Plastic Surgery - Rhinoplasty



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Plastic Surgery

Nose corrections (Rhinoplasty)

The shape and size of the nose lends the individual person his or hers personal features which by no means that it has to be changed. Due to trauma the nose can be deformed and cause functional problems like obstructed airways. As the nose plays a central role in our appearance, the evaluation has to consider the balance between the different segments of the face and their relation to the nose. Many persons seeking a rhinoplasty, for instance, have a weak chin or flat cheekbones and a normal nose. Anatomically the nose-profile is "lifted" up by the nasal bones and the cartilage. The skin is mostly thin and stiffly connected to these structures by fibrous tissues, which explains the long duration of the postoperative swelling after a rhinoplasty.

Anaesthetic: Conscious sedation and local anaesthetic.

Operating time: 1 - 2 hours.

Technique: Incisions are usually made in the nostrils and the soft tissues are separated from the bones and cartilage which now can be reshaped. If breathing problems or deviations are present, this can be improved by a septoplasty. Sometimes an "open" procedure could be beneficial; leaving a tiny scar on the columella or sometimes the nostrils should be narrowed through incisions at their bases. A cast or a splint is placed over the nose for 6-7 days and in some cases an internal dressing is applied for 2-3 days. The healing procedure can produce unexpected irregularities due to scar formations that may need a secondary correction. This happens in about 5%.

What happens afterwards?

	When the anaesthetic subsides, a short intensive pain can be felt about ½ an hour. After that there is no pain.
	As the nose is only tamponated in cases where deviations are corrected, blood will drip from the nose during the first two days.
	To prevent bleeding you should not bend forwards during the first two weeks.
	Immediately after splint removal the new shape can be seen. Already after an hour the natural swelling which will gradually disappear during the first month hides this. The maturation of the scary tissues takes a year and first then the final outcome can be judged.
	Crusts obliterating the nostrils can be dissolved by the 3rd day with moistened cottonpellets moistened with water. The crusts should not be torn away!
	Physical activities should be abandoned for one month.

COMPLICATIONS
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections that in case it happens will be treated with antibiotics.

Swelling: A little swelling over the noseridge and the tip can pertain for several months, as the skin has to shrink and redrape itself over the new "stand". In few cases a secondary boneformation can occur that need a minor correction. Normally smaller irregularities can be felt but as long as they are invisible, no correction is needed. Smaller scarformations can also need revision. All these unfavourable biological outcomes can occur even in the best hands

Numbness: It is quite normal with numbness over the tip and nostrils after a rhinoplasty. It normally disappears spontaneously.

Deviations: Deviations caused by the septum can reoccur despite proper correction.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation.

This text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska klinik i Malmö Sweden