What is Rhinoplasty (Nose plastic surgery)?
Rhinoplasty is the surgical reshaping of the nose in order to obtain a more beautiful and more aesthetic nose appearance from congenital or acquired nasal deformities.
- Who are the candidates for rhinoplasty?
- What is the pre-operative preparation process like?
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Rhinoplasty is the surgical reshaping of the nose in order to obtain a more beautiful and more aesthetic nose appearance from congenital or acquired nasal deformities.
Anatomically, the nose consists of three main structures: the upper 1/3 bone, the middle 1/3 and the lower 1/3 cartilage structure.
(Picture 1)
In rhinoplasty operations, it is necessary to reshape bone, cartilage or both, depending on the location of the problem. (Picture 2, Picture 3)
Who are the candidates for rhinoplasty?
Rhinoplasty surgery lower age limit; 17 years for women and 18 years for men. There is no upper age limit if the person does not have a serious health problem that will prevent him from undergoing surgery. If it causes severe nasal obstruction and/or growth and development retardation, “Rhinoplasty + MIST” surgery should be performed at earlier ages.
What are the risks of rhinoplasty?
Risks that are not specific to rhinoplasty and can be seen in any surgery;
– Bleeding
Infection
Side effects due to anesthesia
Risks specific to rhinoplasty;
– Temporary numbness in the nose
Scar (over-healing) tissue formation (very rare)
Septum perforation (very rare)
These risks are variable for each patient. Your surgeon will inform you whether you are in the high-risk group in this regard.
What is the pre-operative preparation process like?
- Detailed history taking
– Previous nasal trauma,
– Presence of previous nose surgery,
– Presence of bleeding disease (Hemophilia, Von Willebrand etc.)
– The list of routinely used drugs will be noted.
2. Physical examination
Your doctor will do a complete physical exam, including blood tests. He or she will examine your facial features and the outside of your nose. The inside of the nose will be checked with an endoscope with a camera at the tip. With the physical examination, the surgeon determines what changes need to be made with the surgery. It allows you to predict how your physical characteristics, such as the thickness of your skin or the strength of the cartilage of your nose, may affect your surgery result. Physical examination is also important to determine the effect of rhinoplasty on nasal breathing.
3. Photographing process
Your surgeon’s office staff will take pictures of your nose from different angles. From these photos, your surgeon uses computer software to obtain a possible post-operative appearance. Since the photos provide you with visual detail and insight about the outcome of the surgery, they are effective in making a joint decision with your surgeon about the type of surgery. Photos are used as a reference during surgery; it will also be used for before and after comparisons and for long-term follow-up.
4. Decision-making process with the patient
You and your doctor should talk candidly about your expectations together. Your doctor will explain realistically what can and cannot be done for you with rhinoplasty surgery. It is very important that you feel comfortable and conscious, and be clear about your expectations and goals while planning the possible outcome of the surgery with your surgeon.
Do I need to be accompanied by my friends or relatives on the date of surgery?
After the surgery is scheduled, a family member or friend should be present to drive you home if you are going to have day surgery. If you are going to have surgery that requires an overnight stay, a family member or friend will need to stay with you overnight to assist with self-care duties during the post-operative recovery.
Which drugs should not be used before the operation?
Do not use the blood thinners listed below two weeks before and two weeks after the surgery, as they will cause bleeding during and after the surgery. If necessary, your surgeon will contact your heart doctor.
Aspirin and other blood thinners should be avoided;
Non-steroidal pain relievers such as Salicylate, Aspirin, Majesic, Kumadin, Warfarin, Eliquis, Xeralto, Proxifen, Plavix, Ibuprofen, Naproxen, Exedrin, Fish oil (fish oil), Omega 3, Pepto-bismol, Vitamin E, Turmeric (Turmeric ) should not be used.
Other substances;
Marijuana (Cannabis)
Cannabis oil and cannabis derivatives should also not be used.
Can I smoke before surgery?
Since smoking delays the wound healing process, it is beneficial to quit smoking before the operation.
What should be done the day before the surgery?
At least 6 hours before the operation time, eating and drinking, including water, should be left and fasting is required. Blood pressure pills should be taken with a little water. Asthma and COPD patients should definitely use their medications. You should definitely inform your surgeon about any upper respiratory tract disease, fever, cough or any abnormal condition you feel in your body.
