What kind of aesthetic and functional problems can be solved by rhinoplasty?
Difficulty in the passage of air through the nose may be due, in addition to some type of functional problem such as rhinitis, to a deviated nasal septum or enlargement of the inferior turbinates. Septoplasty can correct the deviated septum and turbinoplasty can reduce the size of the turbinates. When there is a respiratory difficulty, some of these techniques are practiced along with aesthetic rhinoplasty.
From the aesthetic point of view, rhinoplasty can solve virtually any defect of the nose. Thanks to it we can eliminate the existence of a hump (or ridge) in the dorsum, rotate the tip upwards or downwards, correct a deviated dorsum, narrow the tip or the base of the wings, increase the projection of the tip, etc.
What anatomical considerations should be taken into account before performing a rhinoplasty?
The fundamental limiting factor to modify the appearance of the nose is the thickness of the skin. The presence of a thick skin prevents, for example, to reduce the projection of the tip (what patients often refer to as “I have a very big nose”) or to achieve a very fine tip.
In addition to this there is another factor that should exclude certain people as candidates for rhinoplasty, even more important than the previous one and that has nothing to do with the type of tissues that the patient has: the expectations that the patient has regarding the intervention.
As in any other cosmetic surgery procedure, no patient should undergo rhinoplasty if the attending surgeon doubts that he/she has realistic expectations. To avoid this, I never operate on any patient without having first made a computer simulation on his own photograph in which I show him what can be expected from the intervention in his individual case. On that simulation I ask the patient to tell me what he/she would like to change and I explain what can or cannot be achieved and what should or should not be achieved (not everything the patient wants may be desirable from an aesthetic point of view). If the patient expects something impossible to achieve (due, for example, to the thickness of his skin) or is not convinced by the “ideal result” that I have simulated on the computer, I never operate on him because it is very likely that he will not be satisfied with the result.
What does the procedure consist of?
The objective of rhinoplasty is to modify the shape and/or size of the nose by reshaping its bony and cartilaginous structure. This can be done through incisions inside the nose, in the nasal mucosa, in which case there is no visible scar (this is called closed rhinoplasty) or by adding to the above a small incision in the columella (the tissue that separates the two nostrils, the entrance to the nostrils). The latter technique is known as open rhinoplasty and leaves a small scar on the skin of the columella, practically imperceptible after a few weeks. Both techniques have their advantages and disadvantages and neither is better than the other in all cases.
How long does it take for the patient to return to normal activity and is there any scarring or scarring after the procedure?
The recovery time depends on the type of activity and the particular evolution of each patient. The most evident swelling and bruising of the eyelids and/or cheeks usually disappear 10-12 days after surgery (sometimes even sooner).
The patient can perform activities that require little physical effort (such as working on the computer from home) almost from the day after surgery. To appear in public without a very evident deformity it is necessary to wait about two weeks. To perform more strenuous activities (including intense physical exercise) the patient should wait for a month after the intervention.
As for the scars, in the case of closed rhinoplasty these do not exist in the skin. In the case of the open technique, the minimal scar that remains in the columella is barely perceptible after a few weeks. In addition to this, and regardless of whether the rhinoplasty was closed or open, when the base of the wings must be narrowed, there will be small scars in the area, barely noticeable even after a few months. Finally, in more complex cases of nose deformity it may be necessary to remove tissue from other areas of the body to achieve the desired goal (such as the head, ear or rib region). In such cases there will be scars, more or less visible, in these areas. What is really important is that the patient is aware of the possibility of scars and what kind of scars will be left after the procedure and accepts this before undergoing the procedure.
What kind of results can be obtained with this technique and how long will it take for the patient to appreciate them?
The first change after rhinoplasty is observed when we remove the splint from the nose (7-9 days after surgery) or sometimes even before removing it (for example, tip rotation can be seen with the splint in place). We will begin to check the result of the operation at approximately one month, although at that time there is still too much swelling in the nose to make a definitive assessment. The definitive result will not be seen until 10-12 months after the rhinoplasty, once the swelling has completely disappeared.
As for the type of results that can be expected with the intervention, it should be borne in mind that the objective of rhinoplasty, as with any cosmetic surgery intervention, is to make the patient feel better about themselves and improve their self-esteem. It is about increasing the patient’s quality of life through their psychological well-being. If the patient is well informed before the intervention, in most cases he/she will be satisfied with the result.
It should be remembered that rhinoplasty is considered in all texts as one of the most difficult cosmetic surgery interventions (if not the most). For this reason, the patient who is going to undergo it should know that it is the intervention in which it will most likely be necessary to make some kind of retouching (usually small) to achieve the desired result for both the patient and the surgeon.