Rhinoplasty is a surgical procedure that alters the shape of the nose. The purpose of rhinoplasty may include changing the nose’s appearance, improving breathing functionality, or addressing both aspects simultaneously.
The upper portion of the nasal structure consists of bone, while the lower part is composed of cartilage. Rhinoplasty has the capability to modify bone, cartilage, skin, or any combination of these three elements.
Is Non-Surgical Rhinoplasty Possible?
This is one of the frequently asked questions lately, is non-surgical rhinoplasty possible?
Rhinoplasty, literally, is the correction of the deformity of the nose by surgical intervention. Rhinoplasty planned according to the patient’s facial features; It is a permanent intervention that gives shape to bone, cartilage, soft tissue and skin. From this point of view, non-surgical rhinoplasty is not possible according to scientific criteria.
With the latest developments in the field of aesthetic surgery, small-scale non-permanent changes can be made in the nose structure with fillers. How valid and reliable these methods are is still a matter of debate. These methods, which offer temporary correction solutions, may not be suitable for every nose structure. For example, it is not possible to eliminate anatomical problems such as septum curvatures that cause breathing problems with nasal filling.
A person can reach a permanent solution only with rhinoplasty surgery. In this regard, it is important for the patient to decide what he wants and act consciously. Although patients who are afraid of surgery may wonder about this method, it is necessary to keep in mind that it is not possible to bring a permanent structural solution. Patients can overcome these fears only by trusting their doctors and having knowledge about the surgery.
It is also against medical ethics to claim that non-surgical rhinoplasty is possible due to commercial concerns, ignoring scientific criteria.
Massage After Rhinoplasty Surgery
One week after rhinoplasty surgery, I recommend massage to our patients after the plaster placed on the nose is removed. What use does this have?
The nose is an organ covered with skin on the bone cartilage tissue in the midline of our face. In order to shape the bones and cartilages during the surgery, we remove this skin layer without disturbing the vascular lymph circulation that feeds it. This makes it easier to work indoors. After the rhinoplasty surgery is finished and the necessary shape is formed, the skin tissue is adhered to this layer and the broken bone tissues are fused correctly, and a plaster is applied so that excess fluid accumulates between the skin and the surgical tissue and edema occurs.
After a week, when the bone boils a little and other tissues adhere, the plaster is removed. In the next process, the nose becomes slightly edematous and swollen.
There are two reasons for this:
The first is the swelling of the tissues when the pressure on them is removed after the plaster is removed, and the vein and especially the lymph circulation in the skin decreases.
After this stage, massage together with oral edema-solving drugs is very beneficial to reduce healing and edema. The aim of the massage is to increase the lymph circulation of the skin on the back of the nose and to discharge the edema due to the accumulation of fluid just below it.
Thus, the accumulation of fluid and edema between the bone and cartilage tissue formed and the skin on the back of the nose placed on it is minimized, and the shape created during the surgery is maintained. For this reason, it is recommended to perform the massage on the skin of the back of the nose in a way that provides lymph circulation to three separate areas.
During rhinoplasty surgery, being careful while lifting the skin on the back of the nose and breaking the nasal bone to shape it and not being able to damage these anatomical tissues is also a factor that helps in very important healing. That’s why I always dissection without damaging the musculoaponeurotic layer of the skin, that is, the vascular nerve lymph circulation, and I always try to cause minimal damage to these tissues by making the bone with the tunnel technique.
Thus, at the end of the operation, swelling and bruising under the eyes is at a minimum level, while the need for massage remains at a minimum level after the plaster cast.
The accumulation of fluid and edema between the bone and cartilage tissue formed and the skin on the back of the nose placed on it is minimized, and the shape created during the surgery is maintained. For this reason, it is recommended to perform the massage on the skin of the back of the nose in a way that provides lymph circulation to three separate areas.
During rhinoplasty surgery, being careful while lifting the skin on the back of the nose and breaking the nasal bone to shape it and not being able to damage these anatomical tissues is also a factor that helps in very important healing. That’s why I always dissection without damaging the musculoaponeurotic layer of the skin, that is, the vascular nerve lymph circulation, and I always try to cause minimal damage to these tissues by making the bone with the tunnel technique.
Thus, at the end of the operation, swelling and bruising under the eyes is at a minimum level, while the need for massage remains at a minimum level after the plaster cast.
