Rhinoplasty (nose plastic surgery) is a correction, restoration, correction of the structures of the nose with the help of plastic surgery techniques. It is used for medical and aesthetic reasons.
Despite its prevalence, nose correction surgeries 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 a cosmetic procedure rather than a medical necessity.
Indications for rhinoplasty
Each plastic surgery is a complex creative process that combines issues of solving aesthetic problems with the preservation or restoration of specific functional characteristics of the organ (in this case it is nasal breathing).
Thus, rhinoplasty can be performed for therapeutic and aesthetic purposes. The optimal age for its holding is 25-35 years.
Medical indications are:
- congenital deformity of the nasal septum;
- polyps and turbine hypertrophy;
- traumatic injuries and post-traumatic changes in bone, cartilage, physiological (due to uneven tissue development) 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 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, snoring at night.
In addition, in children, such defects can cause chronic oxygen starvation of 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 causes of rhinoplasty are the patient's desire to improve the shape of the nose to achieve complete harmony of its appearance. Plastic surgeon services are becoming increasingly popular. Aesthetic indications for rhinoplasty are divided into two major groups:
- objective - these are disproportionate and unattractive size or shape of the nose;
- subjective or psychological: there are no specific criteria for assessing beauty, each person has his own established stereotype and therefore, simply for personal reasons, he may not like his nose.
These causes often affect people's professional and personal relationships, create complexes of dissatisfaction and their own inferiority, especially in the female environment, lead to social maladaptation.
Rhinoplasty for aesthetic purposes is indicated in cases where there are:
- disproportionate size of the nose 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 discrepancy with the height of the nasal dorsal part;
- saddle shape;
- aesthetically unsatisfactory result from 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 purpose and technique of surgery, rhinoplasty is divided into:
- Reconstructive, which aims to restore anatomical disorders as a result of abnormal intrauterine development, traumatic injuries or diseases.
- Aesthetically - correction of existing shortcomings.
According to the same criteria, there are several types of rhinoplasty:
- Reduction or enlargement of the nose.
- Back alignment - correction of saddle depression or removal of a hump.
- Correction of aesthetic imperfections at the top.
- Barrier correction (septoplasty).
- Post-traumatic reconstruction of the structure.
All types of operations are subdivided into:
- primary;
- second;
- it's repeating.
Access techniques
When performing rhinoplasty, depending on the access possibilities, the following techniques are used:
- Closed rhinoplasty,in which incisions can be made in the nasal cavity. Closed access is subdivided into marginal (on the inner surfaces of the wings of the nose), transseptal, inter- and transchondral. 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 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 fold between the nostrils) and along the wings of the nose when they connect to the lip. The technique is used in cases that do not allow the task to be achieved in another (closed) way. It allows you to lift the soft tissues and cartilage up, get enough access to the inner parts of the nose and perform manipulations under constant visual control. Open rhinoplasty is necessary to correct particularly serious changes and technically complex and significant operations - pronounced deformation of the nose, especially in lateral displacement; a combination of nasal deformity with malformations such as "cleft lip" or cleft palate; reconstruction with the help of grafts. The disadvantage of open rhinoplasty is the formation of a noticeable postoperative scar, as well as the forced damage of the columella arteries, which leads to significant and long-lasting swelling 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 they can last 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 adjusted if it is necessary to form an even profile;
- the bones are dissected and displaced to narrow the pyramid of the nose;
- straightens the nose;
- tip correction.
Revision rhinoplasty
Re-plastics of the nose are considered if there has already been surgery in this area. The final formation of the nose after plastic surgery occurs after six months - 1 year. This period is optimal for re-operation. It is performed when:
- condition for impossibility to achieve the goal in one stage;
- unsatisfactory results from the primary operation;
- the need to correct problems that remain after primary rhinoplasty.
According to world statistics, 25-30% of patients who have undergone primary rhinoplasty need a second corrective operation. This is considered normal. It usually lasts no more than half an hour and is performed under local anesthesia. Corrective revision rhinoplasty allows you to correct the defects of the scars and bring the shape of the nose to an aesthetic result that meets the needs of the surgeon and the patient.
