Rhinoplasty

Definition, objectives and principles

The term "rhinoplasty" refers to the modification of the morphology of the nose in order to improve the aesthetic and sometimes functional (correction of possible problems with nasal breathing). The intervention is aimed at changing the shape of the nose to make it more beautiful. We are talking about specifically correcting the existing ugliness, whether it is congenital, appeared in adolescence, as a result of an injury or as a result of the aging process. The principle is to use incisions hidden in the nostrils to reshape the bones and cartilage that make up the strong infrastructure of the nose and give it a special shape. The skin covering the nose will have to re-adapt and overlap due to its elasticity on this bone cartilage scaffold that has been modified. This last point highlights the importance of leather quality to the end result. Thus, it is understood that usually no visible scar is left on the skin. When a nasal obstruction interferes with breathing, it can be treated during the same operation, whether due to a deviated septum or hypertrophy of the turbinates (bone formations present in the nasal cavity). The intervention, practiced in both women and men, can be carried out as soon as growth has stopped, that is, from about 16 years of age. Rhinoplasty can be performed in isolation or combined, if necessary, with other additional gestures at the level of the face, in particular with the modification of the chin, sometimes carried out simultaneously with the operation to improve the entire profile). In exceptional cases, it may be covered by health insurance under certain conditions. In rare cases, improvement in the morphology of the nose can be achieved with non-surgical methods suggested by your surgeon, if this solution is possible in your particular case.

BEFORE INTERVENTION

The motives and requests of the patient will be analyzed. A thorough study of the nasal pyramid and its relationship with the rest of the face will be performed, as well as an endonasal examination. The goal is to define an "ideal" result, adapted to the rest of the face, desires and individuality of the patient. The surgeon, having clearly understood the patient's request, becomes his guide in choosing the future result and the technique used. Sometimes he may advise not to interfere. The expected result can be simulated by photo retouching or computer morphing. The virtual image obtained in this way is only a blueprint that can help understand the expectations of patients. However, we can in no way guarantee that the result achieved will be in any way superimposed on each other. Routine preoperative evaluation is performed as prescribed. Do not take medicines containing aspirin for 10 days before surgery. The anesthesiologist will arrive for a consultation no later than 48 hours before the operation. It is strongly recommended that you stop smoking before the procedure.

TYPE OF ANESTHESIA AND METHODS OF HOSPITALIZATION

Type of anesthesia: The procedure is usually performed under general anesthesia. However, in some cases, thorough local anesthesia with intravenous tranquilizers (“duty” anesthesia) may be sufficient. The choice between these different methods will be the result of a discussion between you, the surgeon and the anesthesiologist. Methods of hospitalization: The intervention can be carried out "outpatient", that is, with departure on the same day after several hours of observation. However, depending on the case, a short hospital stay may be preferable. Then the entry is made in the morning (and sometimes the day before), and the exit is allowed on the next or the day after tomorrow.

INTERVENTION

Each surgeon applies processes that are specific to him and which he adapts to each case in order to selectively correct existing defects and obtain the best results. Therefore, it is difficult to systematize the intervention. However, we can keep the general basic principles: Incisions: they are hidden, most often inside the nostrils or under the upper lip, so there is no visible scar on the outside. Sometimes, however, external incisions may be required: they are made across the columella (the pillar separating the two nostrils) for "open" rhinoplasty, or hidden at the base of the alae if the size of the nostrils is to be reduced. Corrections: The bone and cartilage infrastructure can be changed in accordance with the established program. This fundamental step can implement an infinite number of processes, the choice of which will be made in accordance with the anomalies to be corrected and the technical preferences of the surgeon. In this way, we can narrow a nose that is too wide, remove a hump, correct a deviation, improve the tip, shorten a nose that is too long, straighten the septum. Sometimes cartilage or bone grafts are used to fill in depressions, support part of the nose, or improve the shape of the tip. Sutures: The incisions are closed with small sutures, most often absorbable. Dressings and splints: The nasal cavity can be filled with various absorbent materials. The surface of the nose is often covered with a shaping bandage using small adhesive strips. Finally, a supportive and protective splint made of plaster, plastic or metal is molded and attached to the nose, sometimes it can rise to the forehead. Depending on the surgeon, the degree of improvement needed, and the possible need for additional procedures, the procedure can take anywhere from 45 minutes to two hours.

