NOSE SURGERY
Cosmetic nose surgery (rhinoplasty) is the most frequently performed cosmetic surgical procedure. It enables the nose to breathe more healthily and also makes it more harmonious with the face. The high demand for this procedure has led to a corresponding increase in supply, attracting many surgeons, both experienced and inexperienced, educated and uneducated, to this field.
Treatment Process
2 - 4 hours
1 day
2 weeks
6 - 12 weeks
What is Rhinoplasty?
Rhinoplasty is the most commonly performed procedure among cosmetic surgery procedures. It allows the nose to breathe more effectively and to be more harmonious with the face. This high patient demand also creates a demand, leading to a wide range of surgeons, both experienced and inexperienced, trained and untrained, seeking this procedure.
Our first advice to a patient considering Rhinoplasty is to be aware that while there are highly experienced surgeons, many inexperienced or untrained surgeons perform or attempt this procedure, resulting in a high frequency of patient complaints. The first and most important requirement for a successful rhinoplasty is finding the right surgeon. It’s important to know that for every 100 rhinoplasty procedures, an average of 5 require further rhinoplasty for various reasons. Rhinoplasty is the most frequently performed procedure, but it also results in the highest rate of patient dissatisfaction.
What is the Importance of the Nose on the Face?
The nose, located in the center of the face and extending vertically, is an organ responsible for olfaction and purifying the inhaled air. Its position also determines the facial axis. Because it is located in the center of the face, the phrase “the nose is the soul of the face” is not inaccurate. Interpersonal communication often occurs through eye-to-eye contact. The close proximity of the nose to the eyes makes an asymmetrical or discordant nose striking and attract the attention of others. At least in someone with a nasal deformity, it can lead to the feeling that the other person is constantly looking at their own nose. This obsessive state of mind is present in almost all patients with nasal deformities.
What Is the Role of the Nose in Breathing?
The nose is the region where oxygen, which is essential for life, is taken into the body.
In the nose:
- The flow rate of air (the amount of air passing per unit of time) to be inhaled with each breath is regulated. The flow of inhaled air is controlled by the limited narrowing and widening of the nostrils (external valve). When air enters the nose compressed and at high speed, internal structures slow it down and change its direction. These structures are called the internal valve.
- The nose is divided into two equal parts by a wall called the septum, which is partly bone, partly cartilage, and lined with mucosa on the side facing the cavity. Functionally, the septum divides the nasal cavity into two equal channels. Each time we inhale, the air is directed evenly into these two separate channels. Another important function of the septum is that it acts as a supporting column, carrying most of the weight of the nose.
- The air entering the nasal passages is cleaned, warmed, and humidified before being delivered to the trachea. These processes are carried out by conchae, sponge-like structures inside the nose commonly known as nasal turbinates. Conchae function similarly to an air filter in an engine.
For example, imagine you need 10 units of air with each breath. When you inhale, your nostrils allow 10 units of air to enter. Thanks to the septum, the air is divided evenly into the two nasal passages, 5 units in each. The 5 units of air moving upward in each nasal passage are cleaned, warmed, and humidified by the conchae. As a result, the trachea receives 10 units of clean, breathable air.
What Structures in the Nose Impair Breathing and Their Treatment Methods?
What is a Deviated Septum?
A deviated septum is the most common condition that causes permanent breathing problems. The front of the septum is made of cartilage, while the back is made of bone. If this wall is severely deviated to one side, making breathing difficult, it is called a deviated septum. The important information here is this: If we randomly examine the noses of 10 people while walking, we will find that at least 7 of them have a deviated septum. In other words, no one’s septum is naturally straight. Therefore, a deviated septum during an examination is never a reason for surgery. Therefore, if surgery is necessary, the septum must significantly narrow one nasal passage, and the patient must have persistent and uncomfortable breathing problems on that side.
What is Septoplasty?
It is the surgical correction of a deformed septum that severely impairs breathing.
