Rhinoplasty (nose plastic surgery) is a correction, restoration, correction of the structure of the nose by plastic surgery techniques. It is used for medical and aesthetic reasons.
Despite its prevalence, nose correction operations are still considered one of the most difficult.
Nose repair operations have been performed for thousands of years. Ancient manuscripts testify to the successful experience of such procedures long before our era.
Medicine has come a long way compared to ancient physicians, and modern rhinoplasty is more of a cosmetic procedure than a medical necessity.
Indications for rhinoplasty
Every plastic surgery is a complex creative process that combines issues of solving aesthetic problems with the preservation or restoration of certain functional characteristics of organs (in this case it is nasal breathing).
Thus, rhinoplasty can be performed for therapeutic and aesthetic purposes. The optimal age for its performance is 25-35 years.
Medical indications are:
- congenital deformity of the nasal septum;
- polyps and turbine hypertrophy;
- traumatic injuries and posttraumatic changes in bone, cartilage, physiological (due to uneven tissue development) or compensatory curvature of the nasal septum;
- pronounced violation or complete absence of nasal breathing.
Changes in the proper anatomical structure of the nose are very often the cause of functional disorders and pathological conditions - shortness of breath, atrophy or hypertrophy of the nasal mucosa, rhinosinusitis, otitis media, frequent respiratory diseases, night snoring.
In addition, in children, such deficiencies can cause chronic oxygen starvation in the brain, which leads not only to their physical but also mental retardation, and affects their mental development and behavioral reactions. Therefore, rhinoplasty can also be performed on children under 18 years of age.
More than 60% of the reasons for rhinoplasty are the patient's desire to improve the shape of the nose in order to achieve complete harmony of its appearance. Plastic surgeon services are becoming increasingly popular. Aesthetic indications for rhinoplasty are divided into two major groups:
- goal - these are disproportionate and unattractive sizes or shape of the nose;
- subjective or psychological: there are no special criteria for assessing beauty, each person has their own established stereotype, and therefore, simply for personal reasons, they may not like the nose.
These reasons often affect people's professional and personal relationships, give birth to dissatisfaction complexes, and their own inferiority, especially in the female environment, leads to social maladaptation.
Rhinoplasty for aesthetic purposes is indicated in cases where there are:
- disproportionate size of the nose in relation to the whole face - too large or, conversely, too small;
- congenital or acquired deformities;
- curvature of the nasal septum;
- dilated nostrils, hump;
- forked, lowered or too raised, asymmetrical tip, as well as its mismatch with the height of the nasal dorsum;
- saddle shape;
- an aesthetically unsatisfactory result of a previous operation.
In many cases, the medical and aesthetic indications are the same and are the result of the same anatomical defects.
Types of rhinoplasty
In accordance with the desired goal and technique of performing the surgical intervention, rhinoplasty is divided into:
- Reconstructive, whose purpose is to restore anatomical disorders resulting from improper intrauterine development, traumatic injuries or disease.
- Aesthetic - correction of existing defects.
According to the same criteria, there are several types of rhinoplasty:
- Reduction or enlargement of the nose.
- Backrest alignment - straightening the indentation in the saddle or removing the hump.
- Correcting aesthetic imperfections of the tip.
- Septum correction (septoplasty).
- Posttraumatic reconstruction of the structure.
All types of operations are divided into:
- primary;
- secondary;
- repeated.
Access techniques
When performing rhinoplasty, depending on the possibilities of access, the following techniques are used:
- Closed rhinoplasty,in which incisions can be made in the nasal cavity. The closed approach is divided into marginal (along the inner surfaces of the nasal wings), transseptal, inter-, and transchondral. After the incision, the soft tissues separate (separate) from the cartilage and bones that make up the frame, which allows you to freely perform the necessary manipulations. Closed rhinoplasty is less traumatic than open rhinoplasty and eliminates arterial damage and tissue malnutrition, and postoperative scars are completely invisible because they are located in the nasal cavity. It is most often used, especially for aesthetic rhinoplasty.
- Open rhinoplasty- the incision passes along the columella (the skin part of the folds between the nostrils) and on the wings of the nose at their junction with the lip. The technique is used in cases that do not allow to achieve the task in another (closed) way. It allows you to lift the soft tissues and cartilage upwards, to get enough access to the inner parts of the nose and to perform manipulations under constant visual control. Open rhinoplasty is necessary in order to correct especially serious changes and technically complex and significant operations - pronounced deformation of the nose, especially with lateral displacement; a combination of a nasal deformity with malformations such as a "cleft lip" or a crack on the hard palate; grafting reconstruction. The disadvantage of open rhinoplasty is the formation of a noticeable postoperative scar, as well as forced damage to the columella arteries, resulting in significant and prolonged edema of the postoperative tissue.
Rhinoplasty of any type is performed under one of the types of general anesthesia and usually lasts 1-2 hours. Sometimes their duration can reach three or more hours.
How is rhinoplasty performed?
The operation is performed in the following sequence:
- nasal septum correction is performed;
- if necessary, the scales of the nose are reduced;
- the nasal hump is corrected if it is necessary to form a uniform profile;
- the bones are dissected and moved to narrow the pyramid of the nose;
- straightens the nose;
- tip correction.
