Consultation with plastic surgeons with over 20 years of experience – free! Sign up by phone. Waiting for you! Rhinoplasty (nose job) is one of the most difficult operations in the field of plastic surgery. With this operation, you can create a more correct shape of the nose from an aesthetic point of view: reduce it, remove the hump, correct the tip of the nose, etc.
Before undergoing rhinoplasty (nose job), the patient needs to understand that the desired shape of the nose may simply not suit his face type. Therefore, before surgery, it is often better to do a computer simulation of the future result, which helps to assess how the new shape of the nose will combine with the proportions of the patient’s face.
Anatomy of the nose
Anatomically, the human nose consists of three sections: the external nose, the nasal cavity and the nasal sinuses. The external nose is the part of the nose that we see. It is a bone-cartilaginous skeleton covered with skin. Between the oral cavity and the anterior cranial fossa is the nasal cavity. Here, in anticipation of the nasal cavity, thanks to numerous hairs on the skin, the air is cleared of debris, then enters the respiratory area, where the nasal passages are covered with mucous membrane with ciliated epithelium. When exposed to irritants, the mucous membrane swells and the nasal passages close. The anatomy of the nose also includes cavities in the bones of the skull that communicate with the nasal cavity, which are called paranasal sinuses.
Indications for rhinoplasty
The main indication for rhinoplasty is aesthetic dissatisfaction with the shape of the nose, namely:
- high or wide bridge of the nose;
- hump on the osteochondral section;
- wide nose;
- rounded or drooping tip of the nose;
- asymmetry of the nostrils;
- deviated nasal septum.
Today, the main trend is the “Europeanization” of the nose, when the bridge of the nose is low and even, the tip is narrower. Often the reason for rhinoplasty is post-traumatic or congenital deformities, which lead to disruption of the aesthetic appearance and dysfunction of the nose. This can be a complex problem - not only with the nasal septum, but also with the nasal concha and mucous membranes.
Contraindications
Any operation has contraindications if there are health problems. Plastic surgery is not performed if the patient has the following diseases and pathological conditions:
- oncology;
- diabetes mellitus;
- herpetic infection;
- severe pathologies of the heart, kidneys and liver;
- low blood clotting;
- hepatitis B and C.
There are also time restrictions for surgical intervention. These are inflammatory processes in the operated area, respiratory infections and exacerbations of chronic diseases. The operation is not performed on women during menstruation, pregnancy or breastfeeding.
Technique of the operation
There are two schools that develop in parallel and partly compete: the school of open rhinoplasty and the school of closed rhinoplasty. The choice of access depends on the experience and tactics of the operating surgeon. For the patient, the only difference is a small incision on the skin of the nasal septum (columella).
With open access, the incision passes along the columella, with closed access, on the mucous membrane in the vestibule of the nose
Incisions both inside and outside the nose heal quickly and are completely invisible to others.
To gain access to cartilage and bone during correction, closed rhinoplasty In this case, the skin is not separated from the frame. During the operation, miniature surgical instruments are used. For example, to get rid of the “potato” nose shape, the doctor corrects the pterygoid cartilages. Taking into account the required intervention and the structure of the patient's nose, the surgeon uses sutures to tilt or pull the alar cartilages inward, achieving a specific correction. The result is the desired, aesthetically correct shape. The method gives excellent results, the recovery period is relatively short.
Read more about closed rhinoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/zakrytaya-rinoplastika/.
Open plastic surgery provides the greatest opportunities for performing surgery at a high level of quality. At the beginning of open surgery, 2 incisions are usually made. A small cut in the columella, the area of tissue that separates the nostrils. Using a retractor to open the inside, the rhinosurgeon makes a second incision, known in surgery as a marginal incision. It runs from the incision in the columella area to one and the other nostril. Using special surgical scissors, the surgeon carefully cuts the skin along an incision in the columella area to separate it from the frame. The incisions make it possible to correctly separate the anatomical components. This ensures complete visualization of the required areas. The doctor has the opportunity to carefully examine the entire frame, make an extremely precise correction of the structure and give the nose the necessary shape. Using advanced operating technology and special medical instruments, the doctor is able to achieve the desired shape when removing or replacing tissue (including implants).
