RHINOPLASTY - NOSE SURGERY
What is rhinoplasty?
Rhinoplasty is a cosmetic or reconstructive surgery that involves changing the size and shape of the nose . It is performed when the nose is considered unsightly or causes a disability (difficulty breathing through the nose, etc.) .
The plastic/cosmetic surgeon, stomatologist, or maxillofacial surgeon will operate to modify the shape of the bones and cartilage of the nose. They may also insert a silicone prosthesis to fill a hollow, for example. This may be the case following a congenital malformation or an accident. Nasal reshaping can also be 100% aesthetic, when the person is self-conscious about their nose (too big, crooked, hunchbacked, etc.).
Example of rhinoplasty before and after
The image on the right shows an example of a rhinoplasty. On the left is the original photo and on the right is a digital simulation of a rhinoplasty . In this simulation of a nose job, the hump on the nasal ridge was removed and the tip of the nose was reduced and raised. This rhinoplasty simulation was performed using the 3D nose surgery simulation app from chirurgie-avant-apres.fr.
This type of simulation can help you show your surgeon what you would like to achieve. The surgeon then determines whether the operation is feasible.
What are the different types of rhinoplasty?
There are two types of rhinoplasty: open rhinoplasty
and closed rhinoplasty . The difference lies in the incisions made inside and/or outside the nose.
Open rhinoplasty
Incisions are made inside the nostrils and another small incision is made outside, through the columella (the fleshy part between the nostrils). Open rhinoplasty allows for better visualization and direct access to the nasal structures (useful in more complex cases). It leaves a small, visible scar on the columella (under the nose). The scar will become almost invisible over time.
Closed rhinoplasty
All incisions are made inside the nostrils. Therefore, there are no visible scars after surgery. This allows for a faster recovery because the nose is less traumatized and there is less swelling at the tip of the nose. This technique is often used for simple procedures where the surgeon can work beneath the skin without fully visualizing the nasal structure.
In addition to the distinction between open/closed surgery, we also distinguish between aesthetic and functional rhino:
Cosmetic rhinoplasty
Its sole purpose is to modify the visual and aesthetic appearance of the nose. The goal is to erase small defects of the nose and restore the overall harmony of the face.
Functional rhinoplasty
When the malformed or damaged nose is unable to perform its functions:
– smell
– breathing
– filtration
– humidification of the air
The operation restores vital functions in the patient.
Sometimes rhinoplasty is both aesthetic and functional. Surgeons will work on the shape and function of the nose in a single operation or in two operations spaced a few months or years apart. The surgeon first corrects the functional problems and then may intervene again to correct the aesthetic appearance of the nose. This is called rhinoseptoplasty .
Why have a rhinoplasty?
Aesthetic improvement
This is one of the most common reasons for rhinoplasty. It allows for changes in the size, shape, and profile of the nasal bridge, tip, or nostrils, and changes the physical appearance of the patient’s face.
Correction of malformations
Rhinoplasty is used to correct congenital defects:
- nasal abnormalities
- asymmetries
- deformations
- bumps
Respiratory problems
Surgery helps ensure the patient’s respiratory function is functioning properly. Indeed, the operation allows the patient to breathe properly through the nose and stop breathing through the mouth. To do this, the surgeon will deviate the nasal septum or eliminate structural problems that prevent air from passing through.
Injuries or trauma
People who have suffered a nose injury following an accident. This is frequently the case in sports (mountain biking, boxing, skiing, rugby, etc.) and everyday accidents (road accidents, falls, fights, etc.). The surgeon will seek to restore the shape of the nose to its original state.
Effects of aging
The nose can also change with age. Often, the nose sags and becomes droopy over the years. The cartilage grows excessively. Surgery alleviates the effects of aging.
Self-confidence
Improving physical appearance has a positive impact on self-confidence and self-esteem. Surgery improves self-confidence.
Rhinoplasty Before/After Simulations
We simulate rhinoplasty from a photo. Upload your front or profile photo and receive a morphing simulation of your new nose. For any type of nose: too big, too large, crooked, humped, trumpet-shaped, etc.