Rhinoplasty revision
Replacement of the nose is considered if surgical intervention has already been performed in this area. The final formation of the nose after plastic surgery occurs in six months - a year. This period is optimal for reoperation. It is performed when:
- the condition of impossibility to achieve the goal in one phase;
- unsatisfactory results of primary surgery;
- the need to correct problems that remain after primary rhinoplasty.
According to world statistics, 25-30% of patients who undergo primary rhinoplasty need another corrective surgery. This is considered normal. It usually lasts a maximum of half an hour and is performed under local anesthesia. Rhinoplasty corrective revision allows you to correct the defects of scars and bring the shape of the nose to an aesthetic result that will satisfy the needs of the surgeon and the patient.
It is much more difficult to repeat rhinoplasty in cases of poorly performed primary or unfavorable course of the rehabilitation period, which often depends on the individual characteristics of the organism and complications. Such operations require deeper examination and more thorough preparation. They represent a full-fledged plastic according to one of the options, but, as a rule, they turn out to be much more complex and long-lasting. Minor defects during repeated plastic surgery can lead to a final shape disorder, not only, for example, the tip, but also to a pronounced deformation of the entire nose.
Complications and preparation for surgery
Nose plastic surgery is considered to be one of the most difficult plastic surgeries whose outcome largely depends on the skill and experience of the surgeon. Complications occur in 4-15% of cases. They can be postoperative (bleeding, cracking of the skin, rupture of the muco-cartilage lobe, violation of the integrity of the bone pyramid, bone fractures, etc. ) and postoperative.
Possible complications after rhinoplasty:
- functional - atrophic rhinitis, difficulty in nasal breathing, loss of smell, temporary or permanent reduction or complete loss of sensitivity of the skin of the nose and upper lip;
- aesthetically - without changing or exacerbating previous defects;
- psychological - patient dissatisfaction with the results of plastic surgery;
- infectious - prolonged swelling and inflammation, suppuration;
- nasal skin pigmentation, blood vessel formation, mucosal adhesions, and rough scars;
- recurrent nosebleeds and soft tissue or cartilage necrosis.
Preparation consists of:
- Consultations with a plastic surgeon, during which the technical possibilities of fulfilling the patient's wishes are determined.
- Conducting general studies - clinical and biochemical blood tests, blood clotting test (coagulogram), general urine analysis, tests for hepatitis, HIV, syphilis (RW), ECG.
- Perform (if necessary) special studies - imaging of the paranasal sinuses, endoscopic examination of the nasal cavity to identify concomitant anomalies and pathological changes.
- A computer simulation that allows the patient to compare the initial condition of the nose with the results of future rhinoplasty.
- Consultations with therapists and specialized specialists (in the presence of chronic diseases).
- Examination by an anesthesiologist after all examinations.
- Refusal two weeks before surgery to take drugs that affect the processes of blood clotting - acetylsalicylic acid and its analogues, anticoagulants.
- Stop taking sedatives and sleeping pills on the day of the intervention.
Contraindications and rehabilitation
Absolute contraindications for rhinoplasty:
- the presence of any chronic systemic diseases in severe form (endocrine, cardiovascular, pulmonary);
- acute infectious diseases;
- blood clotting disorders;
- menstrual days.
Basic recovery from rhinoplasty takes up to 3 weeks. However, the deadline for the complete end of the rehabilitation period, when the results are assessed, is determined by the doctor and is 6-12 months. During that time, certain restrictions must be respected.
After 1-1, 5 weeks after the intervention, the plaster and sutures are removed. During the first two weeks, do not wash with hot water or take hot baths, as bleeding, bruising and swelling that may spread to the whole face and neck may occur. It is necessary to sleep only on the back in an elevated position, which helps to facilitate breathing and reduce swelling. It is advisable to wear a face shield in dusty places. Bending and lifting weights should be avoided.
Also, within 3 months, you must stop using glasses and wear tight or heavy hats. You can’t visit the pool and sunbathe for 3 months. For hot weather and sun, an umbrella or a wide-brimmed hat is recommended.
When planning rhinoplasty options, an experienced surgeon adheres to the principle of three types of restrictions: restrictions set by the surgeon himself; restrictions imposed by the patient; limitations associated with the patient's condition and anatomical characteristics of the nose.
Price
The cost of surgery depends on the complexity of the correction.
Testimonials
Women's review
"I've always had complexes because of the shape of my nose. I've had it for too long, with a hump and the tip of my nose seemed to part. and better. They removed all the flaws. They even restored the septum, the defect of which I didn't even know. My nose is perfect, just like me. "
Review of a man
"After I broke my nose a few times, my nasal septum moved. I couldn't breathe normally, I snored a lot at night. The diagnosis showed temporary breath holding. The nose looked ugly, it was moved to one side. I have rhinoplasty how. I would straighten my nose and get rid of the problems associated with moving the septum. I did it. I'm happy with the result. Now my nose is normal, as it was before the fracture. It always breathes and I don't snore anymore. "
Rhinoplasty is not always a fad, but it is most often justified by objective need. It is important to choose a competent surgeon and ensure that you have no contraindications for the procedure.