What should I do on the morning of the surgery?
On the morning of the operation, our nurse in charge on the service floor will meet you with your relative.The patient will give you a surgical gown and ask you to wear it. A lockable locker will be available in your room for your personal belongings such as wallets, bags, dresses. After the vascular access is opened, if you are going to have “Rhinoplasty + MIST surgery”, two different nasal sprays will be applied to your nose 3 times with an interval of five minutes. In doubtful cases, a pregnancy test will be performed before surgery if necessary.
Will I be naked when I go to the surgery? Can our spouse or a relative participate in the surgery?
Before coming to the operating room, our service nurse will give you a patient’s surgical gown and ask you to wear it. You will be taken to the operating room with this outfit that you will wear without removing your underwear, so you will not take off your underwear and you will not be naked. Relatives of the patients are never taken to the operating room due to sterilization rules, only the patient is taken to the operating room.
What are the details of rhinoplasty surgery?
Your surgery will be performed using “local anesthesia + sedation” or “general anesthesia”, depending on the degree of difficulty and your surgeon’s preference.
Local Anesthesia + Sedation: This type of anesthesia is generally used for day-to-day, simple procedures. It is limited to a specific area of your body. Your doctor injects a pain reliever into your nasal tissues and completely eliminates your pain sensation locally, together with intravenous (IV, intravenous) injected drugs. In this state, you will be conscious and alert, but you will not feel any pain.
General anesthesia; You take the medicine (anesthetic) by inhalation or through a small intravenous line (IV line) placed in your hand/arm. General anesthesia affects your whole body and makes you completely sleep and unconscious during the surgery. A breathing tube is required for general anesthesia, and you can breathe through this tube.
Rhinoplasty is done with a few millimeter incisions inside your nose or in the most invisible part of your nose. Your surgeon then separates your skin from the bone and cartilage tissues, preserving the tissues, and this process is called elevation. After elevation, a detailed surgical planning is made and the bone structure of your nose is completely changed as desired. Afterwards, the cartilage in your nose is removed and the nasal cartilage skeleton is reconstructed as desired. If the nasal cartilage has been removed by another nose operation, cartilage is taken from the back of the ear or from the rib and reconstructed.
Rhinoplasty surgery and MIST surgery are performed in the same session, to be decided together with the patient before the operation, to provide additional contribution to nasal breathing. The first and only physician to bring and use the MIST technique to Turkey, Dr. Binnetoğlu.
After the desired aesthetic appearance is achieved, the surgeon places the nasal skin and tissue back and sutures the skin on your nose with invisible stitches.
After the surgery is completed; A splint with a silicone tube (Doyle® Splint) is placed in the nose to provide nasal support, facilitate breathing and prevent intranasal adhesions.
(Picture 4, 5) Then, a plastic plaster is placed on the outside of the nose. (Picture 6)
Plastic plaster placed outside the nose; It keeps the changes made in the nose in the correct position, protects the nose from post-operative trauma, and allows the surgery to be concluded in the best way.
After surgery, you will be accompanied by our nurses in a recovery room until you are fully conscious. After the operation, your surgeon; Depending on the size of the operation, the anesthesia technique used and the length of the operation, it will decide whether you are discharged on the same day or hospitalized for one day in the hospital.
What are the post-operative instructions?
– In order to prevent nosebleeds and edema immediately after the operation, you should rest in bed using high pillows with your head up and upright. You may feel some congestion in your nose due to the silicone nasal splint and/or edema placed in your nose during the surgery, this is completely normal.
You should not get out of bed for 6 hours after the surgery. The reason for this is the possibility of dizziness, blackouts and fainting due to the fact that the anesthetic effect has not yet passed.A dark brown, sometimes pink, nasal discharge in the form of oozing for several days is considered normal. (If there is a constant runny nose, a gauze can be taped to the front of the nose to absorb the runny nose and prevent the clothes from getting dirty.
- Picture 7 It may be wise to tape a gauze pad until the runny nose stops and while you sleep).
- Wear front button/zip openable clothing such as shirts. In this way, you will be protected from accidentally bumping your nose while changing.
