Rhinoplasty


Introduction


Rhinoplasty is one of the most frequently performed surgical procedures in plastic surgery. It is a surgery designed to modify the shape and size of the nose in order to achieve a better facial harmony.

Rhinoplasty can decrease or increase the size of the nose, change the shape of the tip or the back, narrow the nostrils or change the angle between the nose and the upper lip. Besides being a key element in facial aesthetics, in many cases rhinoplasty has a restorative and functional function since it corrects congenital problems, trauma and some breathing problems.

Who is the ideal candidate for rhinoplasty?

The ideal candidates to undergo rhinoplasty are those people who seek to solve an aesthetic problem, an improvement, and not the absolute perfection in their appearance.

The most important thing is to have realistic expectations about the results you can achieve, so it is essential to talk with your surgeon and discuss together the desired result.


Surgery duration

1 hour

Bed

4 hour

Recovery

1 week

Anesthesia

Local with sedation or general

Effect

1 week

Results

Permanent


Procedure

Rhinoplasty is a surgical procedure that usually lasts between one and two hours and is usually performed under general anaesthesia, although it can also be carried out under local anaesthesia and sedation. This will depend on the complexity of surgery and the surgeon’s preferences. Talk to your doctor before surgery about which type of anaesthesia is the best for you. Usually, you do not need to spend the night at the clinic.

The upper part of the structure of the nose is bone and the inner part is cartilage. Rhinoplasty can modify the bone, cartilage, skin, or all three.

At the Planas Clinic we perform Ultrasonic Rhinoplasty, which is an innovative technique introduced in Spain by Dr. Jorge Planas. It consists of the use of an ultrasonic device that maximises the precision of surgery and makes possible to smooth and reshape the own bones of the nose without damaging the soft tissues or blood vessels; which minimise bleeding and bruising, as well as reducing postoperative discomfort and avoiding the uncomfortable tamponade.

Ultrasonic Rhinoplasty Video

Rhinoplasty can be carried out inside the nose or through a small external cut (incision) at the base of the nose, between the nostrils. The surgeon will probably realign the bone and cartilage under the skin. The procedure consists of separating the skin from its bone and cartilage support to sculpt the support and then adapting the skin to the new shape.

There are two ways of carrying out this surgery:

Closed rhinoplasty: This surgery is performed through incisions made inside the nostrils so that no external scar is visible. Through the inside of the nose, the surgeon can carve and shape the nasal bones and cartilages and form a new structure. In this way, the skin and mucous membranes retract and adapt until they reach the desired shape.

Open rhinoplasty: It is for the most difficult cases, such as the modification of tip deformities. The surgeon approaches the structures of the nose directly through a small incision at the base of the columella, which will leave a practically non-visible scar.

Each rhinoplasty is a different case that should be carefully evaluated. It is not only a question of reducing or increasing the size of the nose, but of adapting it to the features and characteristics of each person. In this type of aesthetic surgery, it is important to have a dialogue with the patient to see his/her desires and expectations as well as the possibilities of improvement that the surgery offers.

Augmentation rhinoplasty:  Rhinoplasty is not always a reductive surgery. There are patients who need to increase the size of their nose by raising the tip, lifting a sunken dorsum or correcting deformities of congenital or traumatic origin. In these cases, the surgeon usually uses tissue grafts from the patient to give shape or support to the nose.

The technique of dermal regeneration, invented and published by Dr. Jorge Planas, is very useful to correct noses sunken by trauma, previous unsuccessful surgeries, oriental noses or simply noses with a depressed nasal ridge.

The use of the dermal regenerator Integra in rhinoplasty allows generating a thicker dermis to shape the nose, increase the size and/or modify the nasofrontal angle.

The great advantage of this technique is that it does not use any synthetic material, and avoids using .

Video of Sunken Nose

Short nose: Occassionally it is necessary to graft cartilage from the patient themselves to lengthen a short nose.

Video of Short Nose

In the cases where the patient has breathing difficulty, an otolaryngologist will carry out a thorough examination so as to determine what is causing the poor function. In the same aesthetic rhinoplasty surgery performed by the plastic surgeon, the otolaryngologist surgeon will also correct the respiratory function by a septoplasty or cornet surgery.



Results

At Clinica Planas our goal is to make the patient feel happy and comfortable with the new facial harmony after rhinoplasty, with a natural result, without showing an «operated» nose.

During the first few days after surgery, the patient will notice some swelling in the face and bruising will appear. In these first days there may be some concern, but as the appearance improves day by day, the patient will begin to feel happier.

