Rhinoplasty – (Nose surgery)

Rhinoplasty is the medical term used to describe nose surgery or ‘rhinoplasty,’ a procedure usually performed to improve the shape of the nose.

Op.Dr., a leading Rhinoplasty surgeon operating in Ataşehir, Istanbul. Evren AY KOÇ has numerous case experience.

Many people are conscious about the shape of their nose and choose to have Rhinoplasty for cosmetic reasons. Personal and emotional reasons often play a role in this choice. It may also be because they do not like the general shape of their nose and want it to be made smaller. Or they may want a ‘nasal crookedness’ (bump) to be removed. They may not like the width of their nostrils or want the tip of their nose to be thinner. Other patients may choose to have Rhinoplasty due to nasal injury or breathing problems.

Whatever the reason, Rhinoplasty surgery is a delicate procedure that requires careful planning to achieve the desired result, in harmony with the rest of the face.

There are limits to how much a nose can be changed. Different physical characteristics, your age and ethnicity also affect how Rhinoplasty is performed. Known as one of the leading Rhinoplasty surgeons in Istanbul, Op.Dr. Evren AY KOÇ always takes your facial features into consideration when planning any surgery. During your first meeting with him, you will undergo a complete examination and discuss your nose features in detail so that he can make an accurate plan for the surgery you need. You will also be asked about your general medical history, including details of any previous nose injuries or corrective surgeries.

Rhinoplasty – (Nose surgery)

You can learn more about Rhinoplasty Surgery in the sections below.

RHINOPLASTY PROCEDURE

There are different techniques used in rhinoplasty surgery. These are known as closed Rhinoplasty approach, open Rhinoplasty approach or reduction Rhinoplasty approach. All are performed under general anesthesia.

In a Closed Rhinoplasty, surgical incisions are made inside the nostrils, so there are no visible scars from the outside. However, while avoiding a visible scar, there are significant surgical difficulties with this type of procedure as access to the nose is limited and much experience and skill is required by the surgeon.

An open Rhinoplasty uses a small bridging incision along the columella (the column of skin between the nostrils), which allows the nasal skin to fold up, making access inside the nose easier.

Reduction Rhinoplasty, or a ‘rhinoplasty’, is used to reduce or increase the shape of the nose. It may also involve removing a ‘curvature’ or reshaping the tip, bridge or nostrils to create a new profile.

After surgery, surgical tapes and/or a small cast are needed to support and protect the nose for about a week, especially if bone addition is involved and the bones take their new positions. During rhinoplasty, small dissolvable stitches are used inside the nose. You may also have external stitches, which are normally removed within a week.

Reshaping of the tip of the nose is achieved by cartilages under the skin, which are adjusted to thin the nose to fit the new profile. Sometimes it is necessary to place tissue called ‘graft’ into the nose to achieve the desired result. The tissue may be obtained from the nose itself, the cartilage of the ear, or sometimes from a rib.

Nasal tampons may be required to prevent bleeding and ensure proper adhesion of the nasal lining. As a result, you will usually need to breathe through the mouth for 24 hours or until normal breathing can be achieved, and this is a very simple process. Even if a tampon is not used, you will feel blocked and will not be able to breathe fully through your nose. This is due to post-operative swelling and is very normal. If the actual airways have been operated on, the nose may take longer to heal and clear completely.

RECOVERY AFTER RHINOPLASTY SURGERY

In most cases, Rhinoplasty surgery involves an overnight stay in the hospital. The next morning you will be examined and the nasal tampons (if used) will be removed. If everything is okay, you can go home. Most patients take two weeks off work to recover.

Your nose will feel tight and sore after surgery, but surprisingly pain is rare. If you need painkillers, your doctor can prescribe them. Aspirin or aspirin-like medications (non-steroidal, anti-inflammatory tablets) should not be taken.

It is important not to blow your nose or sneeze through your nose. You should avoid bending over or doing any activity for at least a week to reduce swelling and prevent any possibility of nosebleeds. Sports or heavy activity should not be resumed for 6 weeks.