Another important function of the septum is to serve as a supporting column, ensuring the nose remains upright and resilient. Therefore, in cases of septal deviation, the area that makes breathing difficult should be corrected, not removed. This way, the septum’s supporting column function is preserved. Unnecessary removal of a portion of the septum can weaken its supporting force and eventually lead to a collapse of the nasal vault. Reliable studies indicate that surgical intervention on the septum does not improve breathing, except in cases of severe deviation.
What is the Difference Between Rhinoplasty and Septorhinoplasty?
Rhinoplasty is a cosmetic procedure performed on the nose. If the patient has severe breathing difficulties due to a deviated septum, this problem is also corrected during the same procedure. This surgery is called septorhinoplasty. Septorhinoplasty is successfully performed by plastic surgeons.
What is Turbinate Hypertrophy?
Turbinates are structures within the nasal passages that clean, warm, and moisturize inhaled air with the help of mucus and hairs. There are three in each nasal passage. Turbinates are commonly known as the “nasal flesh.” These structures can be likened to the air filters in a vehicle engine. Under normal circumstances, turbinates expand and contract like a sponge, expanding and contracting over 4-6 hour periods, directing air to the other nostril. They function in alternating cycles. Over time, depending on the quality of the air inhaled or as a result of allergic reactions, turbinates can become permanently enlarged, making breathing difficult. This is called “conchal hypertrophy.” Because turbinates can expand and shrink like sponges, they cause blockages that vary depending on the environment and position. They do not cause a fixed, unilateral obstruction.
What is Turbinate Plasty?
Turbinate Cauterization
The procedure of surgically or instrumentally reducing the size of severely enlarged turbinates is called “Conchaplasty.” This procedure is often performed as a short procedure using radiofrequency energy, but rarely, it is surgical. Due to their function, turbinates should never be completely removed. Otherwise, the air-purifying function of the nose cannot be fulfilled, allowing dust and microorganisms to pass directly into the throat. Chronic pharyngitis, bronchitis, and progressive respiratory infections become common. It is possible for the shrunken turbinates to regrow over time and cause discomfort.
What is Nasal Valve Insufficiency?
Respiration rate increases, especially during exertion (exercises, deep breathing). The nasal wings act as valves, controlling the amount of air entering during such situations. In some cases, the cartilages that form the nasal wings are structurally weak and thin. Sometimes this condition can develop due to a previous surgery. When the wings are thin, normal breathing is not a problem, but during rapid and deep breathing, the nasal wings cannot withstand the negative pressure and become compressed inward. This condition is called “Nasal Valve Insufficiency.”
How is Nasal Valve Insufficiency Treated?
Because this is a structural problem, the nasal wings need to be supported and strengthened. Cartilage from the pinna is most commonly used for this purpose, and the nasal alae are reinforced with this cartilage. Nasal valve insufficiency is a significant problem that can be corrected with rhinoplasty.
Patient Reviews
How is the Ideal Nose Described?
It’s impossible to define the ideal nose as “the width, width, and height of an ideal nose should be this or that.” The determining factor in an ideal nose is not its size, but its proportional harmony with the face and other features.
Based on this principle, values such as the nose’s length, width, height, angle with the forehead, and angle with the upper lip are defined proportionally for both genders. For example, the nose’s length should divide the face into three equal parts, and its width into five equal parts. The angle between the upper lip and the base of the nose (rotation) should be 95-105 degrees in women and 90-95 degrees in men. The distance between the tip of the nose and the midface (projection) should not exceed one-third of the distance between the eyebrows and the upper lip, etc.
However, a person’s social status, cultural background, and the visual impressions it creates in the mind are all factors that must be taken into consideration when designing a nose.
How is Rhinoplasty Planned?
In these surgeries, three basic approaches to nose modification can be considered. Either tissue is removed from the nose and reduced in size; tissue is added to the nose and increased in size; or the shape remains unchanged but the patient’s shape is altered.
One of the most important aspects is a careful examination of the patient by the surgeon. Cartilage and bone structures, skin thickness, and breathing difficulties should be thoroughly documented.