Read more about open rhinoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/otkrytaya-rinoplastika/.
Surgeon's comment: “In open rhinoplasty, a small incision is made, after which the skin of the nose is completely folded back and all the structures of the nose are exposed. This access gives very good visualization. For the patient, this access is somewhat more traumatic, because The nasal area is more involved, and in the postoperative period with the open technique, swelling lasts longer. In the future, a small scar remains on the skin, but it is almost invisible. With closed rhinoplasty, all incisions are made inside the nose, on the mucous membrane. But for the surgeon, the operating field is much less visible. A deep knowledge of anatomy is required, because... everything is done almost by touch. Since the result can be obtained equally good with both open and closed surgery, the latter is more popular.”
Suture material and anesthesia
In closed rhinoplasty, the stitches are located inside the nose. The suture material dissolves on its own. In open rhinoplasty, a very thin thread is used for sutures, placed on the skin part of the septum. A clear overlap of the edges is important here in order to obtain the thinnest possible scar after surgery. Naturally, such stitches must be removed.
Rhinoplasty is most often performed using intravenous anesthesia. On average, the operation lasts about an hour, but the time is influenced by the complexity of the case and the desired result. Once completed, the nasal passages are packed and a solid dressing is applied, most often a plaster cast or Denver splint.
Rhinoplasty and septoplasty
In addition to the patient's dissatisfaction with the shape of the nose, among the indications for surgery can also be difficulty breathing, which can be caused by an anatomically deviated septum, or a fracture. A deviated septum not only makes breathing difficult, but also provokes the development and long course of otolaryngological diseases. Therefore, aesthetic plastic surgery of the nose is often complemented by ENT surgery and septoplasty: in this case, in addition to correcting the shape, the deviated nasal septum is also corrected in order to facilitate the patient’s breathing.
Read more about septoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/septoplastika/.
Septoplasty can be done separately, that is, without performing aesthetic correction. However, as a rule, when performing aesthetic surgery, the septum is always corrected to one degree or another (rhinoseptoplasty). If this is not done, breathing function may deteriorate.
Read more about rhinoseptoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/rinoseptoplastika/.
Non-surgical rhinoplasty
Minor defects of the nose (small hump, asymmetry, drooping tip) can be corrected with fillers or threads. The undeniable advantage of the procedure is its minimal invasiveness and lower price than surgical intervention. The procedure takes place under local anesthesia, does not cause complications and does not require long-term rehabilitation. Non-surgical rhinoplasty allows you to temporarily change the shape of your nose. The procedure can be repeated, or surgical correction can be planned.
Read more about non-surgical rhinoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/bezoperatsionnaya-rinoplastika/.
conclusions
Rhinoplasty of the tip of the nose allows you to eliminate serious cosmetic imperfections and radically change your appearance. Thanks to the operation, patients solve aesthetic and psychological problems and gain confidence in their own attractiveness. However, in some cases the procedure is contraindicated for objective reasons or is useless because it will not give the desired results. Therefore, it is better to make the decision about surgery after consultation with an experienced surgeon. He will assess the feasibility of the intervention and, if necessary, recommend an alternative, for example, non-surgical rhinoplasty using threads or fillers.
Repeated and restorative (reconstructive) nose surgery
All types of congenital disorders, unsuccessful nose corrections performed previously, injuries - all this is the task of repeated, reconstructive (restorative) plastic surgery. Such operations are definitely more complex and less predictable for both the surgeon and the patient. During revision rhinoplasty, you may encounter “surprises” in the form of scar tissue, your own or foreign materials located on the bridge of the nose.
Repeated operations in the nose area can be performed no less than 6 months after surgery, and preferably after a year.
As for broken noses, it is not always possible to restore a completely injured nose, but it is definitely possible to significantly improve the situation.
Revision rhinoplasty is a fairly complex operation and is not performed by every surgeon. To achieve the desired result, the surgeon must be a true professional and have extensive experience in performing such operations. This operation is performed in Moscow, including in our clinic, where the operation is performed by leading specialists with extensive experience. Be careful when choosing a clinic and a surgeon, because repeat surgery (to correct the results of an unsuccessful operation) is quite difficult due to the presence of scar tissue and a possible lack of nasal tissue.