- Nasal saline irrigation should be started 2 hours after the operation as described by our nurses and should be continued for 14 days.
- If concomitant MIST surgery has been performed, nasal irrigation should be continued for 3 weeks.
- For the first 7 days, nasal cleaning by blowing should be avoided.
- Sneeze with your mouth open to equalize the pressure in your nose.
- In winter, dryness of the nose and throat may occur due to mouth breathing. An air humidifier or aromatherapy device can be used to prevent these drying out.
- 2-2.5 liters of water should be drunk daily.
- Prescribed antibiotics and pain relievers should be used.
- The antibiotic ointment prescribed by your doctor should be gently applied to the stitches under the nose with a cotton swab (Q type), twice a day, until the stitches are removed.
- A very small amount of temporary swelling or bruising on your eyelids in the first week after surgery is considered normal. Swelling and bruising completely disappear at the end of the first week.
- Air travel is not recommended within 7-10 days, as the pressure effect inside the plane may cause bleeding. If MIST surgery is also performed to reshape the internal structure of the nose and sinuses in addition to rhinoplasty surgery, 3 weeks of air travel is not recommended.
- Under normal circumstances, you can wash your entire body one day after the operation. However, you should wash your hair by throwing your head back, as in hairdressing salons, by protecting your nose. Plastic plasters and tapes placed outside your nose after surgery should not come into contact with water so that they do not separate from the skin. You can wipe your face with a damp and soapy cloth. During the wiping process, plastic plaster and tapes may get a little wet, in this case there is nothing to be afraid of, but care should be taken not to get too wet. You can take a normal whole body shower, including your hair, after the plastic plaster and bands outside your nose are removed after 1 week under normal conditions. Shower/bath water should be warm, not hot. There are no restrictions on the use of soap and shampoo. You can dry your nose with very sensitive and small touches with a soft towel after shower/bath.
- Constipation is common after surgery. To prevent constipation, you should consume high-fiber foods such as fruits and vegetables.
- Avoid excessive facial expressions such as laughing.
- You can brush your teeth lightly, provided that you do not move your upper lip too much.
- Normal activities (go to work, etc.) should be avoided for 10 days, and heavy sports (including aerobics and jogging) should be avoided for 3 weeks.
- Do not use glasses or sunglasses for at least 6 weeks after the operation on your nose.
- When going out, use sunscreen cream with a sun protection factor of 30 (SPF 30) or higher, especially on your nose. Too much sun exposure can cause permanent irregular color changes on the skin of your nose.With or without surgery, your nose changes throughout your life. Therefore, it is difficult to say when you get your “final result”.
- However, most of the edema disappears within a year the final result of the surgery.
- If an unusual situation develops after the operation, you should definitely call our office.
Which Drugs Can Be Used as Post-Operative Pain Relief?
In the postoperative period, a drug containing a combination of Paracetamol and Codeine that does not cause bleeding will be prescribed.
What is piesorinoplasty (Ultrasonic rhinoplasty) and why should it be preferred?
The first modern rhinoplasty was performed in 1887 in the United States by Dr. Performed by John Orlando Roe. From the first rhinoplasty surgery to the present day, the general outline of the operation still includes the same features, even if the surgery itself has become a more sophisticated surgery. Despite advances in understanding the structure and function of the nose, the social and psychological aspects of rhinoplasty, and long-term outcomes, most rhinoplasty surgeons follow the same rules.
Most patients who come for rhinoplasty surgery have a similar concern. They think that her nose is too big and does not fit her face shape. The procedure performed for this group of patients is called “Reduction rhinoplasty (nose reduction aesthetics)”. The typical features of a large nose are a combination of a large nasal hump, broad nasal bones, a bulging nasal tip, and/or wide nostrils. No more than bone and cartilage tissue should be removed during nose reduction. In general, the best aesthetic results are obtained in surgeries performed by removing a small amount of bone and cartilage. During the straightening of the classical large nasal bones; Files, hammers and surgical chisels are used to lower the nasal arch and narrow the nasal bones. In classical techniques such as rasp and hammer, the cutting process is done by applying pressure on the bone, and in this case, the desired shape may not be obtained one hundred percent. Dr. In 2004, Massimo Robiony introduced the technique called “Ultrasonic rhinoplasty” or “Piezorhinoplasty”, which is a groundbreaking technique in the correction of large nasal bones.