Sleeping elevated using extra pillows will also help reduce swelling. Also, in rare cases, your eyelids may bruise and your eyes and face may swell after the surgery. This may be related to the anatomical structure of the patient. Most swelling will subside within a few weeks, and delicate make-up can be applied to cover the bruises immediately after the cast is removed.

If you have had a closed Rhinoplasty there will be no stitches on the outside, but with an open Rhinoplasty there will be stitches along the central stitch (columella). Although these stitches are dissolvable, the nurse may cut their ends after surgery. If you have had a nostril reduction, you will have external stitches that will need to be removed after about a week. The scars will be slightly red at first but will fade into the natural shade of the nose. They will fully recover over time.

After surgery, surgical tapes will cover the outside of your nose. A small cast may also be needed for about a week to support and protect the nose. After removal, tape may need to be applied over your nose for a few more days to help control swelling while the nose heals.

IT IS NORMAL FOR THE NOSE TO FEEL A LITTLE NUMB AFTER SURGERY, BUT SENSATION WILL RETURN AS THE NERVE SUPPLY TO THE SKIN REGENERATES ITSELF OVER THE NEXT FEW MONTHS.

It may take several months for all the swelling to settle, so it’s important to understand that the shape of your new nose is not final after the cast is removed. Scar tissue forms under the skin of the nose and although it is not visible, it can affect the shape. This scar maturation process takes an average of six months, sometimes longer, so you need to give your body the time it needs before the final result of your new nose becomes apparent.

RISKS RELATED TO RHINOPLASTY SURGERY

Infection and bleeding are possible, but the healing process is normally straightforward. Serious complications are very rare. If you develop an infection, your doctor will prescribe a course of antibiotics.

It is very important that you do not have a cold or cough during your surgery. If you have any doubts or concerns, please discuss them with your doctor.

Nose surgery is a very special procedure and recovery takes time. As a result, approximately 10% of patients will require further improvement. This is especially evident in noses that have suffered severe injury or if there has been a very large reduction in nose size. If it is likely that a second procedure will be needed, your doctor will inform you.

Most secondary procedures are usually a case of minor adjustment, but you should be aware that no surgery can be performed until it is safe to do so, normally 6 to 9 months after your initial surgery.

Your doctor Evren AY KOÇ will provide you with comprehensive information about Rhinoplasty after your first consultation.

Is rhinoplasty suitable for me?

Rhinoplasty surgery creates a permanent change in the shape of the nose, so before undergoing surgery it is very important to consider your reasons for wanting surgery and how a new nose will improve your confidence and health. If you’re considering rhinoplasty, it’s usually because there’s a particular feature of your nose that you don’t like. In the first consultation with your doctor, this issue will be highlighted and fully discussed together with the possible outcome that can be achieved. He will always strongly advise the patient to reflect on what has been discussed after the consultation to ensure they are fully informed as to whether surgery is the right course of action for them. Many times patients choose to have a second consultation to help them confirm things and ask additional questions. The patient who wants to have surgery will not be charged for the first examination or a second examination and conversation.

How is the recovery after rhinoplasty?

Recovery will largely depend on the extent of the procedure, but generally you will need to wear a nose cast for a week and some facial bruising may occur for a few weeks. It is very important to avoid physical exertion for about six weeks after surgery, as swelling always gradually resolves on its own. After 4 to 6 weeks, most of the post-operative swelling will have subsided, but it may take several months to see long-term results. In some cases, it may take up to a year for all tissues to fully settle and the final result to be fully understood. If extensive work has been done on the tip of the nose, it may be particularly slow before the final result is fully visible.

Is rhinoplasty painful?

Surprisingly, Rhinoplasty causes very little pain. In fact, it is one of the least painful cosmetic procedures. If there is any discomfort, it can be easily controlled with mild painkillers.

How do I choose a rhinoplasty surgeon?

