Who is suitable for?
Rhinoplasty is perhaps the most widespread procedure regarding cosmetic facial surgery in Greece. Our know-how and experience allow us to intervene in the nose both aesthetically and functionally. So, whether what you are asking for is to get a nose that will satisfy you aesthetically and visually, or you are asking to correct functional issues, or both, we have both the means and the knowledge to provide it. It should be noted that in most cases with aesthetic problems, scoliosis of the nasal septum coexists, as well as hypertrophic orbits, which must be corrected in the same operation in order to avoid and resolve problems of supporting the nose and breathing.
There are some basic principles that define the aesthetics and harmony of a nose and these principles always take into account the overall proportions of the face. There is, however, no specific “cookie cutter technique” and the nose in a rhinoplasty is shaped according to the available ratio, facial features and personal preferences. My recommendation is usually to achieve a nose with a natural and timeless result, which from a straight dorsum ends at a slightly raised tip, but without giving the image of a “protruding” nose. The nose should be in proportion to the chin and eyes, and its size is usually determined by the dimensions of the face. An excessively small nose may be lost on a relatively large face, while a very large nose may excel as a characteristic over eyes, cheekbones, lips, etc. The goal is to achieve the best possible for each face, starting from its already existing characteristics, in order to achieve a beautiful and natural result. But beyond recommendations and ideal proportions, more important is the personal desire of each person and how he has envisioned his nose. It is not right or always possible to match another person’s nose, with other features and other proportions, to the face in question, but we can follow some general standards or stereotypes of beauty. Sometimes it helps to do a computer simulation to better understand the changes we want to achieve, without of course being able to rely fully on electronic means. Through the discussion and experience of the surgeon it is possible to fully understand exactly what we want to achieve with a rhinoplasty and we can adapt the operation to achieve exactly that.
There are 4 basic rhinoplasty techniques:
1. Open structural rhinoplasty
2. Closed open roof rhinoplasty
3. Open preservation
4. Closed preservation rhinoplasty Each of these techniques has its advantages and is more suitable for some specific cases. For example, with a closed rhinoplasty, either open roof or preservation, the possibilities of changing at the top are more limited than with an open rhinoplasty. Also, rhinoplasty preservation technique, i.e. rhinoplasty is preferable when the pubis of the back is relatively smaller, or when there is functional and anatomical instability of the middle third of the nose. Regardless of the rhinoplasty technique we choose, correction always involves the functional part of nose breathing. This means that any malfunction is treated, either due to scoliosis of the diaphragm, orbital hypertrophy or other functional problems inside or outside valvular mechanism. When there is intense snoring, this may be due to hypertrophy of the grape, as well as congestion of the nose due to scoliosis of the nasal septum and hypertrophy of the nasal turbines. In these cases, the grape is reduced, in addition to correction of breathing through the nose.
In closed rhinoplasty, the incisions are made in the inner side of the nostrils, i.e. it is an operation that leaves no visible marks. The cartilaginous and bony skeleton are released and all the anatomical elements of the skeleton are modified step by step. The aim is after correcting the individual problematic parts of the nose to restore the proportions of the pyramid again and adjust the upper lateral cartilage and the cartilage of the tip to the pyramid. A major development of rhinoplasty in recent years is the use of cartilage autologous grafts for extra support or strengthening of the nose, which firstly offers us greater control of the result as well as protects the nose from falling especially of the tip, which can occur after many years. Structural rhinoplasty is the surgery of choice when we want to intervene more on the top of the nose. The term structural, i.e. structural, indicates that a complete reconstruction and support of the cartilage of the tip is performed with cartilage grafts. The grafts are preferably taken from the septum of the nose, but if they are not available in the diaphragm they can be taken from the sides, where no functional or aesthetic alteration remains.
In open structural rhinoplasty, cartilage grafts are crucial as they are the foundation for the perfect support and shaping of the tip. This technique is essentially the modern evolution of rhinoplasty, based on the theory of the tripod of the top, i.e. the reinforcement of the nasal domes with a third leg that is either an extension of the septum (septal extension graft) or the columella (strut graft). In addition, additional grafts, such as spread grafts or spreader flaps, can be used for correction or strengthening of the middle third of the nose and functional treatment of the mechanism of the internal valve, or more specialized grafts of the tip or aral cartilage.
All these techniques give us absolute control over the outcome of the result, while limiting the uncertainties that can affect the result in the first months of recovery. They also enable us to treat complex nose problems, such as intense asymmetry, anatomical or genetic abnormalities such as cleft lip and cleft palate, as well as revisional cases where rhinoplasty has preceded.
A newer technique is preservation rhinoplasty, which can be performed either openly or closed. The advantage of this technique is that the middle third of the nose remains intact and osteotomies are not performed on the back of the nose. It is mainly indicated in people with very thin skin on the nose, where osteotomies can leave some visible imperfections, In people with relatively small puberty or with asymmetry of the nasal bones and finally in people with instability of the middle third. There are two conservation techniques, the so-called push down and let down, where controlled peripheral osteotomies are performed and a part of the septum is removed under the back so that the nasals can move as an entity inward. It is not a technique that can be applied in every case of rhinoplasty equally successfully, but where there is an appropriate indication it seems to have many advantages.
A special category is secondary or revision rhinoplasty, i.e. the case where correction is performed in the context of a previous nose operation. First of all, in these cases we need to make a detailed analysis of the individual aesthetic and functional problems that exist and examine which of these problems can be treated, to what extent and in what way. These are usually more demanding operations, requiring greater anatomical and technical knowledge and experience. Correction in secondary rhinoplasty can be done either openly or closed, but almost always the use of cartilage or other grafts is needed to replace what has been removed in a previous operation. This grafts can be taken from the septum, as long as it has not been damaged in previous surgery, or from the ribs. The operation may be of short or very long duration, depending on the corrections that need to be performed. Finally, it should be mentioned that from a reconstructive point of view we can restore the nose after partial or total loss either after injury or after excision to remove neoplasms. The restoration is done with grafts and flaps from the forehead or from the labial folds, with a very satisfactory aesthetic and functional result.
Rhinoplasty is performed under general anesthesia, although in limited corrections, such as in the tip area, it can be performed even under local anesthesia. In any case, there is no need to stay in the clinic and the return home is done on the same day of surgery. The nasal splint remains for a week. Pain after surgery is minimal or non existent. After the first week, the splint and silicone sheets are removed from the nose. The swelling of the nose gradually begins to subside after the second week and
disappears completely after 8-10 weeks. The nose is sensitive for the first 4 weeks and injuries should be avoided.
In general, people who have undergone surgery return to work and their daily activities 10 days after surgery. Intense physical exercise is possible after the 4th week. After about 3 months, the nose acquires a natural image and the final result settles after about 6 months, but it may take 12-24 months to fully complete the recovery. As far as bruises are concerned, modern rhinoplasty has significantly reduced bruising around the eyes. Practically either we have no bruises, or a little yellowness after one week, when the splint is removed. This applies whether it is open or closed rhinoplasty. There is no pain in any rhinoplasty technique.
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