part of the consultation process, it is crucial to do a thorough analysis to identify and clarify any possible unrealistic expectations of the patient.

Rhinoplasty is more than just a nose job. What is rhinoplasty from the point of view of a specialist – aesthetics? 

Rhinoplasty options and techniques

The field of rhinoplasty offers the following options:

• Aesthetic (cosmetic) rhinoplasty to improve the appearance of the nose and face.
• Functional rhinoplasty to restore the function and form of the nose. This type of reconstructive surgery can also be used to correct birth defects and deviated septum.
• Secondary rhinoplasty, which revises or corrects any problems that occur after the first rhinoplasty. Sometimes with complicated rhinoplasty procedures, even the best plastic surgeon can’t avoid this, although the correction tends to be more complex.
• Septoplasty, which is performed to correct deviation of the nasal septum. The nasal septum is a thin septal structure that separates the left and right nostrils. Septal deviation occurs when the septum is displaced from its normal position and causes blockage of the nasal passages, which can lead to breathing problems and other health problems such as recurrent nosebleeds, upper respiratory tract infections, influenza or chronic sinusitis, or chronic cough associated with nasal problems. During septoplasty, the plastic surgeon either makes incisions or manipulates the cartilage and tissues of the septum to flatten them. This procedure is usually performed under general anesthesia or local anesthesia with sedation and can take anywhere from 30 minutes to several hours.

There are two main rhinoplasty techniques: open and closed.

In open rhinoplasty, the surgical approach to the nose is made by making a vertical incision in the middle of the nose (columella) – the thin tissue that separates the nostrils. Once this incision is made, the cortex of the nose skin is turned upward, allowing the surgeon direct access to the structures inside the nose. The surgeon is able to precisely manipulate all structures of the nose, such as cartilage, bone, and tissue, thereby addressing the correction of nasal abnormalities. Open rhinoplasty is often used for more complex surgical procedures, such as nasal reconstructions after injuries or complex aesthetic interventions. The advantage is that the underlying anatomy of the nose is clearly visible, leading to more precise corrections as well as the ability to more easily access problem areas. However, this surgical approach can have a longer recovery period and a larger visible scar compared to closed rhinoplasty.

Closed rhinoplasty is a minor intervention to reshape the nose. During it, the plastic surgeon works through internal incision sites, which means there is no external scar to be visible after recovery. This approach to nose reshaping is often suitable for patients who are looking for subtle changes or have minor nose corrections. Benefits include less risk of scarring and a shorter recovery period compared to open rhinoplasty. Still, closed rhinoplasty can be more technically challenging because the surgeon works with limited access and less visual information about the internal structures of the nose.

Who is rhinoplasty indicated for?

Patients may decide for rhinoplasty for a number of reasons. These are usually divided into aesthetic and medical. From an aesthetic perspective, the surgery is often sought to address aesthetic deficiencies such as nasal asymmetry, inappropriate nose tip size, nasal bumps, or nasal curvature, which can cause patients to feel dissatisfied with their appearance and negatively affect their self-esteem.

Functional reasons for surgery may include breathing problems, such as those caused by deviated nasal septum or other structural anomalies, which can be effectively corrected by plastic surgery to improve not only the aesthetics but also the functionality of the nose.

Psychological aspects of rhinoplasty

For many patients, an unsatisfactory nose can be a source of psychological discomfort. Rhinoplasty offers a solution that leads to the “creation” of a nose that meets the patient’s aesthetic expectations and enhances his or her self-esteem and self-satisfaction. Such a positive change can also have an impact on the patient’s social life, job satisfaction and interpersonal relationships. It is important to have realistic expectations and to thoroughly discuss all aspects of the surgery with a qualified surgeon who can offer a procedure tailored to your individual needs.. How can rhinoplasty change a patient’s life?

Rhinoplasty before and after

Before undergoing rhinoplasty, like any other plastic surgery, you will have a consultation with a plastic surgeon. During this consultation, you will discuss about a variety of factors to determine if you are a good candidate for surgery and to ensure that the procedure is consistent with your desired results:

Your goals: express what changes and final result you would like to see on your nose in terms of appearance, what your overall expectations are.

Nose reshaping options: your surgeon will explain the different nose reshaping options available to you. This includes both aesthetic changes and functional improvements related to breathing.

Medical history: your surgeon will ask about your medical history, including any existing medical conditions, allergies to medications, and previous medical treatments or surgeries. It is very important to provide accurate information to ensure your safety during surgery. This, too, may weigh in on whether you will ultimately be able to undergo rhinoplasty.

