Rhinoplasty

What is Rhinoplasty?

Rhinoplasty is a cosmetic surgery performed to correct or reconstruct the appearance of the nose. In addition to aesthetic purposes, rhinoplasty is also performed to address structural issues that cause breathing problems. It is a commonly performed procedure for treating nasal fractures.

Rhinoplasty can alter the size, shape, and angle of the nose.

Thanks to advancements in surgical techniques, rhinoplasty procedures today yield highly successful results.

When is Rhinoplasty Necessary?

Rhinoplasty is necessary in the following situations:

• When the patient has aesthetic concerns
• In cases where functional disorders, such as septum deviation or nostril narrowing, cause breathing problems
• For sinus issues
• For nasal fractures
• In cases of cleft lip (in combination with other procedures)
• In severe facial burns, as they can lead to nasal obstruction.

At What Age Can Rhinoplasty Be Performed?

Rhinoplasty should only be performed after the nose has completed its development. If performed earlier, the results may change as the nose continues to grow, potentially requiring revision surgery.

For women, rhinoplasty can typically be performed at ages 15–16, and for men, at ages 17–18. However, in specific cases that affect the individual’s health, it may be performed at an earlier age.

Rhinoplasty Examination

The rhinoplasty examination is one of the most critical steps in the process. It is essential for the patient and the surgeon to thoroughly understand each other’s expectations and discuss the potential outcomes to ensure satisfaction after the surgery. Therefore, all details should be addressed during the examination.

Patients may benefit from writing down their thoughts and concerns before the appointment to ensure they can share every point with their doctor without forgetting anything.

During the examination, before-and-after photos of previous rhinoplasty patients are reviewed, helping the patient form a clearer understanding of the potential results. Using computer-assisted tools, the surgeon explains what can be done and what kind of reshaping would suit the patient’s facial structure. Additionally, the surgical process, techniques to be used, and post-operative expectations are clearly explained.

How is Rhinoplasty Performed?

Rhinoplasty is typically performed under general anesthesia. Unless necessary, patients are discharged the same day. The surgery usually lasts between 1–3 hours, depending on the complexity of the case.

Not every technique is suitable for every condition, so the surgeon determines the appropriate method (open or closed technique) based on the patient’s specific needs.

The procedure involves accessing the targeted area through a surgical incision, making the necessary corrections, closing the area, and supporting it externally with a splint.

If tissue augmentation is required, it may be harvested from the patient’s ear or rib, or synthetic materials may be used.

Thanks to modern techniques and advanced materials, rhinoplasty has become a much less intimidating procedure.

Rhinoplasty Techniques

The techniques used in rhinoplasty are equally effective. However, the surgeon chooses the technique based on the specific requirements of the case. For example, the open technique is often preferred for reshaping the nasal tip, while the closed technique is commonly used for addressing nasal ridge issues. Nonetheless, after a thorough evaluation, the surgeon may determine that a different technique offers greater advantages.

In rhinoplasty, two main techniques are employed: the open technique and the closed technique.

Open Rhinoplasty

The open technique is primarily used in cases involving significant nasal tip problems or severe deformities. It is also more commonly preferred for addressing functional disorders. This technique allows the surgeon to clearly view the nose’s condition, including its cartilage and bone structure, enabling more precise measurements and interventions.

During the procedure, an incision is made on the external part of the columella (the partition between the nostrils), the tissues are lifted, and the necessary corrections are performed before the area is closed. Although a very small scar may remain on the nasal tip post-surgery, it is subtle and does not cause discomfort.

Closed Rhinoplasty

The closed technique is typically used for patients without significant functional issues but who have problems such as nasal arches. In this approach, the surgeon performs the procedure endoscopically through the nostrils. However, as not all structures are fully visible, maintaining control can be more challenging.

Which technique is better for rhinoplasty: open or closed?

The question of whether the open or closed technique is better for rhinoplasty is one of the most frequently asked by patients. Both techniques have distinct advantages and disadvantages. The choice of technique is determined by the surgeon based on the specific characteristics of the case. The success of rhinoplasty is not solely dependent on the choice between the open or closed technique; the patient’s adherence to postoperative care also plays a crucial role in the outcome.

Advantages of Open Rhinoplasty

The advantages of the open technique in rhinoplasty include:

• Providing a clear view of the surgical area,
• Facilitating better identification of problems,
• Allowing the surgeon greater control,
• Enabling easier management of bleeding,
• Permitting more precise interventions.

Disadvantages of Open Rhinoplasty

The disadvantages of the open technique in rhinoplasty include:

• Leaving a faint scar on the nasal tip, although it is barely noticeable and not bothersome for the patient,
• Taking longer to perform compared to the closed technique,
• Resulting in slower resolution of swelling compared to the closed technique.

Advantages of Closed Rhinoplasty

The advantages of the closed technique in rhinoplasty include:

• No visible scarring, as the procedure is performed through the nostrils,
• Less swelling and bruising compared to the open technique,
• Faster recovery time.

Disadvantages of Closed Rhinoplasty

The disadvantages of the closed technique in rhinoplasty include:

• Limited visibility of the surgical area,
• Reduced control for the surgeon.