Is rhinoplasty painful?
Pain during surgery
Rhinoplasty is usually performed under general anesthesia. The patient is unconscious during the procedure and feels no pain. Therefore, the procedure itself is painless. Some minor operations are performed under local anesthesia.
Postoperative pain
After surgery, it’s normal to feel some pain, tightness, and discomfort. The surgeon will prescribe pain-relieving medication. It’s also recommended to apply cold to the area. For this, it’s recommended to use a hot water bottle or a dry hot water bottle that you’ve previously stored in the freezer. Make sure to use the fabric cover to avoid burning the skin.
Swelling and bruising
Swelling and bruising around the nose and eyes are normal after rhinoplasty. While this is not painful in itself, it can contribute to discomfort. Again, cold will be applied to soothe the nose.
Respiratory discomfort
If the surgery is intended to improve respiratory function, the patient may experience temporary breathing discomfort during recovery as the soft tissues swell to decrease.
Sensitivity to touch
The operated area is sensitive to touch for a while. Sensitivity returns quickly (unless a nerve has been damaged).
When to have rhinoplasty?
Facial maturity
Rhinoplasty should be performed until facial growth is complete (late adolescence). This ensures that the results of the surgery are adapted to the final shape of the face.
Health status
The patient must be in good physical and mental health. Unresolved health problems increase the risks associated with surgery and recovery.
Emotional stability
The decision to have rhinoplasty should be made at a time when emotions are normal, neither depressed nor euphoric. This can influence the decision and impair healing.
Planning
Choosing a time when you can take the time you need to recover is essential. Avoid scheduling rhinoplasty before major events or stressful periods (weddings, exams, etc.).
Availability
Make sure you have enough time available for pre-operative consultations, surgery, and recovery. Rhinoplasty requires a period of rest and recovery. It is important to follow the surgeon’s recommendations.
Season
Some patients prefer to schedule rhinoplasty in late fall or winter for better recovery. Care must be taken to protect the nose from the cold.
When to perform a nasal tip rhinoplasty?
Nose tip rhinoplasty is a surgical procedure that modifies the shape or structure of the tip of the nose. This procedure is considered in the following situations:
Nose tip too wide or too narrow :
When the tip of the nose is too large, the surgeon will intervene to remove material. When it is too thin, he will modify the position of the cartilage, insert a prosthesis, or perform injections (temporary benefit).
Asymmetry of the tip of the nose:
When the tip of the nose tilts to the left, right, up (trumpet nose) or down (droopy nose), the surgeon will modify the orientation of the tip of the nose so that it is symmetrical with the rest of the face. We speak of a bulbous (bulbous), square (boxy) or droopy (droopy) tip of the nose.
Tip projection correction :
This refers to the distance between the tip of the nose and the face and the direction the tip of the nose faces. A tip rhinoplasty adjusts the projection to create a more balanced nasal profile.
When to perform rhinoplasty for a wide nose?
Aesthetic dissatisfaction
A nose whose base width is considered too wide. Rhinoplasty reduces this width and creates a slimmer, more defined appearance.
Harmonization of facial features
If the nose is perceived as too wide in relation to other facial features, surgery can help achieve a more aesthetic balance.
How to find a surgeon for rhinoplasty?
Recommandations
Talk to friends, family, and colleagues. They’re sure to know someone who’s had surgery and can offer advice. Their experiences and recommendations are invaluable.
Reviews
Research different surgeons in your city and read reviews, being vigilant about fake reviews.
Initial consultation
Meet with several surgeons to discuss your goals and ask questions. Surgeons will be able to show you the results of their previous rhinoplasties. This will help you get to know the surgeon and their approach better.
What are the risks of rhinoplasty?
Bleeding
Excessive bleeding may occur during or after surgery. Severe postoperative bleeding may require re-hospitalization.
Infections
Although infections are rare, there is a risk of infection after any surgery. Antibiotics may be prescribed to prevent infections. All postoperative instructions should be followed to reduce the risk.
