Rhinoplasty (nose plastic) is the correction, restoration, correction of the structures of the nose by means of plastic surgery techniques. Used for medical and aesthetic reasons.
Despite its prevalence, nose corrections are still considered one of the most difficult.
Nose repairs have been done for thousands of years. Ancient manuscripts testify to the successful experience of such procedures long before our era.
Medicine has moved one step further than ancient doctors, and modern rhinoplasty is more of a cosmetic procedure than a medical necessity.
Indications for rhinoplasty
Each plastic surgery is a complex creative process that combines the problems of resolving aesthetic problems with the conservation or restoration of specific functional characteristics of the organ (in this case it is nasal breathing).
Therefore, rhinoplasty can be performed for therapeutic and aesthetic purposes. The optimal age for carrying out is 25-35 years.
The medical indications are:
- congenital deformity of the nasal septum;
- polyps and hypertrophy of the turbinates;
- traumatic injuries and post-traumatic changes in bones, cartilage, physiological (due to irregular development of tissues) or compensatory curvature of the nasal septum;
- pronounced violation or complete absence of the possibility of nasal breathing.
Changes in the correct 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 defects can cause chronic oxygen deficiency 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 the age of 18.
Over 60% of the reason for rhinoplasty is the patient's desire to improve the shape of the nose to achieve complete harmony of her appearance. Plastic surgeon services are becoming more and more popular. The aesthetic indications for rhinoplasty are divided into two large groups:
- objective: it is disproportionate and unattractive size or shape of the nose;
- subjective, or psychological: there are no specific criteria for evaluating beauty, each person has their own consolidated stereotype, and therefore, simply for personal reasons, they may not like their nose.
These reasons often affect people's professional and personal relationships, give rise to dissatisfaction complexes and one's inferiority, especially in the female environment, leads to social maladjustment.
Rhinoplasty for aesthetic purposes is indicated in cases where there are:
- disproportionate size of the nose to the entire 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 spine;
- saddle shape;
- aesthetically unsatisfactory result of the 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 aim pursued and the technique of performing the surgery, rhinoplasty is divided into:
- Reconstructive, the purpose of which is to restore anatomical disorders resulting from improper intrauterine development, injury or traumatic disease.
- Aesthetics - correction of existing deficiencies.
According to the same criteria, there are several types of rhinoplasty:
- Reduction or enlargement of the nose.
- Backrest alignment - correction of a saddle depression or elimination of a hump.
- Correction of aesthetic imperfections of the tip.
- Septum correction (septoplasty).
- Post-traumatic reconstruction of the structure.
All types of operations are divided into:
- primary;
- secondary;
- repeated.
Access techniques
When performing rhinoplasty, depending on the access options, the following techniques are used:
- Closed rhinoplasty,where incisions can take place in the nasal cavity. The closed access is divided into marginal (along the inner surfaces of the wings of the nose), transseptal, inter- and transcondral. After the incision, the soft tissues are separated (separated) 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, as they are located in the nasal cavity. It is used more often, especially for aesthetic rhinoplasty.
- Open rhinoplasty- the incision passes along the columella (the cutaneous part of the fold between the nasal openings) 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 to lift the soft tissues and cartilage upwards, to obtain sufficient access to the internal parts of the nose and to carry out manipulations under constant visual control. Open rhinoplasty is necessary to correct especially severe changes and technically complex and significant operations - pronounced deformity of the nose, especially with lateral displacement; combination of deformity of the nose with malformations such as "cleft lip" or a cleft of the hard palate; reconstruction by means of grafts. The disadvantage of open rhinoplasty is the formation of a noticeable postoperative scar, as well as the forced damage to the arteries of the columella, resulting in significant and long-lasting postoperative tissue edema.
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:
- correction of the nasal septum is performed;
- if necessary, the shells 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;
- straighten the nose;
- tip correction.
Revision rhinoplasty
Re-plasty of the nose is considered if there has already been surgery in this area. The final formation of the nose after plastic surgery occurs in six months - 1 year. This period is optimal for reoperation. It is carried out when:
- condition of impossibility of reaching the goal in one phase;
- unsatisfactory results of the primary operation;
- the need to correct the problems that remain after primary rhinoplasty.
