Rhinoplasty

Patients who turn to the plastic surgeon to undergo aesthetic rhinoplasty surgery are generally people dissatisfied with the shape and proportions of their nose, perceived not to be in harmony with their face and with their aesthetic standards. In the case of difficult breathing due to deviation of the septum, this operation can take on both aesthetic and functional value, combining the reshaping of the shape of the nose with the correction of the deviation of the septum (septorhinoplasty). A final group of patients who undergo rhinoplasty surgery is made up of those who, dissatisfied with the result of a first rhinoplasty, request a surgical revision with the aim of improving their profile: in this case we speak of secondary rhinoseptoplasty. Rhinoplasty is an operation that modifies the profile of the nose and consequently the shape of the face, a key element of our identity; the decision to undergo the operation must therefore be the result of a thoughtful and mature process and not of a hastily and impulsive decision. The operation is not recommended before the age of 16 for women and before the age of 17 in men, because the structures of the nose and face are still in the growth phase.

An initial consultation with the plastic surgeon will help to eliminate doubts and perplexities, to understand exactly how the operation will take place and what all the options and possibilities are suitable for your case. In order to achieve an optimal result, the possible minimal variations of the surgical procedure will be evaluated based on the anatomical characteristics and needs of the patient. The visit is not binding and gives the opportunity to receive all the information and satisfy any curiosity regarding the surgical and post-surgical program, the drugs to be taken, the analyzes and checks to be performed and the costs.

Based on what is deemed most appropriate and adequate, the plastic surgeon will decide which surgical technique to use between:
– Closed Rhinoplasty: the incisions are made inside the nostrils and the operation is performed through them without having a direct view of the field. The advantages of this technique are imperceptible scars from the outside and a faster post-operative course;
– Open Rhinoplasty: in addition to the incisions inside the nostrils, it is also incised at the level of the base of the columella (the part of skin and cartilage that divides the two nostrils). The advantage is that it allows a direct view of the field. The disadvantages are a slightly longer post-operative period and the scars which, although reduced, are slightly more visible.

If necessary, both can be combined with the correction of the cartilaginous septum with septoplasty. The duration of the operation is approximately 1 hour and a half to 2 hours and takes place under general anesthesia. The length of stay is 1 day. After local infiltration with vasoconstrictor solutions to reduce intra-operative bleeding, the incisions are made at the vestibular level. In the case of the open technique, in addition to the vestibular incisions, an incision is also made at the level of the base of the columella, allowing the skin of the tip of the nose to be completely raised and the operation to be performed in the open. In the case of septoplasty, the cartilaginous nasal septum is detached from the mucosa that covers it, the deviated portions of cartilage are straightened, the excess portions are removed and the modeled septum is repositioned in place. The bridge of the nose is reduced using special rasps and is narrowed through an osteotomy of the nasal bones. Surgical fractures of the nasal bones can only be avoided if, after having reshaped the back and eliminated the hump, the nose is not too wide. Subsequently, the tip of the nose is modeled by removing part of the excess cartilage and/or, if it is necessary to increase its projection, by positioning small cartilage grafts using those of the previously removed septum. The rhinoplasty ends with the suturing of the surgical accesses, the positioning of swabs inside the nostrils and the positioning of an intention device made of thermo-moldable plastic material.

The nasal swabs will be removed the day after the operation (3 days later if septoplasty has been performed). The retainer is removed and replaced after approximately 6 days. After a further week the appliance is permanently removed. The sutures dissolve spontaneously over about 2 weeks. In case of open rhinoplasty, the sutures of the base of the columella are removed 6 days after the operation. The peri-orbital hematomas, resulting from the detachment of the tissues and the osteotomies carried out, will disappear within approximately 10 days. Work activity can be resumed after 6-7 days and sports activity after approximately 30 days. In the first post-operative periods it will be very important to be careful to avoid the use of glasses and prolonged exposure to the sun.

In the first post-operative days, the presence of slight pain, swelling, redness and bruising in the treated area will be normal. Post-operative discomfort can be controlled with normal painkillers and anti-inflammatories.

The residual scars will be, in the case of closed rhinoplasty, two small invisible scars hidden inside the nostrils. In the case of open rhinoplasty, the scar at the base of the columella will be almost invisible.

The result of the surgery depends on several factors: the patient's initial clinical condition, the healing capacity and compliance with the post-operative instructions given by the surgeon. The definitive result will be visible after about a year, but the results and benefits will be noticeable immediately.

Complications of the operation are rare, but possible: hematomas and bleeding, infection, delayed healing of the surgical wound, hypertrophic scarring, modification of skin sensitivity.