Anesthetic Reactions
Adverse reactions to anesthesia can occur, but healthcare workers are trained to react quickly.
Bruising and Swelling
Bruising (accumulation of blood) and swelling are side effects of surgery. They contribute to postoperative discomfort. To combat this, it is recommended to apply cold with a hot water bottle.
Healing Problems
Healing is not the same for all patients. It is important to follow the surgeon’s advice , especially for nasal washes.
Alterations in sensation
Changes in sensation in the nose may occur (numbness or tingling).
Asymmetry
After complete healing, it is not uncommon to notice slight asymmetry.
Aesthetic dissatisfaction
The final result may not meet the patient’s expectations. Discussion with the surgeon during preoperative consultations is essential to avoid this. It is strongly recommended to have a before/after photo simulation before the operation to ensure there are no misunderstandings with the surgeon.
What are the steps of a rhinoplasty?
1) Initial consultation
This is the first meeting with the surgeon. You present your aesthetic or functional concerns and express your expectations regarding rhinoplasty. You can bring a simulation to demonstrate exactly what you would like. The surgeon examines the nasal structure, takes photographs, and assesses the feasibility of the operation.
2) Simulation
A simulation is performed to simulate the result using a rhinoplasty simulator . This will help the patient visualize the result they would like to achieve. Some surgeons include simulation in their service.
3) Preparation for the intervention
Medical examinations
The patient undergoes medical examinations (blood tests, x-rays, etc.) to assess their general health and their ability to undergo surgery.
Informed consent
The patient is informed of the potential risks and signs an informed consent form.
4) Day of the intervention
Anesthesia
Before the procedure, the patient is anesthetized. This is usually a general anesthetic (the patient is asleep and unconscious). Local anesthesia is only used for nasal tip surgeries and injections (which are not considered surgical procedures and whose benefits are temporary).
Incisions
The surgeon makes the necessary incisions, either inside the nostrils (closed rhinoplasty) or inside + outside with an additional incision on the columella (open rhinoplasty).
Remodeling of nasal structures
The surgeon modifies the cartilage and bones to achieve the desired result. He may also insert a silicone graft.
Sutures, bandages, plaster and splint.
Once the operation is complete, the surgeon sutures and applies a nasal dressing. This dressing can be external and/or internal. The surgeon may also place packings, a cast, or a splint, which will be removed a few days after the operation.
5) Post-operative period
Medical surveillance
The patient is monitored during the postoperative period to ensure that he or she recovers normally.
Medical prescriptions
Medications (pain relievers and antibiotics) are prescribed to manage pain and prevent infections.
Post-operative instructions
The surgeon will provide detailed instructions on how to care for your nose after surgery. He or she will outline a schedule for returning to normal activities and give you tips for minimizing swelling and bruising.
6) Follow-up
Several post-operative visits are scheduled to assess healing, remove sutures and monitor progress.
Full recovery can take several months and final results will not appear until later due to post-operative swelling.
Developments after rhinoplasty
End of operation
The nose is swollen and bruised.
The first few days after surgery, swelling and bruising are at their peak.
1st week
The swelling begins to go down and the bruises begin to fade.
1st month
Most of the initial swelling disappears, but residual swelling persists.
Internal tissues continue to heal. Results are not yet final.
3 to 6 months
Most of the swelling has gone but minor fluctuations may still occur.
Scar tissue continues to stabilize.
6 months to 1 year
The residual swelling has disappeared.
The results of the rhinoplasty stabilize and the nose takes its final shape.
1 year and older
The results are considered stable.
What is the difference between “thin skin” and “thick skin”?
The distinction between “thin skin” and “thick skin” is an important factor to consider in rhinoplasty, as the nature of the skin influences the aesthetic results of the procedure. Here are the differences:
Thin skin
Thin skin is characterized by a relatively thin skin layer. Changes are more visible with thin skin.
The anatomical details of the nose are more visible. Surgeons are more careful when reducing cartilage and bone to avoid overly visible results and trumpet noses.
