PROCEDURES IN COSMETIC NOSE SURGERY

RHINOPLASTY

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Rhinoplasty is truly one of the challenging surgeries in aesthetic and plastic surgery. Its difficulty arises not only from the technique and the need for extensive experience but also from the fact that our work is not just sculpting; many factors specific to the patient (such as wound healing, age, nasal skin thickness, etc.) come into play. All these patient-specific factors can either make the surgery easier or more difficult.

Sculpting!! While rhinoplasty could roughly be called sculpting and shares some similarities, it's an entirely different matter. During surgery, we are dealing with living tissues that can bleed, and they deserve to be treated with as little trauma as possible. Gentler treatment often results in less post-operative swelling in noses (although there are many other factors that can increase edema), but at least the surgeon performing the operation should have some foresight and intuition about the results, even if it's not sculpting per se.

Photographs!! Your doctor will likely take photographs of you from various angles, perhaps accompanied by a moving video. This is important both legally and to remember your nose's initial state. Usually, a few months after the surgery, patients forget their old noses and feel like their noses have always been in their post-operative shape. Sometimes your doctor can show you the possible shape of your post-operative nose using various computer programs. It's important to remember that the nose is not a static structure but a living tissue, so achieving the desired ideal nose shape is approximate. Many personal factors can cause deviations from this.

Nose and Facial Aesthetics


Throughout the centuries, the ideal nose shape considered beautiful has changed, but today, there are certain criteria for a beautiful nose shape accepted by many societies. The nose should be proportional both to the face and within itself.

Golden Ratio


As a general rule, the height of the nose makes up one-third of our face's three equal parts. This area is the most prominent when looking at the face. Therefore, if a nose job is done well, it can significantly improve a person's appearance. A well-done nose job means that when looking straight at you, the nostrils' insides are not visible, the tip of the nose looks natural, and the cartilages are in their proper places. In side views, the columella, the skin area between both nostrils, should neither sag too far down nor rise up and should not have an unnatural appearance. Most importantly, people who know you later shouldn't be able to tell that you've had a nose job. The ideal male nose and ideal female nose are quite different. These criteria are based on certain proportions in facial structures, with women typically having smaller and slightly upturned noses, while men have straighter, higher-bridged, and more masculine noses. The nose should be harmonious both in vertical and horizontal dimensions and proportions. Beauty is subjective and varies from person to person. Here, the patient's desires and how realistic and achievable they are will be assessed by an experienced aesthetic and plastic surgeon. In the end, with pictures taken from various angles, the patient and surgeon decide on a nose shape together. All this should be done with the aim of regulating and facilitating breathing as well during surgery.

The Nose as a Breathing Organ


Over the years, many patients who seek aesthetic nose surgery also have various airway problems inside their noses. The most common problem among them is the deviation of the structures that make up the middle of the nose, called the deviated septum, which consists of septum bone and cartilage. During aesthetic nose surgery, all problems related to the airway are addressed. Ideally, aesthetic nose surgery should aim to improve both appearance and function. It's essential to remember that the nose is not just for aesthetics; it's a breathing organ as well. In aesthetic nose surgery, the two structures that provide airflow to the nose, the external nasal valve and the internal nasal valve, must be preserved. If necessary, these sections should be restored. The external nasal valve is, in fact, composed of the structures that make up the nostril. The internal nasal valve is the opening structure located between the midline cartilage (septum) of the nose and the upper lateral cartilages. In some patients seeking aesthetic nose surgery, various airway problems exist within the nose. All these problems related to the airway are attempted to be resolved during aesthetic nose surgery. Ideally, aesthetic nose surgery should aim to improve both appearance and function.

