Rhinoplasty (Nose Aesthetic Surgery)
Ear Nose Throat Diseases
What is Rhinoplasty?
Rhinoplasty, commonly referred to as a nose job, is a surgical procedure aimed at enhancing the appearance of the nose for aesthetic purposes. While it may have a concise definition, rhinoplasty is a complex and intricate surgical procedure with various factors to consider. Sometimes, individuals may consider rhinoplasty due to their own desire for a more attractive nose, or it may be suggested by a doctor for medical reasons or minor nasal obstruction. Therefore, the patient undergoing rhinoplasty should be satisfied with the results, and their expectations should align with those of their surgeon. Proper psychological assessment of the patient, clear communication of expectations, and potential outcomes to the patient and their close circle are essential aspects of the process. For instance, it should be communicated to patients beforehand that a significantly large nose cannot be transformed into an extremely small "button" nose, or that a very long nose may only be partially reduced in size. Every nose is unique, and the post-operative result should appear natural and pleasing to the individual and those around them.
Preoperative Assessment for Rhinoplasty
Thorough patient history should be obtained.
A psychological analysis of the patient should be conducted.
An ear, nose, and throat (ENT) examination should be performed. In cases of severe nasal congestion due to conditions such as significant allergies or nasal polyps, surgical procedures that narrow the nasal passage, like osteotomies (bone-breaking) or reduction surgery, should be considered cautiously, as reopening a severely obstructed nose may not yield optimal results.
Radiological examinations may be required if deemed necessary.
Before-and-after photos can be used to create a simulated image of the potential outcome using Photoshop.
Patients should receive detailed information about the rhinoplasty process.
Who is Eligible for Rhinoplasty?
For females, rhinoplasty is generally considered after the age of 17, while for males, it's usually after the age of 18, assuming that bone development is complete. While the upper age limit for rhinoplasty is debated, some surgeons prefer to limit it to around 50 years for both genders.
Patients may come with reference images of the desired nose. Alongside genuine requests, patients who believe that rhinoplasty will make them exceptionally handsome or beautiful should be presented with realistic expectations of potential changes post-surgery.
Rhinoplasty Surgery
Rhinoplasty techniques can be broadly categorized as open and closed. In general, around 90-95% of rhinoplasties worldwide are performed using an open technique, but closed techniques are also applicable. Experience plays a crucial role in rhinoplasty, and even in revision rhinoplasty, minor closed adjustments can yield excellent results. Personally, I tend to use the closed technique for noses that do not have significant asymmetry in the tip area. The key difference between the two techniques lies in the visibility of nasal structures and the ease of surgical maneuvers. The most important principle is to ensure that each nose appears different before and after surgery, while also maintaining a natural look. After rhinoplasty:
The nasal tip angle should be approximately 90-95 degrees for males and 100-110 degrees for females.
The nasal dorsum (bridge) should be straight in males and slightly curved in females.
Nasal nostrils (alar bases) should be symmetric.
Most importantly, the nasal airway should be open and allow for comfortable breathing.
Over the years, the fundamental principles of rhinoplasty have remained relatively consistent, but advances in suture materials, surgical instruments, and the use of grafts (either from the patient or synthetic) for strengthening nasal structures have become more prominent.
Surgery durations can vary but generally range between 2 to 3 hours. For traumatic nasal anatomy or revision rhinoplasties, the procedure may take longer.
Patients typically wear silicone or soft merocel nasal packing for 1 to 2 days, followed by metal, plastic, or plaster splints for around 7 days.
After the splints are removed, the nose will appear swollen and may have some bruising. While approximately 90-95% of the final result is achieved within the first month after surgery, the nose will continue to settle and reveal its true shape over 6 to 9 months, depending on skin thickness.
Complications of Rhinoplasty
Complications can be categorized as early and late.
Early complications are rare but may include bleeding, temporary infection within the first weeks, temporary nasal congestion, bruising, and swelling.
Late complications, which occur in around 15-20% of cases, may necessitate revision surgery. These can involve deformities of the nose (e.g., twisting, asymmetry, an open nasal dorsum, or a collapsed nasal bridge), nasal adhesions, septal perforations (holes in the nasal septum), nasal obstruction, among others. It's essential for surgeons to be prepared for and address these complications when they arise.