Ultrasonic Rhinoplasty (Piezo Rhinoplasty)

In simple terms, Ultrasonic Rhinoplasty (Piezo Rhinoplasty) involves the use of sound waves instead of traditional tools like chisels and hammers commonly used in rhinoplasty surgeries.

The blade used in Ultrasonic Rhinoplasty, which operates with sound waves (ultrasonic), is called a piezotome. The piezotome is specifically designed to cut only bone. This minimizes damage to surrounding tissues during bone cutting or breaking. Additionally, it reduces vessel damage, limits bleeding into the tissue, and is considered a highly reliable method.

Advantages of Ultrasonic Rhinoplasty

Ultrasonic Rhinoplasty has gained significant popularity among patients due to its numerous advantages. These advantages include:

• The area of operation is clearly visualized, allowing for more precise and comfortable intervention.
• The blade, which acts with sound waves, affects only the bones, ensuring that vessels and soft tissues remain unharmed.
• Unintended fractures in the bones do not occur.
• Cuts made on the bones are exceptionally smooth.
• Since there is no trauma to soft tissues, edema, bruising, and pain are minimal.
• Recovery is faster.
• The risk of complications is reduced.

Before Rhinoplasty

One of the most critical aspects of preparation is that the patient and physician thoroughly discuss all details before the surgery and ensure the patient’s expectations are realistic. Patients should also understand that when rhinoplasty is performed for purely aesthetic purposes, without a genuine functional issue, most insurance companies do not cover the costs.

Additionally:

• If the patient has undergone any prior nasal surgery, this must be disclosed to the physician.
• Any infections, such as the flu, occurring just before the surgery must be reported to the physician.
• Allergies to any substances or medications must be communicated to the doctor.
• If the patient is taking any medications or has a chronic condition, this must also be shared with the physician.
• Blood-thinning medications, certain vitamins (e.g., vitamin E), fish oil, and other supplements that increase bleeding should be discontinued 15 days before the surgery.
• Herbal teas should not be consumed starting one week prior to the procedure.
• If the patient feels psychologically unprepared, the surgery should be postponed.
• Smoking and alcohol consumption should be avoided for two weeks before the operation.
• Patients who may be pregnant should not undergo surgery and must avoid pregnancy for three months following the procedure.
• No food or drink should be consumed for at least eight hours before the surgery.
• Patients should be well-rested and in good physical condition before the procedure. Taking a warm shower and going to bed early the night before is recommended.

Adhering to these preoperative guidelines is crucial for the success of the surgery and the recovery process.

Rhinoplasty Day

On the day of the surgery, patients should follow these instructions:

• If the patient needs to take essential medications (e.g., for diabetes), they may do so under the doctor’s supervision.
• The patient should avoid wearing makeup or nail polish.
• Hair products such as gel should not be used.
• The patient should have a companion present.
• Male patients should shave their mustaches.
• Clothing that is easy to put on and take off should be chosen.

After Rhinoplasty

After rhinoplasty surgery, patients are typically discharged on the same day unless otherwise advised by the doctor. The subsequent steps are as follows:

• The nasal tampon is removed approximately three days after the surgery. Silicone tampons do not adhere to the nasal tissues, so patients do not experience pain during removal.
• The splint and bandages placed on the nose are removed about seven days after the operation.
• Pain can be managed effectively with prescribed painkillers.
• During the first week, it is normal for light red-colored fluid to discharge from the nose. However, if the discharge is excessive, the doctor should be informed.
• Cold compresses are applied to help reduce swelling and bruising.
• A temporary reduction in the sense of smell is normal and may last for 1–2 months following the procedure.
• Nasal congestion is commonly experienced during the first few months after surgery.
• As nasal breathing may be challenging immediately after the operation, patients should breathe through their mouth.
• Dissolvable sutures are generally used and do not require removal. Non-dissolvable stitches, if present, are removed seven days post-operation.
• Most patients can return to work approximately one week after the procedure.
• The nose reaches its final shape approximately one year after surgery.

Things to Consider After Rhinoplasty

Adhering to the doctor’s post-operative instructions is crucial for achieving the desired outcome and ensuring a smooth recovery process.

Key points to consider after rhinoplasty surgery include the following:

