Rhinoplasty (nose plastic) is the correction, restoration, correction of the structures of the nose using plastic surgery techniques. Used for medical and aesthetic reasons.
Despite its prevalence, nose correction surgeries are still considered one of the most difficult.
Nose repair surgeries have been carried out for thousands of years. Ancient manuscripts testify to the successful experience of such procedures long before our era.
Medicine has made a step forward compared to ancient doctors, and modern rhinoplasty is more a cosmetic procedure than a medical necessity.
Indications for rhinoplasty
Each plastic surgery is a complex creative process that combines the issues of solving aesthetic problems with the preservation or restoration of specific functional features of the organ (in this case, it is nasal breathing).
Thus, rhinoplasty can be performed for therapeutic and aesthetic purposes. The optimal age for conducting it is 25-35 years.
Medical indications are:
- congenital deformity of the nasal septum;
- polyps and turbinate hypertrophy;
- traumatic injuries and post-traumatic changes in bones, cartilage, physiological (due to uneven 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 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 reason for rhinoplasty is the patient's desire to improve the shape of the nose to achieve complete harmony of his appearance. Plastic surgeon services are becoming more and more popular. Aesthetic indications for rhinoplasty are divided into two large groups:
- objective - these are disproportionate and unattractive sizes or shape of the nose;
- subjective, or psychological: there are no specific criteria for assessing beauty, each person has his own stereotype, and therefore, simply for personal reasons, he may not like his nose.
These reasons often affect the professional and personal relationships of people, give rise to complexes of dissatisfaction and their own inferiority, especially in the female environment, lead to social maladjustment.
Rhinoplasty for aesthetic purposes is indicated in cases where there are:
- disproportionate size of the nose in relation 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 dorsum;
- saddle shape;
- aesthetically unsatisfactory result of the previous operation.
In many cases, 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 surgical intervention, rhinoplasty is divided into:
- Reconstructive, the purpose of which is to restore anatomical disorders resulting from improper intrauterine development, traumatic injuries or diseases.
- Aesthetic - 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 subdivided into:
- primary;
- secondary;
- repeated.
Access techniques
When carrying out rhinoplasty, depending on the access options, the following techniques are used:
- Closed rhinoplasty,in which incisions can take place in the nasal cavity. Closed access is subdivided into marginal (along 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 carry out 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 most often, especially for aesthetic rhinoplasty.
- Open rhinoplasty- the incision passes along the columella (the skin 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 achieving the task in another (closed) way. It allows you to raise soft tissues and cartilage upward, to gain sufficient access to the inner parts of the nose and to carry out manipulations under constant visual control. Open rhinoplasty is necessary to correct particularly serious 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 using 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 for 1-2 hours. Sometimes their duration can reach three or more hours.
How is rhinoplasty performed?
The operation is carried out 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 an even profile;
- bones are dissected and shifted to narrow the pyramid of the nose;
- straightens the nose;
- tip correction.
Revision rhinoplasty
Re-plasty of the nose is considered if there has already been a surgical intervention 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:
- the condition of the impossibility of achieving the goal in one stage;
- unsatisfactory results of the primary operation;
- the need to correct problems that remain after primary rhinoplasty.
According to world statistics, 25-30% of patients who underwent primary rhinoplasty require a second corrective surgery. 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 scarring deficiencies and bring the shape of the nose to an aesthetic result that will satisfy the surgeon and the patient's needs.
It is much more difficult to carry out repeated rhinoplasty in cases of poorly performed primary or unfavorable course of the rehabilitation period, which often depends on the individual characteristics of the organism and complications. Such operations require a deeper 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. Minor flaws 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 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 ruptures, tearing of the muco-cartilaginous 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 sensitivity 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 vasculature, adhesions of the mucous membrane and rough scars;
- recurrent nosebleeds and soft tissue or cartilage necrosis.
Preparation consists in:
- Consultation with a plastic surgeon, during which the technical possibilities of fulfilling the patient's wishes are determined.
- Conducting general studies - clinical and biochemical blood tests, blood clotting studies (coagulogram), general urine analysis, tests for hepatitis, HIV, syphilis (RW), ECG.
- Carrying out (if necessary) special studies - pictures of the paranasal sinuses, endoscopic examination of the nasal cavity in order 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 future rhinoplasty.
- Consultations of a therapist and specialized specialists (in the presence of chronic diseases).
- Examination by an anesthesiologist after all examinations.
- Refusal two weeks before the operation from taking drugs that affect the processes of blood coagulation - acetylsalicylic acid and its analogues, anticoagulants.
- Stopping 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.
Basic recovery from rhinoplasty lasts up to 3 weeks. However, nevertheless, the term for the complete end of the rehabilitation period, when the results are assessed, 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 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 may occur with spread to the entire face and neck. It is necessary to sleep only on the back in an elevated position, which helps to facilitate breathing and reduce swelling. In dusty places, it is advisable to wear a protective mask on the face. Bending and lifting weights should be avoided.
Also, within 3 months, you must stop using glasses and wearing 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 determined by the surgeon himself; restrictions imposed by the patient; restrictions that are 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
Review of a woman
"I always had complexes because of the shape of my nose. It was too long, with a hump and the tip of the nose seemed to bifurcate. Last year I decided to have rhinoplasty. If I had done it before, then my life would be now, Probably better. They removed all the flaws. They even restored the septum, the defect of which I did not even know. My nose is perfect, like myself. "
Review of a man
"After I broke my nose several times, my nasal septum shifted. I could not breathe normally, I snored heavily at night. Diagnostics showed temporary holding of breath during sleep. The nose looked ugly, it was displaced to one side. I have to have rhinoplasty to straighten my nose and get rid of the problems associated with the displacement of the septum. I did so. I am glad with the result. Now my nose is normal, as it was before the fractures. It always breathes and I no longer snore. "
Rhinoplasty is not always a whim, but most often it is justified by an objective necessity. It is important to choose a competent surgeon and make sure that you have no contraindications for the procedure.