ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Aesthetic Nose Surgery (Rhinoplasty)

Aesthetic nose surgery (rhinoplasty) is the most common plastic surgery performed for both men and women in our country. 


Nose Aesthetics Surgery  

The procedure performed in rhinoplasty is to reshape the nose by changing the structure of cartilage and bones. In order to create a more aesthetic nose shape, sometimes it is necessary to cut the bones and cartilages, and sometimes, on the contrary, to complete the missing parts and change their shape. 
It would be very correct to accept rhinoplasty or aesthetic nose surgery as the most difficult and unknown surgery of plastic surgery.  


Why is Aesthetic Nose Surgery Difficult


Aesthetic nose surgery is difficult because the nose is like a closed box and you have to do this surgery on only one side of this box. There are many unknowns in this surgery because the bones and cartilages that make up the structure of the nose exist independently of each other but as a whole and may behave differently during the recovery period. For this reason, this is the plastic surgery that is followed by the most frequent revision, namely a second correction surgery. It is considered normal for a world-class surgeon to have to make revisions to one out of every 10 cases.  


On the other hand, this surgery gives very good results when done well.  


SURGERY:  
Rhinoplasty surgery can be performed in two ways as open and closed technique.  
In the closed technique, all cuts are made inside the nose. The surgeon completes the operation by working from the inside. In the open technique, a 3-4mm cut is made at the tip of the nose and the tip of the nose is opened.  


The difference between the two techniques is related to the surgeon's command of the operation. The closed technique made from the tip of the nose is more like performing an operation in a bottle. If you are only planning to get something out of the bottle, there will be no problem, but if you want to make a model of a ship inside, it will be difficult. In the open technique, the surgeon can see the structures in the anterior 2/3 of the nose in front of them.  


Which technique is better is always a matter of debate among the doctors who perform this surgery, and no decision has been made on this issue.  
As you can see from my descriptions above, my preference is mostly for the open technique. The most important reason for this is that I do not believe that the result of a fine work that is done without actually seeing what is going on can be good. It is something that even the advocates of the closed technique cannot object, that many surgical maneuvers are possible only with the open technique, and corrections that cannot be imagined with the closed technique are possible with the open technique. I believe that the possibility of revision decreases after open surgeries.  


The biggest handicap of the open technique is the scar on the tip of the nose. But this scar is almost vague after a well-done surgery and remains under the nose. Many patients forget this scar after surgery.  


However, consult your doctor about this and trust them. Every surgeon will get the best results with the methods they know best and believe they are the best. The above are just my personal opinions.  


I SEE VERY BAD RESULTS, WILL I HAVE THEM TOO?  

I also see “operated noses” that are unnatural, very small, with nostrils visible when viewed from the front. I explained on a separate page how you can understand a badly performed nose surgery. Remember that the outcome of the surgery depends entirely on the techniques used by the surgeon, their skills, and what they want to do.  


Giving an upturned nose shape by only making the nose smaller creates an unnatural result. In modern techniques, almost nothing is removed, only the locations, positions and shapes of the tissues are changed.  



If you examine this figure, you can see one of the most common aesthetic mistakes. This is a method often used in old techniques. In the past, in order to make the nose look upturned, the nose was made smaller and the starting point was taken as low as possible. Thus, an illusion was created as if the nose was up, but the result would not be natural. It is necessary to start the nose from where it should start, that is, almost at the level of the pupils, and give its entire shape accordingly.  

How Can I See What Kind of a Nose I Will Have After the Surgery?   


There are computer programs prepared for this purpose. Your doctor will likely give you an idea with one of these. However, a real operation planning and measurement cannot be made with these programs and they can only give a general idea.  


If your doctor is using one of the new measurement-based techniques, they will want to take measurements on your pictures. For this, they will either hold a ruler in your hand while taking your photo and measure accordingly, or print the picture they took in real size.  


I calculate the golden ratios and the ideal face profile by making fine measurements before the surgery. As a result of my calculations, I draw a profile picture by hand. For detailed information on profiling, click here. 


COMPLICATIONS AND PROBLEMS THAT MAY OCCUR: 
The risk of bleeding in every surgery may be more serious in rhinoplasty. Especially if non-aesthetic procedures are to be performed in the nose to relieve nasal congestion, which should be done if necessary, the possibility of unwanted bleeding increases. It is an organ that contains medium-sized vessels in the nose. But this type of bleeding usually does not reach dangerous levels and can be stopped with simple tampons.  
Adhesions called synechiae may develop in your airways after surgery, and these can make it harder for you to breathe than before the surgery. This is usually easy to treat but may require a second surgery.  
Very rarely, a hole may occur in the structure called the "septum", which forms the middle of the nose. This is usually not a problem, but in rare cases, it can cause a sound when breathing. It is difficult to treat and requires reoperation.  
Infection in the nose is almost impossible. This organ, which has a very strong blood supply, is very resistant to inflammation. If infection develops after this surgery, you can enter the medical literature.  
But if you experience aesthetic problems, deformities or don't like the shape of your nose after this surgery, no one will be surprised. Therefore, the most common complication of this surgery is the aesthetic angle.  
 
