Rhinoplasty

Rhinoplasty
Rhinoplasty describes all kinds of different surgeries, that change the shape of a nose. Some people desire to have the appearance of their nose changed. The motivation for such surgery varies a lot.

Rhinoplasty describes all kinds of different surgeries, that change the shape of a nose.

Some people desire to have the appearance of their nose changed.

The motivation for such surgery varies a lot.

Many patients had accidents, or prior surgeries with the result of an undesired shape of the nose.

Some people disagree with the look of their nose as they inherited it from their parents. Often they have the desire to do a “nose-job” already for many years. 

There are also some people, who just got the idea to change their entire body appearance and want to begin with the nose.

Or sometimes someone has talked them into it, or it is a mood coming out of a current fashion.

A typical request is then: I want a nose like Nicole Kidman or like  Penelope Cruz or Charlize Theron. Some patients with dark skin or African origin are asking for a nose shape similar to Michael Jackson as he had it at a certain time of his career.

It is very important to find out, what the motivation of a person is, when they ask for a nose reshaping.

There are surgeons and clinics , who support the creation of a desire to change someone’s appearance. I am against this practice and advocate primarily to leave the everyone’s nature untouched  and unaltered.

You can compare a plastic cosmetic surgery with a holiday trip.

What  both have in common is  the positive expectations people have when they book for them. Also nobody is forced to go for it. But still both of them may end as a disappointment and even as a disaster.

When we book them, our mind casts out all possible negative outcomes of our decision. As little as we think of the holidays beginning with misplaced luggage  or a stolen credit card we think about plastic cosmetic surgery or non invasive cosmetic procedures ending with a visible mark. To a certain extend it is the task of the surgeon to open the patients mind for such possibility.

It is however human nature to take risks for their convenience in all walks of life and blend out uncomfortable thoughts.

As a plastic cosmetic surgeon I have to acknowledge this and respect the wishes of my clients as well.

But I am not using any convincing picture material or “photoshop” pictures of the patient with a possible future look.

Logically being a “Photoshop” artist is a different profession to being a rhinosurgeon. Therefore both results have nearly nothing in common. I show my patients however how other previous patients went through the surgical process and what their desires were and how it looked at the end of the procedure.

Honesty and transparency is of utmost importance when it comes to touching someone else’s body with the knife, it is their body, their risk and suffering.

Long experience however enables the surgeon to minimize this risk a lot. Using the appropriate surgical technique, instruments and material recduces the risk of failure...

How can I know which technique is the right one?

There is no patient case identical to the other, but still many problems are very similar and can use similar approaches.

Identifying the problem consists of the examination together with the intention of the patient after good consultation.

I had for example a patient with a pround bony hump and a deviation of his nose after multiple  fractures  from rugby playing.

A deviated nose is most symmetrically rectified, if the surgeon approaches the structures from midline ( open technique) but the patients concern was not the deviation but rather the irregularities of the bony parts of the nose.  Many people have a slightly deviated nose and have no issues with that, but irregularities are catching the eye of the onlooker. This patient was a businessman meeting frequently with customers. His concern was valid. His desire was to have a nose that does not particularly attract attention.

Decision : no open approach required; with the effect that the surgery was less traumatic and didn’t bear the risk of columella scarring.

Sometimes, especially in revision cases, it is necessary to harvest building material to reconstruct the original shape  of the nose, or to reconstruct a pleasant and functional shape of the nose. In such case it is best to choose material from the own body. I usually find sufficient amounts of cartilage in the ears. However some surgeons use rib cartilage or artificial material like Goretex , Silicone or Medpore.

Very interesting will be the development with stem cell bred cartilage. Already today I am using PRP, which is platelet rich plasma, a centrifuged product from the patient’s blood.

This liquid contains a high amount of growth factor and provides a persisting effect in combination with the building material of choice, e.g. diced cartilage.

I used these materials especially for the reconstruction of smooth and symmetric shapes of the nose.

In my practice a combination of the use of a bony structure from deeper inside the nasal septum and the ear cartilage was always capable to reconstruct good nasal tip support and a straight nasal septum.  

Another point patients should be aware of, is the postoperative implications from rhinoplasty.

A rhinoplasty is usually a day surgery. Depending on the individual patient it can also be performed with a short stay in the hospital.

There will be a thin cast  outside of the nose . The cast is usually made from a thermoplastic material. The purpose of this cast is not only protection, it reduces the swelling of the nose and shortens the period  of postoperative swelling. As swelling is a main reason for pain it is also the main contributor to reduce the pain.

Inside the nose will be  silicone splints. Those splints are provided with a pipe to enable the patient to breathe. The effect of the splints is similar to the cast only from inside.

Both the splints and the cast are removed after 7 days.

In my eyes you can see from the amount of bruising the quality of the surgical work. The more bruising, the less careful was the intraoperative preparation. There are exceptions, but in such cases the surgeon can tell already before the surgery that you may experience bruising.