• For the first few days after surgery, patients should rest with their head elevated.
• Turning the head at a 45-degree angle while lying down during the first three weeks may alter the shape of the nose, so caution is necessary.
• In the initial post-operative period, soft and cool foods are recommended.
• Patients may shower with lukewarm water (close to cold) using soap or shampoo two days after surgery.
• After showering, the splint can be dried using a hairdryer on a low setting or gently with a towel.
• For the first week, avoid excessive facial movements, such as exaggerated expressions or laughter.
• Blood-thinning medications should not be used during the period specified by the doctor.
• Dry lips and mouth may occur due to mouth breathing; staying hydrated is essential.
• Tobacco and alcohol products should be avoided for 15 days to prevent adverse effects on healing.
• Glasses should not be worn for 2-3 months after surgery. If necessary, consult the doctor for guidance.
• Avoid vigorous movements while brushing your teeth.
• Refrain from using saunas, Turkish baths, swimming pools, or the sea for one month after the procedure.
• Contact lenses can be used one week after surgery.
• To minimize swelling, patients should walk and remain upright rather than lying down.
• Avoid strenuous physical activities and sports for the first month.
• Direct sun exposure should be avoided for one month; use protective sunscreen as needed.
• Sports involving balls, such as tennis or volleyball, should be avoided for three months.
• Avoid wearing clothing with narrow necklines, such as t-shirts or sweaters, for the first month to prevent damage to the nose.
• Do not use cotton swabs or similar items for nasal cleaning. Instead, clean the inside of the nose with a spray recommended by the doctor and apply ointment to the stitches using a cotton swab.
• Protect the nose from hard impacts for at least three months to prevent deformities.

Remember that rhinoplasty is a comprehensive process, consisting of pre-operative preparation, the surgical procedure itself, and post-operative care.

Success in Rhinoplasty

Success in rhinoplasty is defined as achieving a nose that is both aesthetically pleasing to the patient and functions properly.

Patients should maintain realistic expectations by clearly communicating their desires and goals with the doctor during the pre-operative consultation. They should engage in an open dialogue and avoid opting for trendy shapes that might lead to future regret. A beautiful nose is one that is proportionate and harmonious with the patient’s facial features. Ultimately, rhinoplasty is a personalized procedure. To achieve the best results, patients must collaborate closely with their physician and adhere to the recommended guidelines before and after the surgery.

Risks of Rhinoplasty

Like any surgical procedure, rhinoplasty carries certain risks. However, with advancements in surgical techniques, materials, and conditions today, these risks have been reduced to an almost negligible level. Possible risks include difficulty breathing comfortably and nasal congestion. However, these are not general risks.

Nasal Revision (Secondary Rhinoplasty)

Nasal revision, also known as secondary rhinoplasty, refers to a repeat rhinoplasty procedure performed due to dissatisfaction with the functional or aesthetic outcome of the initial surgery. However, minor aesthetic concerns do not warrant repeat surgery. It is also important to remember that it takes approximately one year for the nose to fully settle into its final shape, and no attempts should be made to alter its shape before this period. One of the main challenges with nasal revision is that patients often had their initial surgery performed elsewhere, leaving the surgeon conducting the secondary procedure without full knowledge of the previous operation. Consequently, one of the most common questions patients ask is whether they should return to the same surgeon for the second procedure. If the first surgery yielded generally good results but unexpected complications arose, it is advisable to consult the same surgeon. However, if the issues stem from a surgical error, seeking a different surgeon for the revision is recommended.

What is Mini Rhinoplasty / Tip Rhinoplasty (Nose Tip Surgery)?

Mini Rhinoplasty or Tip Rhinoplasty is a procedure aimed at modifying only the nasal tip. This surgery can adjust the tip by reducing, thinning, narrowing, altering its angle, lifting it, or lowering an excessively upturned tip. It is a less extensive procedure performed through the nostrils.  Tip Rhinoplasty typically takes about 30 minutes, with a quick recovery period.  Swelling and bruising usually subside within 2-3 days. Additionally, tip rhinoplasty can be combined with nasal filing.

After Mini Rhinoplasty, it is essential to follow the doctor’s recommendations. To avoid delayed healing, patients should refrain from using tobacco products for at least 15 days, avoid sun exposure while applying protective creams and wearing a hat, and stay away from pools, the sea, Turkish baths, and saunas for one month. The nasal tip should also be protected from impacts until it fully settles, which typically takes about a year.

Hilotherapy Mask

Swelling, bruising, and pain after rhinoplasty are significant concerns for many patients. Ice application has been the most commonly used method to alleviate these post-operative effects.

However, ice application has some drawbacks, including:

• Impaired blood circulation and lymphatic drainage due to overcooling of tissues, leading to delayed healing,
• Occasional redness and limited effectiveness against bruising,
• Discomfort caused by extreme cold, which can also trigger vasodilation as a reaction.

Hilotherapy was developed to address these issues. It is a method based on controlled and consistent cooling therapy. Using a Hilotherapy mask applied to the surgical site, a temperature of 15–20°C is maintained for approximately 4–8 hours.

This method is highly practical and easy to apply, significantly reducing post-operative swelling, bruising, and pain. By allowing normal lymphatic and blood circulation to continue, it accelerates healing while providing greater comfort compared to ice application.

With the Hilotherapy mask, post-operative facial swelling is minimized. The controlled water flow at a specific temperature significantly reduces swelling and pain after rhinoplasty. Particularly during the first 8 hours, Hilotherapy can reduce post-operative edema and swelling by up to 80%.

The once-dreaded trio of rhinoplasty—bruising, swelling, and pain—has become a thing of the past thanks to Hilotherapy!

Experience a recovery as if you never had rhinoplasty! Up to an 80% reduction in bruising, swelling, and pain with Hilotherapy!

Say goodbye to your fears of rhinoplasty!