Vibration is created on the razor-like tip of the piezoelectric device by using high-frequency sound waves. With this technique, the nose is shaped micrometrically without creating pressure, friction and heat in the nasal bones during the bone cutting and shaping process.
Piezorhinoplasty causes much less tissue trauma than classical methods. Therefore, while reducing the amount of postoperative bruising, swelling and pain, a more micrometric cosmetic result is obtained. This results in less need for revision surgery.
Frequently asked questions about rhinoplasty
Can sinusitis surgery be performed at the same time as rhinoplasty?
If you have concomitant sinusitis, Rhinoplasty surgery and “MIST surgery” (sinusitis surgery) can be performed in the same session. The first physician to bring and use the MIST technique to Turkey, Dr. Binnetoğlu. You can find detailed information about MIST surgery on our website. Pricing will be different from rhinoplasty for those who will have rhinoplasty surgery + MIST surgery.
Can allergic rhinitis surgery (Vidian nerve surgery) be performed at the same time as rhinoplasty?
Allergic rhinitis; It is a clinical picture formed by the local inflammatory reaction of the surface epithelial cells (false stratification) starting from the nasal mucosa and extending to the lungs against allergens. In our country, it is seen in 2-28% of adults and 3-40% of children. Sneezing, nasal itching and nasal congestion are the most common complaints. The respiratory system is considered as “One Unit”, therefore, sinus, Eustachian tube and lungs are also affected in addition to nasal complaints, and sinusitis, eustachian dysfunction, fluid accumulation in the middle ear (otitis with effusion) and asthma diseases accompany the picture. can.
Due to nasal congestion:
In adults;
-Cardiovascular system diseases: Cardiac rhythm irregularities such as coronary artery disease, heart attack, heart failure, hypertension, atrial fibrillation and even sudden death,
– Nervous system diseases: paralysis (stroke), headaches, depression, forgetfulness, decreased decision-making ability,
– Hormonal system disorders: sexual reluctance, erectile dysfunction (impotence), increased insulin level, susceptibility to diabetes
Other situations: It can cause traffic accidents, marital problems, decrease in quality of life, reflux etc.
In children;
– snoring
– OSAS (obstructive sleep apnea)
– Unrestful sleep (Sleep disorders)
-Night tremors
– Speech disorders-Bite disorders
– mouth closing disorders
-Crowded teeth, crooked teeth-Wetting the bed at night-frequent respiratory infections
-TMJ (Temporomandibular joint, jaw joint) pain and diseasesDon’t be overweight, don’t be obese
-Memory disorders-Poor athletic performance
-ADD/ADHD( Attention Deficit Disorder/ Attention Deficit and Hyperactivity Disorder)
-Headaches
It may cause developmental delay in children due to a decrease in growth hormone.
In our patients who do not respond to drug treatment, we can control the disease with a special technique, “Vidian neurosurgery”, at a rate of 95%. With this surgical technology, the Vidian nerve, which contributes to the problems of allergies and nasal congestion, is frozen with a cryoprobe (ice surgery) at the entrance to the nasal cavity, or by reducing its function with a diode laser, and nasal congestion and runny nose and other nasal problems are eliminated. The first physician to apply this technique in our country, Dr. Binnetoğlu.
As a result, Vidian nerve surgery, which is an allergic rhinitis surgery together with rhinoplasty surgery, can be performed in the same surgical session.
Can vasomotor rhinitis surgery be performed simultaneously with rhinoplasty?
Vasomotor rhinitis is one of the most common causes of nasal congestion. It occurs as a result of an overreaction of the parasympathetic nervous system. Patients complain of nasal congestion, especially when lying on their back, when eating and when exposed to temperature changes. Allergy tests are negative. Steroid, antihistamine and/or anticholinergic drugs are used in its treatment. We use a new surgical technique in our patients who do not respond to medical treatment. With “Vidian neurosurgery”, a special technique, we can control the disease at a rate of 95%.