Tampon in Rhinoplasty
In rhinoplasty surgery, the biggest fear of my patients before the operation is the tampons placed in the nose. In particular, the stories told by patients who had surgery in the past spread like urban legends, always frightening patients before surgery.
What is the situation actually? Why such a fear?
The answer is simple. In the first years of nasal surgery, the biggest problem was bleeding from the nose after the operation and the healing problems caused by it. Materials that will stop this bleeding and make a print there have been used almost throughout history.
When the materials used in special surgeries such as rhinoplasty were not developed, oily cloths that were left in the nose for a day or two were used. The surgical convenience of these has enabled them to be used for many years. They provided convenience surgically, but it was not so for these patients. This oily, especially antibiotic-impregnated gauze pad, which was taken one or two days after the operation, caused adhesions and caused the patients to feel pain while being taken.
In recent years, these ailments have been eliminated with the developments in the biomaterial industry and patient comfort. In recent years, materials called Silicone Nasal Split, which contain an airway and allow patients to breathe, and which are popularly called silicone tampons, are used in recent years. It has provided great convenience to these patients.
After the operation, especially after a special intervention such as rhinoplasty, they provide support in the nose and cause them to be invisible with their lightness and helping breathing. Even in some centers and doctors, it has been touted as an unbuffered nose surgery. In my rhinoplasty surgery interviews, I first try to eliminate the fears about nasal packing. My patients began to fully understand what was told when they felt nothing when the silicone tampons were removed.
Patients will start to come to the surgery interview with less anxiety when the rumor starts to circulate, like the urban legend, as positive as the other oily cloth.
What Changes in Rhinoplasty?
In the last ten years, especially in Istanbul, the increase in rhinoplasty meetings with international interest showed that we are on the right track in this regard. We were all pleased with the interest of the participants, especially from Europe, in the meetings held under the leadership of our successful colleagues who lead the way in rhinoplasty.
So what happened that we got this interest?
Chief among these is the aim of maintaining the anatomy and functions of this anatomy in rhinoplasty surgeries. Now, the success of the surgeries performed by giving importance to and protecting all the anatomical structures of the nose as much as possible has increased. This allowed us to achieve not only short-term results, but also good long-term results. Regardless of the surgical technique, whether you perform open technique rhinoplasty or closed technique rhinoplasty, respect for tissue and anatomy has given us a lot.
Our successful colleagues, who brought new techniques and approaches, also pioneered and named new instruments used during surgery. This will have very beneficial results for the promotion of our country and patient tourism, and it will provide the promotion of our country’s medicine, which is already good, in the world.
New Developments in Nose Aesthetics
The nose is one of our organs located in the middle of our face and plays the most important function in our breathing. It also determines the shape of our face and our expression.
The thing to be considered when performing nose surgery is that the functions of this organ are not preserved. They keep the cartilages on our nasal back together and ensure that the circulation of our nose, which is located in the most open area to external temperature changes, is not impaired in very cold weather. It has important duties in the formation of the shape of the nose on our back.
Nose aesthetics. This conservative surgery is now used in rhinoplasty surgeries. Names such as Preservationrhinoplasty, Protective rhinoplasty, and unfiltered rhinoplasty are also given. Whether it is closed rhinoplasty or open rhinoplasty, it is a surgery that can be performed with both techniques. Now, both the bone and cartilage part of the nasal dorsum is not surgically removed, and the nasal ridge is straightened by protecting it completely. The advantage of this technique is that both the anatomical regions that need to be protected in the nose are protected, and the natural light angles of the nose are preserved, especially when taking pictures. It was pleasing that the features that I tried to preserve the naturalness of while doing rhinoplasty for years came to the fore again and became widespread.
It is important to use these protective properties, especially in patients whose functional structure is not deteriorated. For example, this includes the connective tissues on the back of the nose and extending to both nasal wings. In particular, the protection of the cartilage and the membrane layers on the bones contribute a lot to the healing process.
Nose Job Surgery and Psychology
I wanted to make some reminders to my patients who will have surgery by compiling the questions from my patients who will have rhinoplasty.
You should discuss with your doctor in detail before deciding on surgery. After getting the necessary explanations for the shape changes to be made on your nose, it will be beneficial to keep your expectations within the limits that your physiological structure will allow.