FREQUENTLY ASKED QUESTIONS: 


Should this surgery be performed by a plastic surgeon or an otolaryngologist (ENT physician)?


Your doctor may be a plastic surgeon or an otolaryngologist. However, do not forget that this is not an operation to say, "Let's take that bone while we're doing it". Sometimes this kind of retouching done in good faith can be very difficult to fix. Discuss everything with your doctor in detail.  


Do you break bones?


We don't break bones. If we want to shape or take parts of it, we "cut" it. Thin chisels are used for this. Sometimes the bones are filed.  


Can this surgery be performed with local anesthesia?


If something is going to be done about the bones, which is mostly necessary, local anesthesia will not be appropriate. This is an operation that requires general anesthesia.  


Is it necessary to put a tampon in? 


It is not necessary to put a tampon. In fact, there is no need to put tampons after many surgeries. A tampon is only needed if serious work has been done inside the nose. Nowadays, modern tampons are not as long as they used to be. 


Will it hurt a lot when the tampons come off?


Tampon removal can be a little tedious, but it's no longer a painful procedure. Consult your doctor about this issue, find out if they will use tampons and what kind of tampon they are considering.  


Is the purpose of rhinoplasty to make the nose smaller and “remove bones”? 


The answer to this question is definitely no. The aim of this surgery is to give the desired shape to the nose. Contrary to popular belief, this is usually achieved not by making the nose smaller, but by enlarging the nose. If there is an excess of a bone called "hump" (in fact, it is mostly cartilage) on the back of the nose, this will of course be removed, but many of these types of noses actually have a low nose tip and it must be raised. In the same way, although many nose tips look fat, the main problem is in the shape and reducing or thinning it only makes the problem bigger.  
 
TIPS: 
It would not be an exaggeration to say that rhinoplasty is the most difficult plastic surgery. It is a surgery that you will be very pleased with if done well, but difficult to correct if done poorly.  
Contrary to popular belief, the slightly upturned European noses that we adore are not tiny but extremely high noses. Therefore, it is impossible for the noses, which are raised only by making them smaller, to stand naturally.  


What to Expect Before and After the Surgery 


This is minor to medium plastic surgery. It is absolutely necessary to receive anesthesia during the operation, so I do not recommend you to have an operation with local anesthesia. The operation must be performed in a hospital; it does not have to be fully equipped or have an intensive care unit. I would not recommend you to have this surgery under the conditions of a doctor's office.  


Your doctor may be a plastic surgeon or an otolaryngologist. I still recommend you to have the surgery with a plastic surgeon, but I know that there are ENT specialists who do this surgery very well. However, do not forget that this is not an operation to say, "Let's take that bone while we're doing it". Discuss everything with your doctor in detail.  


After the surgery, you will have a cast on your nose. You may also have tampons in the nose. Removing new generation tampons is now problem-free. I can say that the tampons told by your friends to be extremely long have become a thing of the past.  


Your first night will be relatively difficult. It will be difficult to breathe through your nose even without a tampon, you will have a headache, you need to apply ice constantly and it will be difficult to sleep. But the next morning you will feel much better.  


How much swelling will occur depends on the procedures performed in the surgery, your body and of course your doctor. In the second surgery, the swelling will be a little more. There will be a slight leak from the tip of your nose for the first 24 hours. This is also extremely normal.  


You should not be worried if you vomit and there is blood in your vomit. Some patients may swallow blood during surgery and this may cause vomiting after surgery. Do not be afraid if the bleeding is not fresh and does not continue, but be sure to inform your doctor.  



After the second day, you can return to your normal life and, for example, go to the cinema. After the cast is removed, sticking a thin tape on the nose helps the swelling to go away quickly.  


ABOUT THE SURGERY:  
Anesthesia type: General  
Where should the surgery be performed: In a hospital's operating room.  
Duration of surgery: 1.5 to 2.5 hours.  
Length of stay in hospital: You can be discharged on the same day.  
Post-operative pain – distress: There may be a slight tingling for a few days. Usually, a simple oral pain killer is sufficient.  
Swelling, bruising: There may be severe bruising and swelling around the eyes between 3-7 days.  
Dressing Tampons, if any, are removed the next day. The cast is removed on the fifth day.  
Stitches: If open rhinoplasty is performed, the nasal tip sutures are removed on the fifth day with the cast.  
When to return to work: 3-7 days.   
Exercise: Long walks after 2 weeks, normal exercising after 3 weeks. It would be correct to start competitive sports like basketball and boxing after 5 weeks at the earliest.  
Final shape: Usually, a significant part of the swelling goes away in the second week. But the final shape appears in the 6th month at the earliest. If there is swelling towards the forehead, especially between the eyebrows, this will continue for up to a year. 

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