Grafting or reinforcement techniques are used to provide structural support when the skin is thin.
Thick skin
Thick skin obscures some of the anatomical details of the nose, making the contours less defined after rhinoplasty. Healing is more complex, and the process of reducing swelling takes longer.
The difference between thin and thick skin has important implications for the planning and execution of surgery. Thick skin increases the risk of crow’s beak nose .
Surgeons must remove more cartilage and bone to achieve the desired results. Thick skin can mask some changes. Additional sculpting techniques are required to achieve natural contours.
What are the benefits of ultrasonic rhinoplasty?
Ultrasonic rhinoplasty (ultrasonic or piezoelectric cutting) is a newer approach to rhinoplasty that uses ultrasonic tools that operate by piezoelectricity to perform cutting, membrane detachment, rasping, and shaping. This technique uses micro-vibrations that allow rasping, cutting, and sanding of the bone with an insert. The advantage is that the inserts have little effect on the soft tissue because they vibrate in time with the tool.
This technique has many advantages:
The use of ultrasound allows for a gentler and more precise approach, which preserves nasal structures. Indeed, this helps minimize trauma to the surrounding tissues.
Ultrasonic instruments reduce bleeding during surgery. This contributes to faster recovery and less postoperative bruising.
Ultrasonic tools allow the surgeon to sculpt the cartilage with great precision. This makes it easier to make subtle changes.
Ultrasonic rhinoplasty is less invasive compared to some traditional techniques.
Ultrasonic cutting avoids the use of tools such as milling machines, which cause overheating and further damage to soft tissue.
What scars are left by rhinoplasty?
Scars resulting from rhinoplasty vary depending on the surgical technique used:
Closed rhinoplasty
The incisions are made inside the nostrils, no external incision is visible.
The scars are completely hidden.
The disadvantage is that access to the nasal structures is limited, making the operation more difficult. The advantage is that the operation is less traumatic and the patient recovers faster.
Open rhinoplasty
The surgeon makes an incision on the columella, which is located between the two nostrils. The scar is usually small and discreet. However, it remains visible, although very well hidden.
This approach provides direct access to the nasal structures, allowing the surgeon greater precision in modifying the shape of the nose.
Scar quality can vary from individual to individual depending on genetic factors, the skin’s ability to heal, and adherence to post-operative recommendations.
What is a cartilage graft?
Cartilage grafting involves harvesting cartilage, usually from the nasal septum (the wall between the two nostrils), the ear, or the ribs, and reimplanting it into the nose. This technique is used to strengthen or reconstruct the nasal structure.
Cartilage grafting is often used to strengthen the tip of the nose. It improves support and creates a more defined tip.
It is used to correct deformities of the nasal cartilage, such as deviations or asymmetries.
Cartilage grafting is used to increase the volume of the nasal ridge (nasal dorsum) and lateral portions (allae). It can also correct a sagging columella. In some cases, a cartilage graft is necessary to reconstruct and correct problems resulting from a previous operation. This is called secondary rhinoplasty.
Details of the operation:
- The surgeon removes the cartilage.
- He shapes the piece of cartilage so that it fits perfectly.
- The cartilage graft is positioned and fixed precisely (sutures).
The Amazing Story of Rhinoplasty
Rhinoplasty is one of the oldest known cosmetic surgery procedures. In fact, its history dates back several millennia. The first documented rhinoplasty is attributed to Sushruta, an Indian surgeon who lived in the 6th century BC.
Sushruta is considered the father of plastic surgery due to his significant contributions to the field. In his medical treatise Sushruta Samhita , he describes a nasal reconstruction technique called ” nasikasadhana .” This procedure was used to repair the noses of people whose noses had been mutilated, for example, due to legal punishments like nose cutting (a punishment in some ancient societies) or other injuries.
Sushruta’s technique involved removing skin from the forehead or cheek to reconstruct the missing part of the nose. The skin was then molded into the shape of a nose. This approach foreshadowed some of the techniques used in reconstructive nasal surgery today.
