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Rhinoplasty

Being at the center of the face, the deformities of the nose are very difficult to ignore. Sometimes, even very minor defects that are apparent only to themselves can cause them so much anxiety. In order to alleviate the stress that these faults cause, patients can undergo a Rhinoplasty.

Historically, rhinoplasty evolved due to the need to repair broken noses. The technique was developed by Papyrus in ancient Egypt around 3000 to 2500 BC. The knowledge and techniques were shared and spread around India, Rome, Arabia, and Persia. Around the 1500s, rhinoplasty was heavily used for reconstruction for soldiers who incurred injuries from combat and blasts during the war. The surgical principles developed in India regarding flaps for reconstruction of the lips and nose from congenital anomalies like clefts were revisited in order to service these war casualties. It was only in modern times that the procedure evolved to use anesthetic and incisions were being cosmetically hidden (internally located for the closed technique).

Reconstructive Rhinoplasty is commonly done to correct a congenital defect such as a cleft, a functional problem like difficulty breathing due to a deviated septum which may be secondary to trauma or to repair a disfigurement caused by disease (excision of skin cancer on the nose). On the other hand, a Cosmetic Rhinoplasty is done to correct defects such as a hook nose, a flattened dorsum, a bulbous tip, or overhanging ala. Typically, a rhinoplasty entails the manipulation of several aspects of the nose namely the framework (bone and cartilage), the support (connective tissues and ligaments), and the external cover (skin). It is also quite common to place an implant at the dorsum and tip to either enhance the appearance of the nose or to lend additional support and reinforcement. The implant may either be natural, such as cartilage from the ear or septum, or bone from the rib. It may also be synthetic like a medical-grade silicone or polytetrafluoroethylene material (Goretex). Regardless of the purpose of the rhinoplasty, the most important aspect of the procedure is the maintenance or restoration of the patient’s nasal airway.

Preoperatively, the aesthetic goal must be determined by the patient and the surgeon. Clinic discussions will include the incision, the type of implant and other related procedures such as anaplasty, osteotomy or bunching will be discussed. The procedure may be done under local or general anesthesia depending on the extent of the surgery. The technique may either be Open or Closed. If the procedure only requires minimal manipulation of tissues and an insertion of an implant, a closed technique may be done. However, if there will be some reconstruction of the framework and support within the nose (repair of a deviated septum), an open technique must be employed. After creating a pocket, fashioning and inserting the implant and reinforcing the concerned structures, the incisions are closed simply and the patient is taped and splinted. Stitches can be removed anywhere from 5 to 10 days.

After surgery, the patient is advised against strenuous activities. Contact sports may be done about 3 months after.  Since the nose is a closed compartment, swelling may be retained for quite some time. Corrected bulbous tips may still appear round even after adjusting the tip by manipulating the cartilages or making a thinner implant.  The earliest that the tip may be appreciated is a month from surgery. Best results are anywhere from 6 to 8 months after surgery. The most important thing to watch out for after rhinoplasty is an infection. Any infection in the body may find its way to the implant (especially the synthetic ones). Pus may form and exit the previous incision site or any area of least resistance. In this case, the implant must be removed and antibiotics must be given. Other complications include extrusion of the implant, a skewed/deviated implant and some minor asymmetry. These may be addressed with a secondary rhinoplasty.

Frequently Asked Questions

How is Rhinoplasty done?

Under local anesthesia, an incision is made either in the nostril or at the base of the columella up to both nostrils. A plane is created from the tip, over the bridge up to the root of the nose. A personally shaped silicone implant, GORETEX implant or cartilage is placed in the pocket and centered. The incision is then closed with non absorbable sutures that will be removed on the 4th day after surgery. The whole procedure just takes less than an hour then you’re on your way home.

How old can the youngest Rhinoplasty patient be?

A child’s nose can continue to grow up to a certain age. Therefore, doing rhinoplasty for cosmetic purposes in a child whose nose is still growing may cause unpredictable changes in the shape and size of the nose. Ideally, in females, the nose stops growing about 2 years after she begins her period, while for boys, it is about at age 15.

Can bumping my nose after Rhinoplasty affect its shape?

Immediately after surgery, we definitely would like you to avoid hitting your nose. It’s the time when your nose is most fragile and the implant has not set. Minor bumps may not affect the appearance in the long run but the trauma of the bump may cause more swelling thus make healing longer.
Minor bumps after a year will no longer affect the shape of your nose.

Do I need to take care of my implant?

Silicone implants have a risk of being extruded by the body. If your nose has been previously well and you begin to experience pus from the incision site accompanied by peeking of the implant, you need to call your surgeon.

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