No one needs an emergency Rhinoplasty, so it is recommended that you take your time and find a surgeon you like and can trust. Only go to a surgeon who is properly trained and whose experience you trust. The most important factor is the experience of your surgeon. It is often difficult to appreciate a surgeon’s experience from their qualifications alone, so it is important to research as many examples of their work as possible, read patient testimonials, and look at other areas of their rhinoplasty surgery experience. (Ear Nose Throat Head and Neck Surgery). It is also very important not to choose a surgeon based solely on price. More experienced surgeons tend to quote a higher price for obvious reasons. During a face-to-face meeting, you will also get a good idea of whether the surgeon is right for you. They should be caring and reassuring, as well as understanding all your reasons for wanting rhinoplasty.

What is Piezo Rhinoplasty?

WHAT IS PIEZO RHINOPLASTY?

What is piezo rhinoplasty?

Piezo rhinoplasty is simply the technical name for ultrasonic rhinoplasty. This is a new form of rhinoplasty that avoids the hammer and chisel technique to reshape the nasal bones. It provides greater precision and reduces unwanted trauma and soft tissue damage that can occur with traditional rhinoplasty techniques.

Op.Dr.Evren AY KOÇ has significant experience in Piezo rhinoplasty, as one of the first surgeons to adopt this technique in our country.

How does piezo rhinoplasty work?

This form of rhinoplasty avoids hammers and chisels, which are relatively crude instrumentation. Instead, a piezotome is used to reshape and shrink the nasal bones. Piezotome is a special tool that transmits ultrasonic energy to bone without damaging the surrounding soft tissue. Because the energy is delivered specifically to the bone, no secondary damage occurs, meaning soft tissue swelling and bruising is reduced. The piezotome device comes with a variety of attachments shaped like sculpting tools used to reshape bone.

What is the advantage of piezo rhinoplasty?

This is a gentler technique that provides the surgeon with greater precision. There is less swelling and bruising, and some patients notice almost no bruising. The hammer and chisel technique may cause some splintering of the bone and unintentional fractures. This is prevented with a piezotome. It also allows it to be shaped in a way that is not possible even with fine files. In some cases, even fractures of the nasal bones can be prevented.

The technique also fits into the modern trend of conservative rhinoplasty, which is a philosophy of reshaping tissue rather than destructively removing it during rhinoplasty, which is so common in old-fashioned techniques. The piezotome can be used to reshape bone without breaking it, and it can also be used to protect the bridge of the nose.

Am I suitable for piezo rhinoplasty?

Instrumentation is designed for nasal bone shaping. Therefore, it is only suitable for patients who require reduction or adjustment of the nasal bones. This may include reducing bone curvature, adjusting bone deviations or bone irregularities, and narrowing the bony middome.

The technique is not suitable for nasal tip and cartilage corrections, which are generally performed using suture and graft techniques. The piezotome does not cut or reshape cartilage, as only high bone density allows energy transmission. Therefore, if you only need tip surgery, a piezotome is not suitable.

Another important factor to consider is that piezo rhinoplasty must be performed through an open approach and cannot be used with a closed or intranasal approach. This is because the instruments are not long enough and direct visualization of the bones is required for piezo bone shaping. However, the advantages of using a piezotome for rhinoplasty outweigh the presence of a minimal, unnoticeable scar.

Why don’t all surgeons use Piezo rhinoplasty techniques?

This technique is not common because most surgeons are unfamiliar with this advanced form of equipment and how to adapt and modify standard rhinoplasty techniques to include the use of Piezotome technology. Piezotome equipment is also significantly more expensive.

What is the recovery after piezo rhinoplasty?

There is little or no pain after surgery. Additionally, bruising is significantly reduced. A nasal splint is normally required to hold the nasal bones in place during the initial healing period. This splint is removed after approximately 1 week. During splint removal, most patients will notice minimal or no bruising.

However, it should be noted that since a number of different structures are changed during rhinoplasty, it may take approximately a year to see the final result after full recovery. Unfortunately there is no quick path to the final result, but there are certainly advantages in the precision of the technique, which provides benefits in the early recovery period and the quality of the results obtained.