The physical and physiological limits to be forced may cause more problems in the future. First of all, listen carefully to what your doctor will say and do according to your nose structure. Since technology has developed a lot, everyone can now create visuals that describe how your nose will look later by playing on photos with various applications.
However, there is a truth that I always say that there is never mathematics in tissue, especially in human tissue. In the first years of medicine, what our professors always said was “two times two does not make four”.
Depending on the center or doctor you go to, some simulations can be done with various photography techniques or shootings before the surgery. The most advanced and the simplest of these will actually give the same result, and the shape presented to you will always be the result that is close to expectations. It can never be the same.
Therefore, whether a simulation equipped with very expensive computers is used, which will usually be reflected in the cost of the surgery, or a much simpler application is used, the results for patients do not change. What is important here is the detailed explanation your doctor will make according to your physiology and physical appearance.
The development of cartilage and bone structure is different according to the nose structure and age of everyone. All these should be taken into account when planning the surgery. For example, I always plan differently in my young patients.
In particular, cartilage shaping has an important place and nose operation should be planned and performed according to cartilage development. This is also the case in patients with thick or thin nasal skin. It is always necessary to plan in advance what to do in detail.
Another important situation is our patients with deviation of the bone curvature in the respiratory tract. If deviation surgery is to be added to aesthetic surgery, it is necessary to make the nose entry plan and incision accordingly.
For example, this will always prolong the operation time by half an hour and forty-five minutes, and a breathing surgery will be added to the aesthetic. Therefore, my advice to my patients who will have rhinoplasty; Get detailed information from your doctor about what to do before surgery. Visual simulations of how your nose will look later with a computer program only give you an idea, never expect the same. Your physical appearance, face shape and anatomical features of your nose will always be reflected in the result. Be sure to set your expectations accordingly. Do not choose a surgeon who always makes the same nose for everyone and applies the same technique. Because, like every person, every nose is different, unique and aesthetic surgery should preserve this originality.
Sprays After Nose Surgery
We recommend nasal sprays to our patients, whether they have rhinoplasty or nasal division curvature (deviation) surgeries. It is not recommended to do anything inside the nose for five days after the surgery, as there are silicone nasal splits, that is, nasal packings.
Silicone nasal splits are materials that patients do not feel like nasal tampons and are very comfortable. They have even been touted as an unbuffered nose surgery. After taking these silicones, we recommend nasal sprays to our patients. The reason for this is to wash and clean the inside of the nose and to resume the cleaning and moisturizing tasks of the nasal mucosa. If the nasal concha was also intervened and especially if nasal concha reduction procedures such as radiofrequency were made, there will be some mucous residues due to the healing tissues.
The reduced parts of the nasal meats become a jelly with the effect of temperature and humidity in the nose. Nasal wash sprays help these tissues to be easily cleaned and disposed of. During post-operative dressings, we collect these jelly-like tissues with the help of nasal endoscopes and aspirators, and we recommend patients to use nasal irrigation sprays abundantly. Thus, the jelly-like tissues are removed over time without drying out and forming a crust.
After the tampons are emptied, patients feel quite relief in breathing. However, they may sometimes feel nasal congestion with edema and tissue rashes due to healing tissues. At such times, we recommend nasal sprays as well as nasal sprays. It is necessary to continue cleaning, washer and cleansing nasal sprays in the post-operative dressings, sometimes with opening nasal sprays, until the end of three weeks, when the recovery will be fully realized. Thus, we have an open nose that breathes healthy.
Nose Aesthetic Surgery in Summer
Can you have rhinoplasty surgery in summer?
This is one of the most frequently asked questions from my patients, whereas seasonal variables such as very hot or humid weather do not affect nasal surgeries.
Of course, as in all surgeries, there are points to be considered in nose surgeries. One of the most important things to consider in the summer is to protect yourself from the sun’s rays. In addition, due to the holiday season, our patients should be careful in activities such as tanning, pool and sea. The nose should not be exposed to direct sunlight between the hours of 10:00 – 17:00, when the sun rays are strong after the surgery. In addition, in cases where the use of sunglasses is not possible, a hat should be preferred when going out in the sun.
After the critical period that we will specify after the operation, you can swim in the sea. However, patients should pay attention to direct contact with pool and sea water. Reducing the workload in the summer and entering the holiday period is also ideal for the resting period after rhinoplasty. Especially my patients abroad prefer to have surgery in the summer.