Types and Techniques of Rhinoplasty


In fact, aesthetic nose surgery (rhinoplasty) is generally performed using two techniques: Open Rhinoplasty and Closed Rhinoplasty. Both techniques have their advantages and disadvantages. Your aesthetic surgeon will decide which technique is suitable for your nose. In addition to these two main techniques mentioned, the following techniques are used to shape the nose in aesthetic nose surgery:

Closed Subperiosteal Technique Rhinoplasty: In recent years, I have been using the subperiosteal rhinoplasty technique. In this aesthetic rhinoplasty technique, all incisions are made from inside the nose. Surgery is performed under the membranes of bones and cartilages. Since there are no blood vessels in the surgical plane, bruising and swelling are minimal. Since the ligaments that connect the nose skin to the cartilage structures, known as Pitanguy and Scroll ligaments, are not damaged, the nose remains mobile and natural immediately after surgery. In the end, it is a method that can create more natural-looking noses, although it is a bit difficult to manipulate and the surgery takes 2-3 hours.

Open Rhinoplasty: During this procedure, the incision made for the surgery includes the columella, the middle part of the nose found in both nostrils. This incision allows for easier and more precise visualization and reshaping of the inside of the nose and the nasal tip. Although Doç. Dr. Gürcan Aslan uses both closed and open rhinoplasty techniques, he prefers the open rhinoplasty technique more.

Closed Rhinoplasty: In this aesthetic surgery procedure, the incision used for aesthetic nose surgery (rhinoplasty) remains only inside the nostrils. The surgery is performed by entering through this incision to shape the nose. In the closed technique, all incisions are made inside the nose, and the surgeon performs the surgery without seeing the cartilages at the nose tip, following certain criteria.

Nasal Tip Rhinoplasty: In every aesthetic nose surgery, it is not necessary to break the bones and remove the cartilages. Some patients may have a normal-looking nasal bridge. Their problems are related only to the nasal tip, which can be excessively wide, low, or asymmetric. These patients can have their problems resolved by intervening only in the nasal tip. The advantage is that it is a short procedure with minimal bruising and swelling, and nasal packing is generally not necessary. Patients can usually return to their normal activities the day after the procedure.

Filler Rhinoplasty: Small depressions or irregularities formed on the nose can be corrected and symmetry can be achieved using injectable filler materials. It is not a genuine aesthetic nose surgery. The results are not permanent and are limited. Injections need to be repeated every 6-8 months.

Revision Rhinoplasty: (Secondary aesthetic nose surgery) This secondary surgery is performed to correct problems that occurred after the previous rhinoplasty. The problems that occur can be resolved with minor surgical interventions or may require larger aesthetic surgical interventions. Secondary aesthetic nose surgery is not something that aesthetic and plastic surgeons usually desire to perform.

Where Can Interventions Be Made in Aesthetic Nose Surgery?


The nose is perhaps one of the most complex anatomical structures on the face. The nose is a unique organ with both aesthetic and functional importance that affects facial expression. Besides its aesthetic appearance, the nose's respiratory functions are also crucial. The anatomy of the nose's structure, function, and anatomy is quite complex. The nose is composed of bone, cartilage, soft tissue, and skin covering. Here, only the basic anatomical structures have been mentioned.

The nose is fundamentally divided into three parts. The upper 1/3 of the nose consists of bones. This area is hard and immobile, so in case of injury, the nose bones are likely to break and change shape. The middle and lower 1/3 of the nose are composed of semi-mobile and mobile cartilages. For a successful aesthetic surgery, these anatomical structures need to be carefully evaluated by the aesthetic surgeon.

Nose aesthetic surgery is one of the commonly performed surgeries. With this surgery, the length of the nose can be increased or decreased, nostrils can be reduced, the nasal tip can be shaped as desired, and the angles between the nose, forehead, and lips can be adjusted. It is also possible to lengthen short-looking upper lips by intervening only in the nose, and in some cases, the downward movement of the nasal tip when smiling, which some people complain about, can be eliminated. However, in general, in this surgery, if the nasal bridge is humpbacked or excessive, it is removed, the side nasal bones are fractured to form a pyramid shape, and if the nasal bones are wide, they are narrowed. This way, a pleasing nose bridge is achieved. In females, the ideal angle between the nose and lips is around 95-105 degrees, while in males, it is around 90 degrees.