Examination and measurement of the face: The surgeon will examine and measure your face, paying particular attention to your nose, which is usually also captured in photographs, to enable a ‘before and after’ assessment of the rhinoplasty.

Post-surgery recommendations: People want to have a clear idea of what to expect after surgery, including how long the recovery will take, what the final appearance will be like, and what the possible risks and complications are.

Risks and complications

All surgical procedures, including rhinoplasty, carry some degree of risk. Possible complications include:

• Perforation of the nasal septum
• Infections
• Bleeding from the nose
• Poor wound healing
• Skin discoloration
• Unsatisfactory appearance
• Change in the sense of smell
• Pain
• Scarring, etc.

Rhinoplasty and its healing process is very individual. It is common that sometimes the body reacts to the surgery in different ways, e.g. by so-called asymmetric healing.  This is swelling that affects one side of the nose and not the other. This makes your nose look crooked, but it is not a defect, just a reaction to the recovery. It can occur during the first few weeks after surgery.

Recovery and duties after surgery

Depending on the complexity of the case and other circumstances, rhinoplasty may be an outpatient procedure or the patient may be hospitalized for a period of time.

The plastic surgeon will also assess whether it will be performed under general anaesthesia or only under local anaesthesia, where the nose is numbed or intravenous anaesthesia is administered.

After rhinoplasty, you will experience mild to moderate pain and discomfort. The pain should decrease or disappear a few days to a week after surgery. During this time, you may take over-the-counter pain medications.

After nose surgery is is applied:

• a small plastic splint to minimize swelling and maintain the new shape of the nose during healing. The splint is worn for one to two weeks
• cotton gauze, placed inside the nose. It is worn up to a maximum of two days after surgery, as instructed by your doctor

The nose is specific in that it can take up to a year to fully recover and to “fit” as it should. Immediately after surgery, you will have swelling for four to six weeks, which slowly decreases after three months. Between three months and a year, your nose is still healing and swelling may still be present. You will see full results after your nose is completely healed, which is usually after one year. The timeline varies from case to case.

If you want to speed up the healing process in the first few weeks after rhinoplasty, you can try:

• Applying cold compresses (not ice) to the cheeks or under the eyes (not directly on the nose)
• Keeping your head elevated, especially when sleeping
• Minimise exposure to the sun
• Don’t blow your nose
• Avoid any impact on the face
• Be careful not to put too much pressure on the bridge of your nose when wearing glasses or sunglasses
• Do not lift anything heavy

You should return to work one to two weeks after the procedure. Avoid lifting heavy weights for the first four to six weeks. As for exercise, light exercises are recommended from four to six weeks.

Rhinoplasty of the nose and its cost

Rhinoplasty prices can vary depending on the clinic, the experience and expertise of the plastic surgeon, the complexity of the procedure and other factors. The total cost may include surgical fees, anesthesia fees, preparation and post-operative care fees, and other potential costs.

However, the cost of rhinoplasty should not be the only factor in your choice. It is also important to consider the experience and expertise of the surgeon, the comfort of the clinic, and the friendliness of the medical staff.  People often turn to a specialist also based on reviews, experiences and stories of other patients who have undergone rhinoplasty.

Qualifications and experience of the plastic surgeon

The best surgeon for rhinoplasty is the one who has as many surgeries of this type in his portfolio as possible, an eye for detail and sufficient qualifications. Whether you choose the city of Bratislava or another city as the location for your rhinoplasty surgery, make sure that your plastic surgeon has a wealth of experience and is regularly educated through training or workshops to help achieve the desired results.

Alternatives to surgery

If you are one of those people who are afraid of surgery, you can look for alternative ways to improve the appearance of your nose, such as non-invasive procedures or contouring techniques with the help of fillers.

Filler rhinoplasty uses fillers or injectables to sculpt the nose, such as hyaluronic acid, which is injected into certain parts of the nose to achieve the desired aesthetic changes. These fillers can be used to increase the size of the nose, flatten unevenness, reduce bumps, or make other minor corrections to the shape. Benefits of filler rhinoplasty include a minimally invasive approach, a faster recovery period, and minimal time away from work or normal activities. However, this type of rhinoplasty has limitations and is not suitable for all types of nasal abnormalities or aesthetic goals. Results may last only a few months or years depending on the filler used.

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