They take advantage of summer by removing both vacation and nose surgeries at the same time. If they follow the recommendations, there is no risk of rhinoplasty performed in the summer months.
Frequently Asked Questions About Nose Job Surgery
Nose surgery is an operation that some fear and some look forward to. Well, if you want to learn what nose surgery is, why it is done and what the procedure is, you are at the right place. We have answered the most frequently asked questions about Nose Job Surgery for you.
Will My Nose Collapse or Fall If I Have Rhinoplasty?
It is one of the biggest fears of patients who have rhinoplasty surgery. One of the biggest mistakes that cause the nose to collapse or fall is the removal of the bone on the back of the nose more than necessary.
It is the excessive removal of the bone on the back of the nose. Dropping the tip of the nose is the excessive removal of the cartilage at the tip. Therefore, it is necessary to comply with the scientific techniques of the surgery when working in these areas that determine the shape of the nose during rhinoplasty surgeries.
Especially in those who have had nasal division curvature deviation surgery before, the risk of nasal tip collapse is very high. Therefore, it is absolutely necessary to put support cartilage on the tip of the nose during rhinoplasty for those who have had rhinoplasty before. In those who have had rhinoplasty and correction surgery before, it is necessary to be very careful on the back of the nose, if the bone and cartilage structure on the nasal ridge is removed more than necessary, there is a danger of nasal collapse.
Apart from this, for those who will have rhinoplasty for the first time, such a risk will never be seen if rhinoplasty is performed in accordance with scientific surgical techniques.
I Want a Natural Nose. Is It Understandable That I Have Aesthetics?
If you don’t remember that you had a nose job when you look in the mirror when you get up in the morning after rhinoplasty, you have a natural nose. One of the most important rules of getting a natural rhinoplasty result is to make a nose suitable for the face shape. Each nose has its own anatomical features. And these anatomical features play an important role in determining the shape of the nose.
The limits of what can be done during the surgery, it is very important to perform the maneuvers to shape the nose during the surgery by staying within the anatomical limits of the nose in order to obtain a natural nose. It is necessary to talk very carefully about this issue with patients who come to the surgery interview and show a nose shape belonging to someone else and want a result in that way. The nose shape that looks very nice may not look very nice on another face. If you want to achieve a natural aesthetic and functional “Breathing” result after rhinoplasty, you should act by respecting the limits of your face and nose anatomy. Thus, after the surgery, you will have a pleasant result, and you will have an appearance that is not understood at first glance that you have a rhinoplasty.
Will I Have Swelling or Bruising on My Face After Nose Aesthetics?
After each rhinoplasty surgery, swelling and bruising can be seen from very low to very advanced levels in the nose, under the eyes and on the face. Ensuring this is minimal has to do with the technique and instruments used by the surgeon. Thanks to the techniques developed in recent years and the tools used in rhinoplasty, it is tried to be taken to the lowest level.
One of the causes of swelling and bruising under the nose is due to the correction of the nasal lateral bone in order to shape it. This correction is made by using a cold knife or by using bone straightening tools such as PIEZO with ultrasound waves. In both cases, bleeding and subsequent swelling and bruising may occur due to tissue damage. The most important reason that increases swelling and bruising is not the shaping of the bone, but the damage to the membrane called the periosteum that adheres to the bone.
Swelling and bruising will be minimal if techniques or tools that will cause minimal damage to the bone adhering to the bone while doing all these are used. Advertisements for “rhinoplasty without swelling bruising” surgery are usually maneuvers to attract patients. Although instruments that cause the least damage, such as piezo, are used at the end of your rhinoplasty surgery, some features of your body may also be a reason that increases swelling and bruising, such as “thin skin”.
After rhinoplasty, there will be slight swelling and bruising under the eyes.
Are nose surgeries performed only for aesthetic purposes?
Nose surgeries are performed for 2 different reasons, the first is operations for aesthetic purposes and the purpose is to change the external appearance of the nose and it is done for visual improvement, this is called Rhinoplasty. The Latin Rhino nasal plasti comes from plassein, which means to shape, that is, to shape the nose.
The other reason is the nasal operations called Reconstructive, performed in the inner parts of the nose, in order to solve the existing structural problems of the nose, and to reactivate the tasks that the nose should be able to do but cannot do again, this is called septoplasty.