The decision on how much the nasal tip should be lifted is made in consultation with the patient. This is a maneuver that should be done carefully. When the nose is lifted excessively, an unsightly appearance with visible nostrils from the front can occur. With proper techniques and skilled hands, there should be no drooping of the nose after an aesthetic nose surgery. If necessary, the cartilages at the nasal tip are thinned. All of these procedures, in closed rhinoplasty, are performed through incisions made inside the nostrils, while in open rhinoplasty, a V-shaped incision, which will be almost imperceptible later, is added to these incisions within the nostrils to create the middle line of the skin under the nose. The advantage of open rhinoplasty is the ability to shape the nasal tip in a very controlled manner. Additionally, if there is a problem with the nasal wings, they can also be reshaped.

Doç. Dr. Gürcan Aslan's techniques for breaking the bone in the forehead-nose junction and the side nasal bones result in a more natural nasal bridge, with less swelling and bruising.

After aesthetic nose surgery, despite all the interventions involving broken, shaved, cut, and removed bones and cartilages, there is almost no pain. Any mild pain that does occur can be eliminated with simple pain relievers.

After aesthetic nose surgery:

• Doç. Dr. Gürcan Aslan places a small splint on your nose, which will remain for approximately 7 days. The splint protects the nose from minor impacts and any adverse external effects during the first week.

• Although some patients may not require any packing, for those who do, silicone tampons with holes in the middle, allowing for breathing, are applied.

• After aesthetic nose surgery, you may experience a feeling of fullness in the nose and temporary difficulty in breathing. These issues will resolve rapidly within weeks.

• In addition, the medications to be used after aesthetic nose surgery will be explained to you by your Aesthetic Surgeon. It is important to note that you should avoid using aspirin and its derivatives as pain relievers.

• (It should also be noted that if blood thinners, including aspirin and similar medications, are being used, they should be discontinued 7-10 days before any type of aesthetic surgery) Important!!

• There have been many advancements in the techniques of aesthetic nose surgery in recent years. In the past, there used to be significant bruising and swelling to the extent that the eyes would close after surgery. Nowadays, unless there are significant problems that would complicate and prolong the surgery, there is generally some bruising and swelling under the splint on the nose and to some extent around the eyes after aesthetic nose surgery.

• Applying ice to the eyelids immediately after the surgery will minimize bruising and swelling. (Applying ice cubes to the eyelids can be challenging at times. Therefore, frozen peas, lentils, or similar small foods can be used instead of ice.) Important!!

• Although some medications (such as Arnica Montana) can be used to reduce bruising, they are generally not necessary. Mild bruises that develop within a week will turn yellow and become less noticeable.

• After surgery, keeping your head elevated above your body while resting will be beneficial. Generally, individuals feel well enough to resume their daily activities the day after surgery. The key is to avoid excessive bending and lifting and to be careful not to bump your nose. Especially those with small children and pets should be cautious about their sudden movements. Important!!

First Week Activities:

During the first week, it's important to avoid lifting heavy objects and excessive bending and straightening. Excessive effort and strenuous exercises can lead to bleeding. Limit your diet to foods that don't require wide opening of your mouth. If you need to sneeze, open your mouth and sneeze. It's likely that your nose will be bumped once or a few times during the first week, which is not a problem unless it's a very strong impact. If you follow these precautions, there is no issue with going out for a walk from the 2nd to the 3rd day onwards. Avoid smoking as it can increase swelling in the nose and may cause bleeding. Avoid alcoholic beverages for the first two weeks after surgery.

In summary:

• After removing the cast or splint in 7 days, Doç. Dr. Gürcan Aslan applies a small nose bandage that will be removed within 3-5 days to prevent sudden swelling of the nose due to the removal of the cast.

• Ultimately, any splint and bandage on the patient's nose are removed within 12 days. After this, certain massages are recommended to the patient. Glasses should not be worn for approximately 1 month. Contact lenses can be used starting the day after the surgery.

• Especially in the summer months, the skin of the nose can be sensitive to the sun, so it is recommended to use a protective sunscreen.

Results of Aesthetic Nose Surgery


Usually, swelling decreases to a minimum within the first month after surgery. The swelling in your nose will gradually subside within 1-2 months to the point where it's hardly noticeable that you had surgery. However, it can take 6 months to 1 year for all the swelling to completely disappear, and for the nose to take its final shape. Therefore, patience is required, and it's advisable to wait at least 6 months before considering revision rhinoplasty.