COSMETIC SURGERY OF NOSE-RHINOPLASTY
Nose occupies the center of a person’s face. Any abnormality or disproportion of nose is therefore very obvious. The demand for rhinoplasty is very high. Rhinoplasty is the second commonest cosmetic surgery procedure in USA (Liposuction occupies the first place). It is believed in Asian countries, Rhinoplasty tops the list.
For whom and who gets good result?
The rhinoplasty aims at restoration of nose in harmony with the rest of the face. Many a time patient come with demands like “ Make my nose like the one in this photograph” showing the picture of film stars. It is to be noted here that this is not possible and the nose can only be made to look appropriate with the face. Those who understand this fact and are realistic about their expectations will get good result.
In general, following types of rhinoplasties are done.
- Reduction rhinoplasty tries to make a prominent, big nose more symmetrical.
- Augmentation rhinoplasty tries to increase projection of a flat or depressed nose.
- Tip surgery tries to refine the tip making it sharper.
- Reducing the nostrils.
- Correction of a deviated septum. Septum is the curtain like structure between two sides of the nose. A deviated septum can create functional problems. This can be tackled by procedure called septorhinoplasty.
Rhinoplasty is done after 14 – 15 years of age. The growth of the nose is complete by this time, hence the surgery can no t disturb it.
What does the doctor do in operation?
In almost all cases of rhinoplasty incisions are made inside the nose, thus there is no visible scar. An exception is the surgery for reducing the size of nostrils. Here small incisions are made outside. These incisions are so made that they are least visible later on. Over a period of time they become nearly invisible.
In some selected case the doctor decides to do an external rhinoplasty. This operation involves making a small incision in the area of nose between the nostrils. This incision becomes invisible as the time passes off.
To reduce a big nose, the projection of the cartilage and bony part of the nose is reduced.
To augment a depressed nose, extra tissue or substance is added. Generally there are three varieties of such augmentation materials.
- Silicone: Silicone is a rubber like synthetic material used to augment various parts of the body. The augmentation of the nose with the silicone gives the best result. However, sometimes a patient’s body is not able to tolerate silicone as after all it is a ‘foreign’ material. If it so happens, the silicone can be removed and the nose then returns to what it was before. The nose then can be augmented by other two methods.
- Bone: Here the person’s own bone is used. The bone is obtained from the skull, pelvic bone or the rib. Removal of bone from these area does not leave any defect or functional deficit. The disadvantage of putting the bone is that it gets smaller because of absorption. Hence after some time the augmentation is lost in variable degrees. If bone from skull is used, it gives the best result and the absorption is either absent or minimal. Taking the bone from skull is however technically more demanding for the surgeon.
- Cartilage: To explain a layman, the cartilage can be defined as a soft bone, bone without calcium. It is found in lower half of the nose, the septum of nose (the curtain that separates two sides of the nose), ear and ribs. The cartilage can be taken from all these areas. Augmentation with the cartilage is good for minor augmentation. If a major augmentation is desired, the cartilage is not a good material as it has a tendency to bend.
Some cases require correction of a deviation of the septum of the nose and improvement of the tip of the nose.
Some points about the operation and after care:
- The patient is either given general or local anesthesia.
- The nose is augmented or reduced by the procedures described above.
- Stitches are taken and in some patients, the inside of the nose is packed with wick of gauze. A plaster is given on the outside of the nose.
- The patient can move around in 8 hours and can be discharged on the same day or next day morning. For initial 48 hours movement is to be restricted inside the house from bedroom to toilet and dining room. It is not necessary to lie down in bed all the time. The patient can sit, watch TV, read, listen to music if it is comfortable. It is necessary to put 2 pillows of reasonable size to keep head elevated while lying down.
- The dressing is changed after 48 hours. The gauze wick is removed at that time. The stitches are absorbable type and do not require removal. The dressing is removed after 7 days. The plaster is to be kept for 10 to 14 days.
- The nose and the part around it looks swollen. In some patients even eyes look swollen. This is routine and the swelling increases up to 48 hours. The swelling then goes down over a period of 2 weeks about 80% of it has gone. The remaining some, about 10% of the original, goes down by 6 weeks and finally it completely disappears around 4 to 6 months. The last part of the swelling is confined to the tip of the nose. Hence, though the changes in the shape of the nose are evident to some extent on operation table, the final result can be seen only after the swelling goes away which in some cases may mean 4 to 6 months.
- Red or purple or black discoloration inside the eyes or around the nose is routine and occurs because of collection of blood pigments under the skin. It disappears on its own in 3 weeks.
What are the risks?
Most of the operations end up without any risks. The procedure however carries as much risk of anesthesia as any other operation (non-cosmetic) will do.
The complications associated with this operation are:
- Silicone Rejection
- Reoperation: Some patient may require additional surgery after the initial surgery. Such surgery is done at least 6 months after the original surgery.
It is to be noted that all these complications occur very rarely and not one particular patient will have all the complication.
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