As nose has the highest aesthetic value in the making of a good face, nose reshaping (rhinoplasty) is the most sought after aesthetic procedure by common man. Rhinoplasty consists of two words, RHINO meaning NOSE and PLASTY meaning SHAPING. This procedure was 1st performed by Sushruta(Father of Indian Plastic Surgery)in 800 B.C . Rhinoplasty enhances facial harmony and the proportions of nose. It can also correct impaired breathing caused by structural defects in the nose. Rhinoplasty surgery employs reduction, augmentation or refinement of the patient's nose to give a balanced and proportioned nose. Reduction rhinoplasty commonly involves the removal of a nasal hump along with re-breaking the nose to reduce the width. The tip of the nose may be asymmetrical, depressed or the nose itself may need building up. Augmentation which can be achieved using tissue moved from another part of the patient's body such as skin or cartilage from the ear or rib. Alternatively synthetic material can be used (gortex, silastic) but there is a greater risk of rejection or infection.
When It Is Done ?
Rhinoplasty is most often performed for cosmetic reasons. A nose that is too large, crooked, misshapen, malformed at birth, or deformed by an injury or cancer surgery can be given a more pleasing appearance. If breathing is impaired due to the form of the nose or to an injury, it can often be improved with rhinoplasty. The majority of individuals who undergo nose reshaping surgery are dissatisfied with the appearance of their noses and wish to improve the proportions of their facial features. A smaller percentage of rhinoplasty candidates are patients who deal with discomfort or breathing difficulties due to structural abnormalities or previous nose injuries. The optimal candidates for rhinoplasty are in good general health, understand the risks associated with surgery, and have realistic expectations regarding the surgery results.
Indications of Rhinoplasty
Rhinoplasties are done for different reasons
1. Conginental defects like secondary cleft lip nose deformity
2. Traumatic disruption of normal structure of nose so that the nose is asymmetrical.
3. Purely cosmetic reasons like hump correction, length correction, or for decrease in height of nose etc.
4. Correction of structural as well as functional deformity (deviated nasal septum with crooked or off-center dorsum , or damaged valves)
5. Nasal tip ; drooping, rotating, boxy, bulbous or bifid.
6. Excessively flared or pinched nostrils
How It Is Done ?
Nose surgery is done by two methods
1. Open
2. Closed
Advantage of open rhinoplasty is good visibility of all the defects but at the same time it is more difficult and requires training and expertise.
Closed rhinoplasty is comparatively easier but field of vision is restricted and so all the deformities cannot be corrected by this. It has got limitation of vision as well as surgical outcome.
Primary Rhinoplasty:
Surgery for reshaping of nose in a patient who has never undergone nasal surgery. It can be either a cosmetic procedure performed to improve the appearance of the nose, a medically necessary procedure to improve nasal breathing, or a combination of both.
Secondary Rhinoplasty:
Corrective reshaping of a nose which was operated earlier by a different surgeon. Itrequires exceptional analytical and surgical skill. Only surgeons with extensive training and significant rhinoplasty experience can restore breathing function and improve less-than-desirable results from previous nose surgery.
Revision Rhinoplasty:
Further changes/augmentation or reduction by same surgeon in a previously operated nose.
Any adult (>18 years of age) with perceived aesthetic issues or birth defect can opt for it. As the nasal cartilage is growing till the age of 18 years it is advisable to delay any corrective surgery of nose till this time. In extreme cases where there is severe breathing difficulty it can be performed at 16 years of age.. Regardless of the reason for surgery, we recommend that girls wait until age 14 or 15, and that boys wait a few additional years to undergo rhinoplasty. By this time, the nose should have finished growing.The best way for a patient to determine his or her candidacy for rhinoplasty is to schedule a consultation with a qualified rhinoplastic surgeon.
First and foremost thing is detailed consultation to know about patient's desires and expectations to evaluate the patient's nose and to discuss the procedure, down time and expected/unexpected complications with the patient. Proper evaluation by an anaesthetist as it is done under general anaesthesia is a must. Depending on the patient's age and medical history, blood investigations, chest X-Ray is ordered and if the anaesthetist finds the patient fit for anaesthesia, operation is scheduled.
In preparing for rhinoplasty surgery few instructions are must Stop smoking and avoid taking aspirin, anti-inflammatory drugs, and herbal supplements atleast a week prior to date of surgery as they can increase bleeding.
There is nothing like one nose fits all. So depending upon the evaluation and discussion with patient open/closed approach is chosen. If augmentation is to be done then the patient is given the option of conchal /septal /costal cartilage graft or implant. Different combinations of procedures like augmentation with ala correction and tip plasty or septal correction or only lengthening is done. Pre-op and post-op photographs are taken to compare and to audit the results.
Post procedure nasal pack is kept for 48 hours and nasal splint is placed for 2 weeks to support and protect the new structures during initial healing.
Patient is called for suture removal and if required plaster change on 7th post-op day. Cold exposure /swimming /strenuous exercise /face wash during this period is strictly not allowed for the patient. Once the wounds have healed, regular cleaning of nose is advised and patient can resume his normal activities. While initial swelling subsides within a few weeks, it may take up to a year new nasal contour to fully refine. During this time one may notice gradual changes in the appearance of the nose as it refines to a more permanent outcome.
Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery. Few don't's for patients are-No blowing and nose picking for 4 weeks. At the time of sneezing mouth should be kept open to avoid stress on inflamed nasal mucosa which may bleed.Patient should not use specs (eye glasses)for 4-6 weeks.
Due to donor site (chest) pain/discomfort patient needs atleast 48 hours of hospital stay and regular chest physiotherapy and breathing exercise.It also takes a bit longer to perform this type of rhinoplasty procedure, and the nose will usually be more swollen after surgery.
Though this surgery can be done as day care surgery, but it needs a good hospital with OT staff and anaesthesia facilities. This surgery shouldn't be tried in places with inadequate facilities as complications do occur and may require multi-specialty care.
Swelling and bruising on the nose, cheeks and eyelids are normal side effects. They usually resolve within 2 to 3 weeks after the procedure. Bleeding, asymmetry, possible recurrence of deformity and difficulty in breathing are few usual complications. A touch up procedure may require refining the results. If all pre-op, operative and post-op precautions are taken, complications are negligible.
Results are permanent, but aging may affect. Nasal anatomy and proportions are quite varied and final look of any rhinoplasty operation is the result of the patient's anatomy, as well as of the surgeon's skill. A cosmetic change in the shape of the nose changes a person's appearance as well as improves the self esteem. Surgical goal is to avoid the "operated look" and produce a nose that looks natural, functions properly, and in balance and harmony with other facial features.
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