Rhinoplasty

Nose surgery (Rhinoplasty)
Each person has their own particular physiognomy that characterizes them, besides a distinct nose structure in relation to its size, the cartilage, the skin thickness, the face format, and the hereditary factors. Nose aesthetic surgery has, therefore, the goal to maintain balance and harmony between nose and face, without changing or altering the naturalness and authenticity, in other words, it should improve and refine what already exists without modifying the characteristics of the face. In general, the approach is performed inside the nose (intranasal) acting on the bone and cartilage structure. Eventually, it is performed on the skin in the region, when can be removed bony and cartilaginous excesses and other times, add structures to maintain balance necessary for the good aesthetic result.

Rhinoplasty or nose surgery improves the appearance and proportion of the nose, highlighting facial harmony and improving self-esteem. Nose surgery can also correct breathing difficulties caused by structural abnormalities in the nose.

Rhinoplasty can change:
• The size of the nose, in relation to other facial structures;
• The width of the nasal dorsum;
• The nose outline;
• The tip of the nose, which can be great, fallen or too upturned;
• Large nostrils, wide or upturned;
• Nasal asymmetry and deviation.

Who is it indicated to?
This surgery is indicated:
• If the facial growth is completed and if you are 13 years old or older;
• You are physically healthy;
• You do not smoke;
• You have a positive attitude and realistic expectation of surgical results.

Preoperative
In the preoperative:
- Clear all your doubts before surgery;
- Report in case of flu, cold, temperature or any major organic changes occurring in the period prior to surgery;
- Fasting should be done from the previous day and avoid alcoholic beverages and heavy meals the day before;
- Wash your face with soap SABOFEN before heading for the established hospital.

Anesthesia
Normally the preference is that the surgery is performed under general anesthesia, with few exceptions when it can be under local anesthesia.

Hospitalization
Regardless of local or general anesthesia, there is no need for hospitalization, i.e., the surgery is performed on an outpatient basis. The patient is discharged on the same day of the surgery.

Based on texts by SBCP.

Operation
The nose surgery is performed by closed procedure, in which the incisions are hidden inside the nose, or by open procedure, where an incision is made through the columella, narrow strip of tissue that separates the nostrils. Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to remodel the structure of the nose. Usually, the duration of the surgery is from 1 to 2 hours. The nose surgery can reduce or increase the nasal structures with the use of grafted cartilage from other areas of your body. Most commonly, septal cartilage parts, the partition in the middle of the nose, are used for this purpose. Sometimes, ear cartilage part and, rarely, part of the rib cartilage can be used as well.

Once the underlying structure of the nose is sculpted into the desired shape, skin and nasal tissue are accommodated and the incisions are closed. Additional incisions may be made in the natural furrows of the nostrils to alter their size.

A kind of cast and internal plug will support the nose as the surgery begins to heal for about a week. While the initial swelling reduces within a few weeks, it may take up to a year for the new nasal outline be completely redefined. During this period, you will notice gradual changes in the appearance of your nose. The swelling may appear and disappear and be a little worse in the morning, during the first year after surgery. The rhinoplasty to remodel the obstructed airway requires careful evaluation of nasal structure as regards to airflow and breathing. The septum deviation correction, one of the most common causes of respiratory insufficiency, inclusive, is achieved by nasal structure adjustment to produce a better alignment.

Postoperative
The postoperative period is very calm overall, and practically painless. It is characterized by swelling (edema) and bruising around the eyes that are reabsorbed with time in about 10 days. After surgery, the nose is kept immobilized in a cast or a thermo-weldable plastic material that totally covers it and is removed after about 7 to 10 days. It is also left a tamponage in the nostrils to be removed on the same day or the day after the surgery. Both the cast as the tamponage are important for the modeling stage of the nose, reducing the possibility of postoperative bleeding.

Several phases are characteristics of nose postoperative. Soon after the cast removal, there is an edema (swelling) that decreases over time, although we can already observe that the various aesthetic defects of the original nose have been corrected. The final result will be visible only after six months after the postoperative. Some (few) patients may reach the final result before or after 6 months, however, the persistence of transient edema for a longer period than normal does not interfere on the result. Eventually, there may be a sensation of breathlessness in the first weeks due to the swelling that also occurs inside the nose, but which normalizes with time. Hardly, respiratory functions are affected after the nose aesthetic surgery. Also, it is not unusual a little bleeding from the nostrils on the following two days. This should not be reason for concern and will stop spontaneously.

Caution
- Do relative rest on the first four days, avoiding harsh movements and followed with the head and body, as lower the head;
- Always keep your head elevated during the first days; sleep with 2-3 pillows and face up;
- Usually after the first week there is no inconvenient to be exposed to eventual sun, however, one should avoid long exposures on the first 2 to 3 months, as well as physical exercises that can traumatize the operated nose;
- It is recommended to apply indicated ointment with a cotton swab inside the nostrils to prevent desiccation of natural secretions during this period.

Scar
This surgery leaves no visible scars because the incisions are made inside the nose, and therefore, leave no external scar remains. In special cases, when the nasal wings are treated, there are two small scars in the furrows between the wings and the face which, over time, become practically imperceptible.

It may take several months for the swelling completely disappear and up to a year - and sometimes more - for the result of the surgery be entirety perceived. Although rhinoplasty results are usually permanent, the cartilage may continue moving and remodeling the tissue, changing the result over time.

Important: Do not rely on information from well-meaning friends. Get the necessary information directly from the doctor and you will avoid having doubts and anxiety in the postoperative period.

Rhinoplasty is a surgery that requires greater responsibility among others, because the nose will always be exposed and visible making any detail apparent, not to mention that a very exaggerated or artificial surgery can completely change a person’s physiognomy (this is not our goal) taking the person to ridiculous. Therefore, along with the facial surgery, it is the one that most imposes naturalness on the result, without drawing attention that a surgery was performed on the nose and it is completely justified its involvement.

So the good plastic surgery is the one that it solves the complaints of the patient, but does not appear.

Performed under general anesthesia, with an average duration of 1 hour, it is practically painless and what bothers are swelling and the purplish tone around the eyes that can take two to three weeks to disappear, besides the dressing on the nose that stays for 2 weeks.