Rhinoplasty

General Overview:

Rhinoplasty, a cosmetic nose surgery, is commonly termed as Nose job. It is a type of cosmetic plastic surgery procedure carried out in order to reconstruct the form, restore the functions, and magnify the nose in an aesthetic aspect, by fixing nasal trauma, respiratory impediment (septoplasty), congenital defect and a failed primary rhinoplasty.

In the surgeries – closed rhinoplasty and open rhinoplasty – a plastic surgeon, fabricates an aesthetic, functional, and cosmetically proportionate nose by parting the nasal skin and the soft tissues from the osseo-cartilaginous nasal framework. The surgeon rectifies them as required for form and function, sutures the incisions, and applies either a stent or a package, or both for immobilization of the corrected nose in order to ensure proper healing of the surgical incision.

Non-surgical rhinoplasty procedure rectifies and revises slight defects of the nose with the help of subcutaneous injections of biologically inert dermal fillers. The results obtained are temporary/short lived in comparison with the results of nose surgery.

Indications for Surgery:

The Open & Closed Rhinoplasty approaches rectify:

  • Nasal pathologies
  • Disproportion (an unsatisfactory aesthetic appearance)
  • A failed Primary Rhinoplasty
  • An obstructed airway – This requires straightening the nosal septum too, a surgery called septoplasty. When combined with a septoplasty, the surgery is called a septo-rhinoplasty.
  • Congenital nose defects and anomalies (saddle nose etc)

Congenital anomalies such as:

  • Cleft lip and palate in combination and/or individually
  • Genetically derived ethnic-nose abnormalities
  • Congenital Nasal Deformities

 

Acquired anomalies:

  • Autoimmune system diseases
  • Burns
  • Bites
  • Allergic & vasomotor rhinitis
  • Nasal fractures
  • Connective tissue disorders
  • Naso-orbito-ethmoidal fractures
  • Inflammatory conditions
  • Toxins
  • Venereal infections – like Syphilis
  • Septal hematoma
  • Traumatic deformations due to blunt trauma, blast trauma and penetrating trauma

Deviated Nasal Septum

When there is a deviated nasal septum, the patient may present with difficulty in breathing, sinusitis & snoring. In such cases, a septoplasty to straighten the nasal septum is combined with a cosmetic rhinoplasty surgery, making it a septo-rhinoplasty.


Surgical Procedure for Nose job/ Nasal refinement:

  • A rhinoplastic correction can be performed on a patient who is undersedation, under general anaesthesia, or under local anaesthesia.
  • Initially, alocal anaesthetic mixture of lidocaine and epinephrine is injected for numbing the area, and temporarily reduce vascularity, thereby limiting any bleeding.
  • Generally, theplastic surgeon first parts the nasal skin and the soft tissues from the osseocartilagenous nasal framework, and then rectifies/ reshapes them as required.
  • The nasal septum may need straightening to cure problems with breathing & snoring, etc. This procedure is called a septoplasty & when combined with a cosmetic rhinoplasty, is called a septo-rhinoplasty.
  • Afterwards, the incisions are sutured, and then either an external or an internal stent is applied, and tape, to immobilize the newly reconstructed nose, and so to facilitate the healing of the surgical cuts.
  • Occasionally, the surgeon uses either anautologous cartilage graft or a bone graft, or both, in order to strengthen or to alter the nasal contour(s).
  • The autologous grafts usually are gathered from thenasal septum, but, if it has inadequate cartilage (as can occur in a revision rhinoplasty), then either a costal cartilage graft (from the rib cage) or an auricular cartilage graft (concha from the ear) is gathered from the patient’s body.
  • When the rhinoplasty requires a bone graft, it is harvested from either thecranium, the hips, or the rib cage; moreover, when neither type of autologous graft is accessible, a synthetic graft (nasal implant) is used to supplement the nasal bridge.

There are two types of Septo-Rhinoplasty – Open and Closed.

In Open Septo-Rhinoplasty, the surgeon makes a small, irregular incision to the fleshy, exterior end of the nasal septum – the columella. This incision is additional to the usual sets of incisions used for a nasal correction.

In Closed Septo-Rhinoplasty, the surgeon performs each and every incision exclusively on the inside of the nose and does not cut the columella (no external incision).

Post-operative recovery:

The rhinoplasty patient returns home after surgery, to rest, and allow the nasal cartilage and bone tissues to heal. Assisted with prescribed medications —antibioticsanalgesicssteroids — to soothe the pain and assist wound healing. The patient recuperates in about 1-week, and can go outdoors. Post-operatively, external sutures are removed at 4–5 days; the external cast is removed at 1-week; the stents are removed within 4–14 days; and the “panda eyes”(periorbital bruising) heal at 2-weeks. Throughout the first year post-operative, in the course of the rhinoplasty wounds healing, the nasal tissues will shift moderately as they settle into being a new nose.

Possible Complications:

  • Post-surgical hemorrhage/bleeding which may resolve without treatment
  • Infection – very rare. But may progress to becoming an abscess which in turn requires surgical drainage of the pus.
  • Adhesions, scars
  • Polly beak deformity – nose resembles the beak of a parrot. Occurs due to weakening and external nasal skin turns shapeless.
  • Nasal septum perforation – which may later on progress to chronic bleeding from the nose, difficult breathing, crusting of nasal fluids and whistling breathing.

Non-surgical Rhinoplasty:

Non-surgical rhinoplasty is a medical procedure in which injectable fillers, such as collagen, are used to change and reshape a person’s nose without invasive surgery. The procedure fills in depressed areas on the nose, lifting the angle of the tip or smoothing the appearance of bumps on the bridge. The procedure does not change nose size, though it can be used to rectify some functional birth defects.

Click to read FAQ’s on Septoplasty & Rhinoplasty Surgery

To see the video of an Iraqi bomb blast victim, with a completely broken & damaged nose & treated by external septo-rhinoplasty by Dr. Debraj Shome, click here:

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