Determining the underlying problem and the procedures to be performed in rhinoplasty are matters that the patient and surgeon must decide on together. If the patient’s vision in the mirror matches the problem the surgeon sees when looking at the patient, the patient can be expected to be satisfied with the outcome. The surgeon should ensure that the patient has realistic expectations. During this stage, computer simulations using front and side profile photographs help to make accurate assessments.
How is Rhinoplasty Performed?
Rhinoplasty is a procedure that can achieve very good results in skilled and experienced hands. Problems that prevent the patient from breathing can also be addressed during this procedure. The procedure is performed under general anesthesia and takes approximately 1.5 hours.
Methods Used in Rhinoplasty
Open Technique
This technique involves incising the tip of the nose, called the columella, and completely removing the skin. The surgery is performed with the open technique, allowing the bone and cartilage to be visualized. Cartilage deficiency, secondary and revision rhinoplasty, or thick-skinned noses are particularly well-suited for surgery. Recovery time is slightly longer.
Closed Technique
This procedure is performed through the nose without any skin incisions. It is preferred for noses with normal skin and strong cartilage if this is a first-time surgery. There are no incisions, and recovery time is faster.
After Rhinoplasty
There is almost no pain during the surgery and postoperative recovery. However, the degree of swelling and bruising under the eyes and around the nose varies from person to person. At the end of the surgery, silicone splints with built-in air channels (internal splints) are placed inside the nose. These splints provide support to the nose and allow for some breathing. The patient will only notice the presence of these splints by inserting their finger into the nose. A one-day hospital stay is sufficient. On the seventh day after discharge, the packing is removed, the nasal splint is changed, and the nose is rinsed. In the second week, only the nose is taped. After 14 days, all bandages are removed, and any skin stitches are removed.
Bruising and swelling around the nose disappear completely within a few days. Recovery is much faster, especially in surgeries performed using a subperichondrial (under the membrane) approach.
Month-by-Month Change After Rhinoplasty
- The nose is protected with a splint for the first two weeks.
- By the end of the third week, the swelling in the nose has largely subsided.
- Therefore, the recovery is sufficient to be unnoticeable to those around you.
- By the end of the first three months, the nose will have reached 90-95% of its new shape.
- The remaining 5% will reach its final shape within the next three to six months, usually the tip.
- For smokers or those with thick skin, this recovery period can extend up to a year.
The first three months are the most critical period after rhinoplasty. During this period, patients are strongly advised to avoid glasses, impacts, and smoking.
What is the Importance of the Nasal Skin in Rhinoplasty?
Rhinoplasty involves shaping the bone and cartilage. No intervention is made on the skin covering the nose. Therefore, it’s important to remember that even the slightest asymmetry or irregularity in the nose will be visible externally, especially in patients with thinner-than-normal nose skin. However, in patients with thicker-than-normal nose skin, the contours of the nose will not be fully defined and will appear more rounded and coarse.
Thick-Skinned Nose
The most important characteristic of this type of nose is that, unlike the skin, the cartilage tissue is extremely thin. Contrary to popular belief, this type of nose can be surgically removed, and the wide, bulbous appearance of the nose can be corrected. For thick-skinned noses, the key principles are to use an open technique, thinning the skin from within, and shaping the cartilage by supporting it.
When Does a Thick-Skinned Nose Heal?
It’s important to understand that postoperative swelling in this type of nose will persist for a longer period, and full recovery can take up to a year.
What is the Importance of Smoking in Rhinoplasty?
Rhinoplasty primarily involves working on the nasal bone and cartilage structures. No intervention is made on the skin covering the nose. Therefore, it is crucial that the modified cartilage framework heals without any deformation and that the skin covering the nose fully adapts to the underlying bone and cartilage over time. Smoking, due to its numerous toxic substances, has numerous negative effects.
1- Excessive scarring causes deformity in the cartilage framework.
2- The skin covering the nose prevents proper shaping and proper integration into the underlying bone and cartilage framework.
3- Edema in the mucosa surrounding the inside of the nose is prolonged.
Rhinoplasty Prices
Rhinoplasty surgery prices vary depending on the patient’s complaints and physical examination findings.
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