With this surgical technology, the Vidian nerve, which is the main cause of nasal congestion, is frozen with a cryoprobe (ice surgery) at the entrance to the nasal cavity or by reducing its function with a diode laser, thereby eliminating nasal congestion, runny nose and other nasal complaints. The first physician to apply this technique in our country, Dr. Binnetoğlu.
As a result, Vidian nerve surgery, which is a Vasomotor rhinitis surgery together with Rhinoplasty surgery, can be performed in the same surgical session.
Is rhinoplasty surgery a painful procedure?
Rhinoplasty surgery is a painless operation. Usually, paracetamol (Parol) group painkillers are sufficient. However, a combination of paracetamol + codeine will be prescribed just in case.
Do silicone plaques placed in the nose during surgery cause pain?
In our surgeries, silicone splints are placed in the nose to prevent adhesions that may cause nasal congestion in the long term, and these apparatus do not cause pain at all.
When is the silicone nasal splint removed? Will I feel pain during removal?
The silicone nasal splint is preferably removed within 5-7 days. This process takes 15-20 seconds in total and is a hundred percent painless procedure.
Is a tampon placed in the nose during the operation?
Intranasal packing is never applied in our clinic.
Is there a lot of bleeding during the surgery?
Unless there is a patient-specific bleeding disease, rhinoplasty surgery does not cause excessive bleeding. Preoperative blood tests will determine whether you have a bleeding disease or not. High blood pressure patients should definitely take blood pressure medications before and after surgery.
What should I eat on the way to the surgery? How should we eat after the operation?
It is important that the stomach is completely empty before general anesthesia. Therefore, at least 6 hours of fasting is recommended. If you have medications that you use regularly (such as blood pressure medication), it is okay to take your medication with a small amount of water.
After rhinoplasty, your first food will be given approximately 3 hours later. The first feeding will be with watery light foods. It is recommended not to eat very hard things, especially by breaking them with your teeth.
What is the price of rhinoplasty surgery?
Since each person’s nose is different, different operations are performed for each patient. Rhinoplasty surgery is a personal surgery. Therefore, the price requested from patients is often different.
Other factors affecting pricing include hospital selection, cartilage removal from the ear/rib, operation time, difficulty level of the operation, materials used and team expenses.
What should we do if we have a cold or flu after surgery?
Having an upper respiratory tract infection in the early postoperative period may delay the healing of wounds and cause inflammation in the suture areas. In such a case, you should contact your surgeon, if necessary, your treatment will be changed according to the new situation.
How should I shower after the operation?
Under normal circumstances, you can wash your entire body one day after the operation. However, you should wash your hair by throwing your head back, as in hairdressing salons, by protecting your nose. Plastic plasters and tapes placed outside your nose after surgery should not come into contact with water so that they do not separate from the skin. You can wipe your face with a damp and soapy cloth. During the wiping process, plastic plaster and tapes may get a little wet, in this case there is nothing to be afraid of, but care should be taken not to get too wet. You can take a normal whole body shower, including your hair, after the plastic plaster and bands outside your nose are removed after 1 week under normal conditions.
Shower/bath water should be warm, not hot. There are no restrictions on the use of soap and shampoo. You can dry your nose with very sensitive and small touches with a soft towel after shower/bath.
How long does it take for under-eye bruises to go away?
Thanks to the technique used in rhinoplasty surgeries and the precautions taken after the surgery, edema and bruising around the eyes are less common. However, if the patient’s subcutaneous connective tissue is not tight enough, bruising is likely. The bruises will be completely gone within a week-10 days following the surgery.
How many days do patients coming from outside the city have to stay in the hospital and in Istanbul?
They must come to Istanbul at least one day before the operation. The patients are examined and the new nose shape design phase is completed together before the surgery. Hospitalization is recommended for the first night after surgery. The patient is discharged home or to the hotel the day after the operation. They are required to stay in Istanbul for a total of 10 days, including the postoperative silicone plaque removal and stitch removal process.
After how many days can patients coming from outside Istanbul travel by plane?
Air travel for 7-10 days is not recommended, as the pressure effect inside the plane may cause bleeding. If MIST surgery is also performed to reshape the internal structure of the nose and sinuses in addition to rhinoplasty surgery, 3 weeks of air travel is not recommended.