Septorhinoplasty, on the other hand, is a one-time operation to restore both the aesthetic surgery and the function of the nose and is common in our country.
What are the criteria for a successful nose surgery?
In order for a nose surgery to be considered successful, three rules must be followed, the first and the primary demand of patients is that the nose shape should have a natural and beautiful appearance. The second is that there are no deformities that will disturb the patient as they heal and sit over time. The third is the preservation of the breathing feature, which is the most important function of our nose. If these three basic rules are met, both the operation will be successful and a result that the patients are satisfied with is obtained.
Are the surgeries performed with general anesthesia?
We recommend that nose surgeries are always performed under general anesthesia, and we do so.
In how many days are plaster, bandage and tampon removed after surgery?
After the operation, he rests in the hospital for 1 day, and as soon as he comes out of the operation, both a bandage and a plaster are applied. The plaster is removed after a week and when it is removed, the patient can see the shape of his nose, and a tissue-colored bandage can be put on for a few days to prevent edema when it is removed, but this is not mandatory. If there is not much swelling and bruising, certain nasal massages are done and no further procedure is required.
Why does swelling and brusing occur after rhinoplasty?
After undergoing rhinoplasty, swelling and bruising can occasionally manifest beneath the eyes. This occurrence stems from the surgical process itself. Numerous suggestions regarding this phenomenon circulate in the market. Specifically, individuals who have undergone rhinoplasty may experience the shaping of nasal bones, leading to swelling and bruising around the second or third day post-surgery. Regrettably, these effects are an inevitable outcome.
Irrespective of the technique employed by the surgeon, due to the necessary alteration of bone structure for nasal reshaping, such changes are bound to take place within the bones. Consequently, swelling and bruising beneath the eyes can persist for several days as a result of edema and potential reactions. Despite the availability of various creams and medications targeting these issues, the disparity between those who utilize such products and those who do not remains minimal. Therefore, the most advantageous practice for patients during the post-operative period is to maintain proper hydration by consuming ample amounts of water.
In how many days will the bruises on the face disappear?
The main recovery period is 1 week after surgery. Since the swelling and bruising will pass after 1 week, the person can return to his normal life after this period. In some cases, this period may be extended, but this is rare. Generally, 3 weeks after rhinoplasty, the nose will recover and you can do everything you normally do. In patients who wear glasses, you can wear their glasses after this period, do sports or go swimming. It takes 6 months to 1 year for the nose to fully recover and regain its pre-aesthetic feel.
Are nose surgeries painful?
Although it is generally said that nothing will happen, there may be a very slight burning sensation on the nose for the first hour or two after the surgery, but this is not felt much due to the anesthetic drugs, and the patient may not even feel it due to the effect of anesthesia. In the period after that, there is never any pain. Most patients think that they will be in pain for days because the nasal bone will be broken, but this worry is unfounded.
When we observe certain noses, we can promptly discern their aesthetic appeal. What accounts for this phenomenon?
Operations are not uniform, but personal, each person has a unique chin and cheekbones, in short, a facial structure, so nose shaping is done for this area. A person’s facial structure shows what is possible and what is not. The important thing is not to make the nose of the person’s dream, but to make the nose that best suits the person’s face and wishes.
Who should do rhinoplasty surgery? Plastic surgeons or otolaryngologists?
Rhinoplasty and septoplasty are subjects that require different areas of expertise, and comprehensive certification is required in order to undergo surgery on this subject. I am certified in both fields. While choosing a doctor, it should be considered whether he is an expert in which field or in both areas. The other issue to be considered is the experience and previous work of the doctor.
What is nose revision surgery?
Revision nose surgery is a situation that is needed as a result of the dissatisfaction with the result in the first surgery or the formation of unwanted healing tissues during the healing process. Therefore, the first operation and what is done during the operation reduce the chance of revision, which requires proper care for the tissue. The basic principle here is to restore the nose to its natural and never-operated appearance by paying attention to the tissue again, no matter what has been done before.