The final aesthetic aspect must follow an evolution that will take not less than six months. It is a slow and progressive evolution that may even go unnoticed. However, it is important to emphasize it to get the final result.



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Pre-operative

Before scheduling rhinoplasty, you should meet with your surgeon to discuss important factors to see if surgery may work for you. The key points to achieve a satisfactory and realistic result of the surgery are: An exhaustive medical history, a physical examination, taking photographs and a conversation to talk about motivations and expectations of the patient.

As in all procedures, a prior medical examination is essential to detect any possible anomaly that could contraindicate surgery. The skin of the nose and its surroundings should not have any inflammation or infection and also any flu or cold that cause nasal congestion symptoms should be controlled.

If there is difficulty breathing, the otolaryngologist will evaluate the patient to indicate the appropriate treatment to improve function.


Aftercare

When surgery ends, the surgeon places a plastic splint, which will help to maintain the new shape of the nose, and will be removed 6 days after surgery.

Depending on the technique, nasal plugs will or will not be placed in both nostrils to prevent bleeding and stabilize the nasal septum. At Clínica Planas we perform the technique of Ultrasonic Rhinoplasty that has the advantage of avoiding plugs. However, if in a specific case the surgeon had to place plugs, they are removed after 3 days.

Return to normality

The postoperative of a rhinoplasty surgery is not painful at all. After surgery, and especially during the first 24 hours, you may have a slight swelling and feel some discomfort in your nose. This discomfort is well controlled with medication.

You will notice that swelling and bruising around the eyes increase up to a maximum of 2 or 3 days. In any case, you will feel much better than you look.

Most bruises and swelling will dissapear in about 2 weeks.

It is normal that a slight nosebleed occur during the first few days. Try to blow gently during the first week until the tissues heal.
In case you have plugs placed in your nose, they will be removed 1 or 2 days later.

If you have a plaster or stitches placed, they will be removed one week later or two weeks at most.

Most patients who undergo rhinoplasty feel well 2 days later, and are able to return to normal activity in a week or so. However, some activities should not be performed until a few weeks later by following the instructions given by the surgeon.


Some recommendations to be followed are: Avoid any kind of rough physical activity (such as jogging, swimming, doing push-ups,...) for 2 or 3 weeks and any activity that put you at risk of hitting your nose, or sunbathing for 8 weeks.
Wash your face and apply makeup carefully. You can put your contact lenses again as soon as you want, but if you wear glasses you should take some precautions.


Immediate Aftercare



F.A.Q.

All patients who breathe badly will also be examined by an otolaryngologist who will diagnose and indicate the treatment to be followed so as to achieve a perfect respiratory function.

If surgery is needed to improve function (either septoplasty or turbinate surgery), the otolaryngologist will carry out surgery at the same time as the plastic surgeon performs the aesthetic rhinoplasty.

When ossification (bone tissue formation) has finished in the facial bones which normally happens between 15 and 17 years of age. Nevertheless, it is always better to wait until the age of 18 before making the decision to operate. 

No, it does not. Normally, no painkillers are needed.

Possible complications are very rare in this type of intervention. An infection may be caused or more nose bleeds than usual, an abnormal reaction to the anaesthesia, or little veins may appear in the skin on the nose which are generally only temporary (very rare complications, but they may appear in any surgical intervention). 


For the first three days of surgery, a small sponge plug must be worn and breathing has to be done through the mouth. Once the plug has been removed, you can then breathe through your nose, although this may be difficult at first as small crusts may have formed inside the nose and there may be unavoidable post-surgical inflammation.

Once the dressing is removed after ten days, your nose will be correctly shaped and rather attractive so as to be able to live a completely normal life. As for the specifics, the final results will need more time, in general around six months. 

You should avoid sun exposure for the first two months after surgery. The area which needs the most protection from the sun is the lower eyelids and if they are exposed to the sun and have any bruising, dark marks can be left in the skin which will take time to disappear. 

Even though it is not visible, swelling produced by the operation remains for a long time. This is very noticeable when wearing glasses as a deep mark is left at the resting point on the nose. There is no contraindication, however it is recommended not to wear glasses for long periods during the first month after the operation. 


Expert opinion

Dr. Jorge Planas
Dr. Jorge Planas

With some of my patients that I often see, either as friends or professionally, I have observed many times that after having rhinoplasty done, they experience a real and positive change in the way of looking at life and the level of their own self-confidence rises considerably.

The results are very gratifying and the best cosmetic surgery helps the patient to forget their previous appearance quickly.

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