Read more about revision rhinoplasty here: https://mosplastica.ru/services/plasticheskaya-khirurgiya/rinoplastika/povtornaya-rinoplastika/.
Cost of the procedure
The price depends on the complexity of the operation, technique, type of anesthesia, equipment and medications used. There are other factors that influence pricing. The cost of the procedure in the capital’s clinics is higher than in most Russian regions. The services of a qualified surgeon who knows the original technique will cost more than the average specialist. And the primary operation will cost less than correction of unsuccessful surgery.
Nasal implants
Implants for nose reconstruction are made of medical silicone or other synthetic materials. They have a shaped contour and are applied by the surgeon to the bridge of the nose. There are camouflage implants, when a thin film is placed on the bridge of the nose in order to cover all irregularities after rhinoplasty. Synthetic nasal implants are used quite rarely - usually only when it is necessary to increase the bridge of the nose when there is not enough tissue. Most often, rhinoplasty surgeons use cartilage and bone implants (autografts). You can use ear and rib cartilage, as such tissues take root better.
Possible complications
Complications usually arise due to the surgeon’s unprofessionalism and violation of the preparatory and rehabilitation regime. The most common negative consequences are a rough scar at the incision site, wound infection, dry mucous membrane, loss or distortion of sensitivity in the operated area. For any complications, medical consultation is required. If necessary, the patient is prescribed additional therapy, and in severe cases, repeated surgery.
Mobility of the nose after rhinoplasty is normal. Within 12–18 months after the intervention, patients may experience spontaneous changes in the shape of the tip, which lowers, rises, or moves to the side. Experienced surgeons warn in advance about this problem and help solve it.
Rehabilitation period after rhinoplasty
How long does rehabilitation take after rhinoplasty? The answer to this question largely depends on the patient's postoperative regimen:
- After surgery, it is advisable to stay in the hospital for the first day or two. This will make it easier for doctors to monitor the initial stage of wound healing.
- Then you can go home, but during the first 2 weeks you must come to the clinic for dressing changes every 4 days. In addition to dressings, the doctor monitors how the scarring process progresses.
- It is advisable to stop playing sports for 2 months, and contact sports (boxing, wrestling, etc.) can be started no earlier than six months after the operation.
- There are also restrictions on temperature conditions: for up to two months you cannot warm up, steam, visit baths, saunas, and for the first time you cannot even use a hot hairdryer.
- You need to sleep on your back.
The external consequences of the operation are leveled out after about 2 weeks, but the recovery period takes a little longer.
After rhinoplasty, in which both cartilaginous and bone parts are corrected, swelling and hemorrhage are sure to occur. They usually spread to the area of the lower eyelids, sometimes to the area of the upper eyelids, cheekbones, forming hematomas under the eyes. It takes 12-14 days for them to completely go away. The patient himself, on average, feels for up to two months that he has had surgery in the nasal area.
Preparation
Nose correction takes place after preparation. Your surgeon will instruct you on how to prepare for rhinoplasty.
Preparation for rhinoplasty involves standard examinations:
- Electrocardiogram.
- Chest X-ray or fluorography.
- Picture of the nose.
2 weeks before the upcoming procedure, stop taking blood thinning medications . 7 days before rhinoplasty, it is recommended to refrain from drinking alcohol and smoking. Light food is left in the diet for 24 hours, and food and water are abandoned 6 hours before.
Before the operation, consultations with an anesthesiologist are held. The specialist clarifies information about anesthesia tolerance.
List of tests
The following tests are performed before rhinoplasty:
- Blood (general, biochemical, electrolytes, coagulogram, blood group, Rh factor), - within 14 days.
- HIV, HBS, HCV, RW - within 3 months.
- Urine - 14 days in advance.
Does it hurt?
During the rhinoplasty itself, the patient does not feel anything, because he is in a state of medicated sleep or the doctor applies an analgesic.
During the rehabilitation period, there is more inconvenience than pain - for example, due to tampons in the nose, which are removed after a day, and swelling. Compared to breast surgery, rhinoplasty is said to be painless.
