Rhinoplasty involves the surgical modification of the shape of the nose. It is needed if the patient is concerned by a large, long, hooked, wide, oblique, or somehow disproportionate nose. The problem is most often hereditary, although it occurs only after the age of 16-18, or it can be acquired less frequently as a result of a previous injury or rhinitis. Surgery can usually take place after the age of 18, there is no upper age limit.
Thorough preliminary discussion is very important for the success of rhinoplasty. The operating physician should be aware of the patient’s needs and ideas, and the patient should know what changes are possible and thus how the harmony of the face changes. Unfortunately, not all expectation or nose shape is achievable, the possibilities are limited by the given anatomical features. However, multiple and varying degrees of change are possible in the nose, some are more beneficial, others less so. Computer modelling is a useful aid in the joint planning of the outcome of rhinoplasty, where different options and shapes can be viewed. /At our clinic, computer modelling is free. / We take pictures of the patient with a digital camera and then, using the computer, we create possible nose shapes. From these, during a second meeting with the patient, we can choose the most ideal shape possible. A relative or acquaintance of the patient may, of course, participate in the consultation and discussion of the modelling. However, it is important to be aware that the shape obtained by modelling cannot be achieved in 100 % by surgery, but only approximately.
The essence of the surgery is to reshape the bony, cartilaginous frame of the nose. In a complete rhinoplasty, this means carving or sawing the nasal bone and then rupturing it, which is actually a planned, controlled nasal fracture. We also reduce the nasal cartilage, change their arches, their relationship to each other, and, if necessary, shorten the soft parts of the nasal wings. For partial rhinoplasty (this is rarer), only one or the other of the above is performed. The skin of the nose follows these changes with a slight delay, almost straining on the new frame beneath it. Rhinoplasties can usually be performed by incision made on the inner surface of the nostril so that surgery does not leave a scar on the skin of the nose. If it is also necessary to reduce the nasal wings, this can be solved with a barely visible fine scar placed in the nasal wings. Open rhinoplasty, which is commonly used for more complex nasal apex corrections, results in a barely noticeable scar in the skin area between the nostrils.
Rhinoplasty is commonly performed under general anaesthesia because the carving and sawing of the nasal bone could be painful even under local anaesthesia. Before surgery, general health examination, laboratory tests: blood, urine test, ECG are required. After the operation, an impregnated tampon is placed in the nostrils, and a cast fixation is applied to the back of the nose, which is fixed to the face with adhesive strips. Patients spend the first night at the clinic but may leave in the morning after removing the tampon. There is usually no pain, the inconvenience is caused by the fact that the first night you can only breathe through your mouth due to the tampon.
Cast fixation is required for 5-12 days, depending on the degree of breakdown of the bone structure. During this time, we recommend resting at home, also because the appearance is extremely unfavourable due to bruising or swelling that usually develops on the eyelids. The absorption time of bruising is approx. two weeks. Its absorption can be accelerated by ice. If ice gel is not available, a milk bag is also suitable, which must be removed from the freezer and its contents crushed before the ice forms a block. It can be applied to the eyes dry, wrapped in towel 8-12 times a day for 20-25 minutes. In the first days, it is recommended to rest in a semi-sitting position. It is forbidden to blow your nose, bend, lift a heavy object. Avoid hot or spicy foods or from consuming alcohol. To improve nasal breathing, a nasal ointment or a nasal drop may be used.
After rhinoplasty, the first check is made at the time of cast removal. This does not cause any inconvenience. Seam removing is only necessary if an external incision has been made, the internal seams are self-absorbed. It should be noted that after cast removal, we cannot yet see the final shape of the nose. There is a significant improvement over the preoperative condition, but it takes an additional 4-5 months to reach final shape. This is because, as a result of the surgical trauma, there is even a slight swelling between the tissues and a few days are not enough for the skin to retract. Sunbathing and solarium are forbidden for a month and a half after the operation, and the nose must be protected from even minor impacts. Wearing glasses in this case requires individual consideration. The next control test will take place after one and a half to two months.
Rarely, there can be a not very significant but disadvantageous change in the nose 1-2 months after an otherwise successful operation. This can be a small deviation of nasal axis, a small bump under the skin, or an unfavourable change in the position of the tip of the nose. This is not actually a complication, but a rare (4-5%) unpredictable condition due to the tensile-distorting effect of internal scarring on the nasal skeletal structure during healing of the separated tissues. You may need corrective surgery later. Bleeding or inflammation, which can be expected in any surgery, can occur with a frequency of 1-2% and can be controlled with tighter tamponade and antibiotics. Similarly, serum-like discharge from the nostrils that lasts for weeks is rare. Decreased sensation on the back of the nose or tip of the nose is very rare and improves on its own within months. There is no need to fear of smell disorders in the case of rhinoplasty. Significant narrowing of one or the other nasal passage can occur with a frequency of one thousandth, which can make it difficult to breathe in the nose, as well as cartilage or skin necrosis, which can deform the nose and thus necessitate further surgery.