AFTER THE INTERVENTION: OPERATIONAL OBSERVATION

The consequences are rarely painful and it is the inability to breathe through the nose (due to the presence of wicks) that is the main inconvenience of the first days. Observe, especially at the level of the eyelids, the appearance of edema (swelling), and sometimes ecchymosis (bruises), the importance and duration of which vary greatly from one person to another. For several days after the intervention, it is recommended to rest and not make any effort. The locks are removed between the 1st and 5th day after the operation. The tire is removed between the 5th and 8th day, where it is sometimes replaced with a new, smaller tire for a few more days. In this case, the nose will still appear quite massive due to swelling, and there will still be breathing discomfort due to mucosal swelling and possible crusting in the nasal cavities. The stigmatization of the intervention will gradually decrease, allowing a return to a normal socio-professional life after a few days (10 to 20 days depending on the case). Sports and violent activities should be avoided for the first 3 months.

RESULT

This result most often corresponds to the wishes of the patient and is quite close to the project established before the operation. A delay of two to three months is necessary to get a good overview of the result, knowing that the final form will be obtained only after six months or a year of slow and subtle evolution. Changes made by one are final and only minor and late changes will occur in relation to the natural aging process (as for an unoperated nose). The goal of this operation is improvement, not perfection. If your wishes are realistic, the result should please you very much.

DISADVANTAGES OF THE RESULT

They may result from a misunderstanding of the goals to be achieved, or from unusual scarring phenomena or unexpected tissue reactions (poor spontaneous skin tightening, retractile fibrosis). These small imperfections, if not well tolerated, can be corrected by surgical retouching, which is generally much simpler than the initial intervention, both from a technical point of view and from the point of view of operational observation. However, such retouching cannot be carried out for several months in order to act on stabilized tissues that have reached good scar maturation.

POSSIBLE COMPLICATIONS

Rhinoplasty, although performed primarily for aesthetic reasons, is nonetheless a true surgical procedure that comes with risks associated with any medical procedure, no matter how minimal. A distinction should be made between complications associated with anesthesia and those associated with surgery. With regard to anesthesia, during the consultation, the anesthetist himself informs the patient about anesthesia risks. You should be aware that anesthesia causes reactions in the body that are sometimes unpredictable and more or less easily controllable: the fact of going to a perfectly competent anesthetist practicing in a truly surgical context means that the risks involved are statistically very low. In fact, it should be known that over the last thirty years techniques, anesthetic products, and monitoring techniques have made tremendous progress offering optimal safety, especially when the intervention is performed outside the emergency room and in the home of a healthy person. Regarding the surgical procedure: By choosing a qualified and competent plastic surgeon trained in this type of intervention, you limit these risks as much as possible, but do not eliminate them completely. Fortunately, after a rhinoplasty performed according to the rules, true complications rarely occur. In practice, the vast majority of operations are carried out without problems, and patients are completely satisfied with their results. However, despite their rarity, you should be informed of the possible complications:

• Bleeding: these are possible during the first few hours, but usually remain very mild. When they are too important, it may justify a new, more thorough drilling or even a recovery in the operating room.

• Hematomas: These may require evacuation if they are large or too painful.

• Infection: despite the natural presence of germs in the nasal cavities, it is very rare. If necessary, quickly justifies appropriate treatment.

• Unsightly Scars: These can only touch external scars (if any) and are very rarely unsightly to the point of needing retouching.

• Skin attacks: although rare, they are always possible, often due to a nasal splint. Simple wounds or erosions heal spontaneously without leaving marks, unlike cutaneous necrosis, fortunately exceptional, which often leaves a small area of ​​scarred skin. In general, one should not overestimate the risks, but simply know that a surgical intervention, even outwardly simple, is always associated with a small share of dangers. Using a qualified plastic surgeon ensures that they have the training and competence needed to know how to avoid these complications or treat them effectively if needed.