It is much more difficult to perform re-rhinoplasty in cases of poorly performed primary or unfavorable course of the rehabilitation period, which often depends on the individual characteristics of the body and complications. Such operations require more in-depth review and in-depth preparation. They are a complete plastic according to one of the options, but as a rule they turn out to be much more complicated and time consuming. Minor defects in repeated plastic surgery can lead to a final violation of the shape, not only, for example, at the tip, but also to a pronounced deformation of the entire nose.
Complications and preparation for surgery
Nasal plastic surgery is considered to be one of the most difficult plastic surgeries, the result of which largely depends on the skills and experience of the surgeon. Complications occur in 4-15% of cases. They can be during surgery (bleeding, tearing of the skin, rupture of the mucous-cartilage valve, disruption of the integrity of the bone pyramid, fracture of the bone site, etc. ) and postoperative.
Possible complications after rhinoplasty:
- functional - atrophic rhinitis, nasal breathing difficulties, loss of sense of smell, temporary or permanent reduction or complete loss of sensitivity of the skin of the nose and upper lip;
- aesthetically - without changing or worsening previous defects;
- psychological - the patient's dissatisfaction with the results of plastic surgery;
- infectious - prolonged swelling and inflammation, suppuration;
- nasal skin pigmentation, vasculature formation, mucosal adhesions and rough scars;
- recurrent nosebleeds and necrosis of soft tissues or cartilage.
The preparation consists of:
- Consultation with a plastic surgeon, during which the technical possibilities for fulfilling the patient's wishes are determined.
- Conducting general tests - clinical and biochemical blood tests, blood clotting test (coagulogram), general analysis of urine, tests for hepatitis, HIV, syphilis (RW), ECG.
- Performing (if necessary) special tests - photos of the paranasal sinuses, endoscopic examination of the nasal cavity in order to identify concomitant abnormalities and pathological changes.
- Computer simulation that allows the patient to compare the initial condition of the nose with the results of future rhinoplasty.
- Consultations with a therapist and specialized specialists (in the presence of chronic diseases).
- Examination by an anesthesiologist after all examinations.
- Refusal two weeks before surgery from taking 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;
- days of menstruation.
The main recovery from rhinoplasty lasts up to 3 weeks. However, the period for the full end of the rehabilitation period, when the results are evaluated, is determined by the doctor and is 6-12 months. During this time, certain restrictions must be observed.
After 1-1, 5 weeks after the intervention, the plaster and sutures are removed. For the first two weeks, do not wash with hot water or take hot baths, as bleeding, bruising and swelling may occur when spreading to the whole face and neck. It is necessary to sleep only on your back in a raised position, which helps to facilitate breathing and reduce swelling. In dusty places it is advisable to wear a face shield. Bending and lifting weights should be avoided.
Also, within 3 months, you should 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 wide-brimmed hat is recommended.
When planning rhinoplasty options, an experienced surgeon adheres to the principles of three types of restrictions: restrictions set by the surgeon himself; restrictions imposed by the patient; limitations that are related to the patient's condition and the anatomical features of his nose.
Price
The cost of the operation depends on the complexity of the correction.
Reviews
Examination of a woman
"I've always had complexes because of the shape of my nose. It was too long, with a hump and the tip of my nose looked split. Last year I decided to do a rhinoplasty. If I had done it earlier, then my life would be better now, probably better. "They removed all the imperfections. They even restored the barrier, the defect of which I didn't even know. My nose is perfect, just like myself. "
Examination of a man
"After I broke my nose a few times, my nasal septum shifted. I couldn't breathe normally, I was snoring heavily at night. The diagnosis showed a temporary hold of air in my sleep. My nose looked ugly, it was shifted to one side. I have to do it. rhinoplasty to straighten my nose and get rid of the problems with the displacement of the septum. I did it. I'm happy with the result. Now my nose is normal, as it was before the fractures. I always breathe and I don't snore anymore. "
Rhinoplasty is not always a fad, but it is most often justified by objective necessity. It is important to choose a competent surgeon and make sure that you have no contraindications to the procedure.