According to world statistics, 25-30% of patients undergoing primary rhinoplasty require a second corrective intervention. This is considered normal. It usually lasts no more than half an hour and is performed under local anesthesia. Revision corrective rhinoplasty allows you to correct scar deficiencies and bring the shape of the nose to an aesthetic result that will meet the needs of the surgeon and the patient.
It is much more difficult to perform repeated rhinoplasty in cases of primary or unfavorable course of the poorly performed rehabilitation period, which often depends on the individual characteristics of the organism and complications. Such operations require more thorough 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 complicated and time-consuming. Small defects during repeated plastic surgery can lead to a final disruption of the shape, not only, for example, of the tip, but also to a pronounced deformation of the entire nose.
Complications and preparation for surgery
Nose plasty is considered to be one of the most difficult plastic surgeries, the outcome of which largely depends on the skill and experience of the surgeon. Complications occur in 4-15% of cases. They can be during surgery (bleeding, skin breaks, tearing of the muco-cartilage flap, violation of the integrity of the bone pyramid, fracture of the bone site, etc. ) and postoperative.
Possible complications after rhinoplasty:
- functional - atrophic rhinitis, difficulty in nasal breathing, loss of smell, temporary or permanent decrease or complete loss of skin sensation of the nose and upper lip;
- aesthetic - no change or worsening of previous deficiencies;
- psychological - patient dissatisfaction with the results of plastic surgery;
- infectious - prolonged swelling and inflammation, suppuration;
- pigmentation of the skin of the nose, the formation of a vascular system, adhesions of the mucous membrane and rough scars;
- recurrent nosebleeds and soft tissue or cartilage necrosis.
The preparation consists of:
- Consultation with a plastic surgeon, during which the technical possibilities of satisfying the patient's wishes are determined.
- Conducting general studies - clinical and biochemical blood tests, blood clotting tests (coagulogram), general urinalysis, tests for hepatitis, HIV, syphilis (RW), ECG.
- Performing (if necessary) special studies - images of the paranasal sinuses, endoscopic examination of the nasal cavity to identify concomitant anomalies and pathological changes.
- Computer simulation that allows the patient to compare the initial state of the nose with the results of the future rhinoplasty.
- Consultations with a therapist and specialized specialists (in the presence of chronic diseases).
- Examination by an anesthetist after all exams.
- Refusal two weeks before the operation from taking drugs that affect blood clotting processes - acetylsalicylic acid and its analogues, anticoagulants.
- Stop taking sedatives and sleeping pills on the day of surgery.
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;
- days of menstruation.
Basic recovery from rhinoplasty lasts up to 3 weeks. However, the deadline for the complete end of the rehabilitation period, when the results are evaluated, is determined by the doctor and is 6-12 months. During this period, some restrictions must be observed.
After 1-1. 5 weeks after surgery, the plaster cast and sutures are removed. During the first two weeks, do not wash with hot water or take hot baths, as bleeding, bruising and swelling can occur and spread to the entire face and neck. It is necessary to sleep only on the back in an elevated position, which helps facilitate breathing and reduce swelling. In dusty places, it is recommended to wear a visor. Avoid bending and lifting weights.
Also, within 3 months, you must stop using glasses and wear tight or heavy hats. You cannot visit the pool and sunbathe for 3 months. In hot weather and in the sun, an umbrella or a wide-brimmed hat is recommended.
When planning options for rhinoplasty, an experienced surgeon adheres to the principles of three types of restrictions: restrictions determined by the surgeon himself; restrictions imposed by the patient; restrictions associated with the patient's condition and the anatomical features of his nose.
Price
The cost of the operation depends on the complexity of the correction.
Testimonials
A woman's review
"I have always had complexes because of the shape of my nose. It was too long, with a hump and the tip of the nose seemed forked. Last year I decided to have rhinoplasty. If I had done it before, then my life it would probably be better now. They removed all the imperfections. They also restored the septum, the defect I didn't even know about. My nose is perfect, just like me. "
Review of a man
"After I broke my nose several times, my nasal septum shifted. I could not breathe normally, I was snoring heavily at night. Diagnostics showed temporary retention of breath in sleep. The nose looked ugly, it was shifted from one side. I have a rhinoplasty done to straighten my nose and get rid of the problems related to the displacement of the septum. I did. I'm happy with the result. Now my nose is normal, as before the fractures. .
Rhinoplasty is not always a whim, but more often than not it is justified by an objective necessity. It is important to choose a competent surgeon and make sure you have no contraindications for the procedure.