What is revision rhinoplasty?
Re-operation of the nose in patients who have undergone rhinoplasty before and the desired result has not been achieved is called “Revision rhinoplasty”. Revision rhinoplasty surgery requires more knowledge and experience than the first surgery. If there is not enough cartilage in the nose, it may be necessary to take cartilage from the ear or ribs.
What is tip plasty (nose tip aesthetics)?
It is the name given to the surgery performed only for deformities at the tip of the nose and no operation is performed on the bony roof of the nose. Swelling and bruising are almost never observed in tip plasty surgeries. Since it is only worked on the tip of the nose, the recovery time is also shorter.
Will my smile deteriorate after the surgery?
Many people describe that their smiles have changed because there will be swelling around the nose and lips during the early recovery period after rhinoplasty surgery. However, as the recovery is completed, this situation improves and the person’s smile does not change after nose surgeries.
How long does rhinoplasty surgery take?
It would not be correct to say a standard operation time for rhinoplasty operations. Since different procedures are performed for each patient, the duration of the operation is patient-specific. However, in general, it takes 2-2.5 hours on average. If cartilage is to be removed from the ear/rib or if it is a difficult nose that will require additional procedures, the operation time may extend up to 5 hours. The duration of the operation; Factors such as the degree of difficulty of the nose structure and the presence of a previous operation affect it. The surgery continues until the targeted aesthetic nose shape is achieved.
Will there be any scars after rhinoplasty surgery?
There are two methods in rhinoplasty, closed and open techniques. Dr. Binnetoğlu’s personal preference is generally for open rhinoplasty. In open surgeries, a few millimeter incisions are made in the area called the columella between the two nostrils (nasal pole). The reasons for choosing this approach are; to be able to use the ultrasonic bone shaping device piezzosurgery easily and to obtain micrometric aesthetic result by visually dominating the nasal bone and cartilage skeleton one hundred percent during the surgery. The sutures are removed after 7-10 days. The surgical scar in this area is usually too small and insignificant to be seen with the naked eye.
When Is Healing Complete?
Although the healing process varies according to the structure of the skin, most of the swelling decreases in the 2nd month, approaches the ideal in the 6th month, but is still not in the final ideal form and is almost 100% complete in the 12th month. However, this process may take up to 2 years in thick skins, while it may take up to 6 months in thin skins. Whether the skin is thin or thick is the most important factor. The recovery process is closely related to the genetic structure of the patient, chronic diseases, age, alcohol-cigarette consumption and nutritional habits.
When Does My Nose Start to Look Beautiful?
At the end of the seventh day, after the plastic plaster and silicone plaques are removed, the swelling in the nose is maximum and this may cause anxiety in the patients. These swellings are a normal condition to be expected after surgery. Your nose starts to look beautiful from the side profile from the 2nd or 3rd week. However, it takes at least 3-4 months to reach the level expected by the patient from the anterior profile. For this reason, our patients should not examine themselves too much from the front profile for the first 3 months and should not receive many comments from their surroundings. During the recovery period, edema may regress asymmetrically and this may cause optical illusions. Remember that nothing in life gets better overnight, it takes time for the human body to heal. In order to see the expected aesthetic results after the surgery on your nose, you need to give your body enough time to heal.
When Can I Return To My Normal Life?
Silicone splints in the nose for one week after surgery; There are plastic plaster and tapes on the back of the nose. At the end of the first week, silicone splint, plastic plaster and tapes are removed. Generally, you can return to your normal life and go to work within 10 days.
When can I swim in the sea and pool?
You can swim in the sea three weeks after the operation and in the pool four weeks later.
Can I wear glasses?
You can wear glasses at least 6 weeks after the surgery.
Is there a possibility of revision rhinoplasty (a second correction surgery)?
Corrective surgeries performed after rhinoplasty are called revisions. For revision surgeries, the ideal time to pass after the first nose surgery is 12 months. The revision rate has been reported as 5-15% in various clinics. These can be major or minor revisions. Major (major) revisions require repeated long-term correction surgery. Minor (minor) revisions are much more limited simple attempts. In our own revisions, there is no charge other than hospital expenses.