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Aesthetic Procedures: Rhinoplasty

Aesthetic Procedures: Rhinoplasty

Aesthetic Procedures: Rhinoplasty

Rhinoplasty

Rhinoplasty_1
Rhinoplasty refers to surgery of the nose. Positioned centrally on the face, the nose is one of our unique defining features. A well-shaped nose helps to act as the focal point of an aesthetically pleasing face. People need and seek rhinoplasty for a variety of reasons, including fixing a traumatic or congenital deformity, improving the nasal airway, lengthening the nose, increasing nasal height, lengthening the nose, or defining the tip. These can be achieved through rhinoplasty surgery. There is no one size that fits all, and your nose should be tailored to your overall appearance.

What to expect during rhinoplasty consultation

Your plastic surgeon will define your desires and goals. He will also ask about any previous history of nasal trauma or blockage, whether you have had any other procedures done previously, and any other questions pertaining to your suitability for surgery. He will then perform a thorough analysis of your face and nose, including functional and aesthetic measurements. If required, scans may be arranged to aid in diagnosis, especially in cases of nasal trauma.

You will also discuss what can be done to meet your expectations, as well as the recovery and potential sequelae with the surgeon. Utilizing advanced facial morphing software, he will be able to show you a simulation of the results of your rhinoplasty and expected result. The goal is to ensure that you are comfortable and confident in the outcome of your procedure.

How is rhinoplasty performed?

Rhinoplasty is usually performed as day surgery under local anaesthesia (LA) with sedation, or under general anaesthesia. It can be performed in an open (full exposure) or closed (minimally invasive) manner. The procedure consists of procedures to add, subtract, or suture the tissues and cartilages of the nose. For more details on each, please see each section below.
 
Cartilage grafts are commonly used in rhinoplasty, and are usually harvested from the existing nasal septum, the ear, or the rib, depending on amount of cartilage required and patient’s preferences.

What can I expect after my rhinoplasty procedure?

After the procedure, external or internal splints will be placed to help with your recovery. You will be observed for a short period in the clinic to ensure that you are comfortable before discharge and that there are no immediate complications. Total downtime is usually about 1 to 2 weeks. The internal splints are removed after 2 to 3 days, and any external splint will be changed regularly during the required wearing period of 2 weeks. Pain is generally well controlled with oral painkillers. There is usually mild bruising or swelling for the first week or so after the procedure, and any sutures or splints are removed at 5 to 7 days after the procedure. The final result is usually seen at 4 to 6 weeks for a closed rhinoplasty, and 2 to 3 months for an open rhinoplasty.

What are the potential risks and complications?

Besides the afore-mentioned pain, swelling and bruising, potential complications are rare. These include uncontrolled bleeding or hematoma, infection, and bad scarring. Infection risk is reduced with post-operative antibiotics, and once your incision heals, scar reduction will be instituted. The scars are usually barely visible. If foreign material such as a silicone implant is used, there is a slightly higher risk of infection, and an overall small risk of the need for implant removal.

Whilst your surgeon will always strive for the best possible results in one sitting, there may be minor asymmetries after the full healing period. These can be corrected with a second operation.

Closed versus Open Rhinoplasty

Surgical rhinoplasty can be performed using a closed or open approach.
Closed approach Open approach
  • Incisions are kept to the inside of the nose
  • No visible external scars
  • Reduced access to nasal architecture
  • Limited corrections
  • Can be used for: nasal dorsal enhancement; tip correction/refinement; alar modifications; bony dorsal hump reduction; bony osteotomies
  • External incision on the columella extending to the inside of the nostril
  • Visible columella scar in the first 2-4 weeks, usually heals very well
  • Full access to nasal architecture
  • More powerful corrections
  • Can be used for: nasal dorsal enhancement; tip correction/refinement; alar modifications; septoplasty; full dorsal hump reduction; bony osteotomies

FAQs

How does rhinoplasty compare to fillers or fat grafting to the nose?

Because of the ability to accurately alter the framework of the nose, rhinoplasty is more precise than fillers or fat grafting to the nose. Fillers are non-permanent solutions to nasal deformities, but can give the individual an idea of what enhancement of part of the nose can look like. Fat grafts are more permanent than fillers. Fillers and fat grafting to the nose, though simpler and faster with much less downtime, must be injected with much care. Inadvertent injection of material into an important vessel can lead to rare complications such as skin necrosis or, in severe cases, visual problems. A discussion with your plastic surgeon will help you make the best-informed choice with regards to your goals and requirements.


References
1. Sajjadian A, Guyuron B. Primary Rhinoplasty. Aesthet Surg J. 2010;30(4):527–39.

2. Rohrich RJ, Ahmad J. Rhinoplasty. Plastic and Reconstructive Surgery. 2011 Aug;128(2):49e–73e.

3. Jeong JY. Obtaining Maximal Stability with a Septal Extension Technique in East Asian Rhinoplasty. Archives of plastic surgery [Internet]. 2014;41(1):19–10.

4. Rohrich RJ, Malafa MM, Ahmad J, Basci DS. Managing Alar Flare in Rhinoplasty. Plastic and Reconstructive Surgery [Internet]. 2017 Nov;140(5):910–9.

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