Rhinoplasty

Patients who go to a plastic surgeon for cosmetic rhinoplasty are generally people who are not satisfied with the shape and proportions of their nose, perceived as not in harmony with their face and with their aesthetic views. In case of difficult breathing due to a deviation of the septum, this surgery can have both an aesthetic and a functional value, and associate the correction of the septum deviation – the so-called septorhinoplasty - to the remodelling of the nose. A last group of patients that undergo rhinoplasty are those who are not satisfied of their first rhinoplasty and require new surgery to improve their profile. This is known as secondary rhinoseptoplasty. Rhinoplasty is a surgery that modifies the profile of the nose and consequently the shape of the face, the cornerstone of our identity. Therefore, patients should think a lot before undergoing this surgery. This kind of decision cannot be impulsive or taken hastily. This kind of surgery is not recommended before the age of 16 for women and before 17 for men, as the structure of both the nose and face are still growing before those ages.

Speaking to the plastic surgeon before surgery helps eliminate doubts and perplexities and understand exactly how the surgery will be carried out and all options suitable for one’s case. In order to achieve the best result, all possible variables to the surgery procedure will be taken into consideration depending on the patient’s physical characteristics and needs. The visit is non-binding and gives one the possibility to have all data regarding the surgical and post-surgery programme, the drugs to take, necessary analyses, check-ups, and cost

The possible surgery techniques - selected depending on the surgeon’s evaluation - are:
- Closed rhinoplasty where the incisions are made inside the nostrils. In this case, there is no direct view of the field. The advantages of this technique are scars that are almost invisible and a faster recovery;
- Open rhinoplasty in which incisions are made inside the nostrils and on the base of the columella, i.e. the part of skin and cartilage that separates the two nostrils. The advantage is a direct vision of the field. The disadvantages are a slightly longer recovery and scars that - though small - are a little more visible.
If necessary, it is possible to associate the correction of the nasal septum via septoplasty. The surgery is done under general anaesthesia and lasts 1.5 - 2 hours. Hospitalisation is 1 day. Incisions are made at vestibular level after local injections of vasoconstrictive solutions to reduce bleeding during the surgery. In case of open technique, apart from the vestibular incisions, an incision is made at the base of the columella to allow the complete lifting of the skin on the tip of the nose and operate in the open. In case of septoplasty, the cartilaginous nasal septum is detached from the mucosa located above, the deviated portions of cartilage are straightened, the excess portions are removed and the remodelled septum is repositioned. The back of the nose is reduced using ad-hoc rasps and tightened via osteotomy of the nose bones. The surgical fractures of the nose bones can be avoided only if the nose is not too wide after having redesigned its back and eliminated the gibbus. The tip of the nose is then modelled removing the excessive cartilage and/or – should it be necessary to increase the projection – inserting little pieces of cartilage previously removed from the septum. Rhinoplasty ends with the sutures, the positioning of nasal packing in the nostrils and of a restraining device made of thermally modelling plastic.

The nasal packing is removed the day after surgery or, in case of septoplasty, after 3 days. The restraining device is removed and replaced after about 6 days. It is then finally removed after another week. The stitches dissolve within about two weeks. In case of open rhinoplasty, the stitches on the base of the columella are removed after 6 days from surgery. The periorbital haematomas caused by the detachment of the tissues and the osteotomies disappear within about 10 days. Return to work is after 6-7 days, whilst return to sport activities is after about 30 days. In the first period after the surgery, it is very important to avoid the use of glasses and prolonged sun exposure.

Patients normally suffer local pain, swelling, reddening and bruises in the treated area during the first days following the surgery. Post-surgery issues can be kept under control using normal painkillers or anti-inflammatory drugs.

In case of closed rhinoplasty there will be two little scars hidden inside the nostrils. In case of open rhinoplasty, there will be an almost invisible scar on the base of the columella.

A good outcome of the surgery depends on many factors: the patient’s initial clinical conditions, his/her healing capacity and compliance with the doctor’s post-surgical indications. The final outcome will be visible after about a year, although benefits will be evident immediately.

Rare although possible risks are haematomas, bleeding, infection, delayed healing of the surgical wound, hypertrophic healing and change in skin sensitivity.