Misconceptions About Rhinoplasty
The questions and fears asked by most of my patients about rhinoplasty surgery are similar. These are generally inaccurate information caused by information pollution on the internet or heard around. I have briefly summarized these mistakes that I hear most often to clarify:
* The tampon put into the nose after the surgery causes pain and pain, it stays in the nose for days. (Wrong)
At the top of these questions is the tampon placed in the nose, usually after the surgery. In the first years of nasal surgery, oily cloths that were placed in the nose and left for a day or two were used because the materials to stop the bleeding by creating pressure did not develop. Although it provides convenience in terms of surgery, the pain and pain caused by its stickiness when removed one or two days after the operation did not leave the same effect in patients.
In recent years, after rhinoplasty surgery, we put air silicone pads inside the nose. It can stay in the nose for up to a week, and it also helps the patient to breathe thanks to the holes in it. We can easily remove the silicone air tampons that we put in the nose on the 5th day of the operation, painlessly and painlessly. Within 1 week after the operation, both tampons, plaster and sutures are removed and my patients can start their daily activities or work.
*After rhinoplasty surgery, swelling and bruising occur on my face for weeks. (Wrong)
Another fear that I heard in my first meetings with my patients and developed over time is bruising and swelling on the face after the surgery. I use the “tunnel” or “canal technique” methods to minimize swelling and bruising that occurs when the nasal bone is broken on both sides, called osteotomy. Thus, with a 3-4 hour ice application after the surgery, it causes very little swelling of the face, around the eyes and under the eyes, and the healing develops very quickly in the following days. As a result, breaking the nasal bone in nose surgeries is a method that forms the basis of the essential surgery. Doing this in appropriate and experienced hands, respecting the anatomy and surrounding tissues, minimizes the swelling and bruising time.
*Even though I have the nose I want with rhinoplasty, my breathing will not be the same as before. (Wrong)
As an ENT specialist, the most important thing for me is that my patients can breathe easily through their nose after surgery. In general, there may be surgeons who hesitate to intervene in the nasal septum against the risk of collapse of the nose while performing rhinoplasty surgery. This can cause breathing problems even if the nose shape is good if there is a curvature in the septum or a condition that affects breathing. Surgical techniques are also known for this. Desired results are obtained with careful interventions to be applied to the septum cartilage and reduction attempts to be made to the nasal concha. Thus, the nose fulfills its full function both aesthetically and functionally.
*After rhinoplasty, my nose will not look natural because it will be very raised or small. (Wrong)
The most frequently asked question before and after the surgery is “Will my nose look natural after the surgery?” When it comes to naturalness, the first thing that comes to mind is that there is no nose shape that shows itself very well in accordance with the face shape, starting from the nostrils. In other words, taking an arched nose within the limits means that the tip of the nose that is not very upturned is raised sufficiently and the nostrils are reduced so that they do not exceed the inner border of the eye. In this way, when a patient who has undergone rhinoplasty surgery is looked at from the outside, it is seen that he has a natural nose structure that is not obvious that he has undergone surgery.
* It is not necessary to be over the age of 18 to have rhinoplasty surgery. (Wrong)
The age range at which rhinoplasty surgery can be performed can be performed from the age of 17 in women and 18 in men, in proportion to the development of the patient’s bone and cartilage tissue. Except in very exceptional cases, rhinoplasty should not be performed in young people who have not completed the development of bone and cartilage tissue.
Tip Plasty and Rhinoplasty
Rhinoplasty surgery is a difficult and complex operation in itself. The most difficult part is to capture the natural, not too upturned and face-worthy state of the tip of the nose. The tip of the nose is the most variable point on the face. The shape, channels, length and width of the nose vary from patient to patient. In addition to the shape of the nose, even the soft or hard skin is an important factor.
The tip of the nose consists of skin, subcutaneous tissue and lower lateral cartilages and creates an image similar to the letter “M”. By intervening on the nasal cartilages, changes can be made on the direction, width, vertical height of the nasal tip and the angle between the upper lip and the tip of the nose.
For these reasons, there is actually no special operation applied to the tip of the nose alone, because rhinoplasty is a whole. Most of the time, when the shape of the tip of the nose is changed, it is an inevitable necessity to intervene in the bone and cartilage behind it. The main and important thing in rhinoplasty is the shaping of the nasal bones rather than the nose type, and the main change is only possible in this way.
Just like making a puzzle, it is necessary to establish the connection between the pieces and put those pieces in the right places. Therefore, a doctor who performs rhinoplasty surgery should be strong in the artistic direction as well as knowledge, experience and technical work.
