Nose Job (Rhinoplasty) Surgery

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Written and checked by Op. Dr. Tamer Haliloglu

Nose Job (Rhinoplasty) Surgery

Nose job (rhinoplasty) surgery is a cosmetic procedure tailored to the individual’s facial structure, aimed at correcting nasal deformities. It’s important to note that rhinoplasty doesn’t address breathing issues. In cases of breathing problems, septoplasty may be recommended alongside rhinoplasty.

 

The common request from the majority of my patients opting for rhinoplasty is that the surgery’s outcome remains discreet. People generally perceive the nose as a key factor in facial beauty. A well-proportioned, unobtrusive nose enhances the overall facial aesthetics. Recent advancements in rhinoplasty have allowed us to achieve this seamlessly and reliably. We can attain highly satisfactory results through techniques tailored to both the procedure and the patient’s desires.

 

To achieve these goals, three fundamental principles must be observed. Firstly, patients commonly desire a post-surgery nose that appears naturally beautiful. Secondly, the absence of any deformities during the healing process is crucial. Finally, preserving the nose’s primary function—breathing—is paramount. Rhinoplasty often includes addressing nasal curvature and deviation to meet these objectives. Following these rules ensures patients achieve a satisfying post-surgery outcome.

 

These three aspects consistently take center stage in medical conferences held in Istanbul in recent years. Discussions and inquiries revolve around these themes, engaging experts from Istanbul and beyond. Both patients and specialists share common concerns centered on these key factors.

 

What does it mean to have a natural looking nose after surgery?

This means that it is not a very prominent shape 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 not raised more than necessary and the nostrils are reduced so that they do not exceed the inner border of the eye. Thus, after the rhinoplasty surgery, when the patient looks from the outside, he/she has a natural nose structure that is not obvious that he/she has had surgery.

 

In order to avoid deformities that disturb the patient at the end of the healing process, two important factors should be considered:

 

The first is the fracture of the nasal bones on both sides during the operation by a method called osteotomy. The second is that the stitches made while shaping the tip of the nose are done very carefully and symmetrically. Another feature of the fracture process of the nasal bone called osteotomy on both sides is that it affects the swelling and bruising in the eyes and surrounding tissues in the nose after the surgery. I always do osteotomy with the “tunnel” method and after the surgery I observe a very small amount of swelling and bruising on the face, eyes and under the eyes. In other words, being careful and attentive in these two anatomical regions ensures that we do not encounter any negativity while sitting in the future.

 

Breathing is the most important of these. As an ENT specialist, my first concern is almost always that the nasal breathing feature of the patient is not affected after the surgery and if there is an obstruction, it is opened. For this reason, surgeons generally refrain from entering the nasal septum when performing rhinoplasty against the risk of collapse of the nose. 

 

If there is a curvature in the septum or a condition that affects breathing, it will cause breathing problems even if the nose shape is beautiful. Therefore, the surgical technique is clear. It can be easily done with careful interventions to be applied to the septum cartilage. When the reduction attempts to be made on the nasal meats are added to this, the desired result is obtained.

 

Expectations and Interview Before Nose Job Surgery

Expectations of my patients: Rhinoplasty surgery is the surgery in which the desired shape is given to the nose. When I decide to do nose surgery on my patients, I always get their demands. The most common request is that it is not obvious that I have plastic surgery. 

 

Secondly, if there is a breathing problem, it is to be resolved. Istanbul in general has a face shape that expresses the whole of Türkiye. It is our geographical luck that we do not have a genetic structure with a very large exaggerated nasal bone. When we divide the face into three equal parts, our nose in the middle part gives the expression of our entire face shape. Therefore, the changes we will make here will have a very important place as they will affect the expression. 

 

The most beautiful comment I heard from my patients after the surgery is that the people around me did not realize that there was an operation and they just said ‘there was a change in expression on her face’.

 

About the photoshop application: Based on my years of experience, I have to say that I am against the photoshop work done before the surgery. Because there is never mathematics in the tissue, it may put the patient in excessive expectations about the surgery. 

 

Since Photoshop is a program after all, it allows you to make the most beautiful nose in the world, but texture is not like that. In addition, the features arising from the patient’s own cartilage and bone structure do not allow changes made in photoshop. Therefore, in my opinion, this is not a useful method other than convincing the patient for surgery. Instead, it is best to talk to the patient in detail before the surgery and explain what might happen with their nose in front of the mirror. 

 

Another method is to show pre- and post-operative pictures of similar nose shapes that have been made before, and it would be the best explanation for the error.

 

Surgery night: It is sufficient to stay in the hospital for one night on the day of surgery. Our patients spend the first night well with the effect of anesthesia. In the meantime, it is enough for them to sleep in the room and apply ice on the cheekbones at intervals of fifteen minutes for the first day. Face masks and other applications recommended elsewhere only add to the post-operative cost. As I explained in my other articles during the surgery, if the nasal bone is broken with the canal technique, there will not be much swelling and bruising on the face and under the eyes.

 

Discharge time: I recommend our patients who are discharged the next day to rest at home and rest with oral medications. In general, my patients start to move freely and do their normal daily activities after the second day. The swelling in the eyes and under the eyes, which will tend to increase on the second and third days, will begin to decrease as of the end of the third day. 

 

We usually take the silicone air tampons that we put in the nose on the fifth day of the operation. From now on, I recommend our patients physiological nasal sprays that will wash the inside of the nose. On the seventh day, I remove the plaster on the nose and the stitches on the tip of the nose. After that, my patients can start work as well as their daily activities.

 

Would it be very obvious that I had a Rhinoplasty (Nose Job) Surgery?

Postoperative outlook and expectations: The common request of almost all of my patients for whom I decided to have rhinoplasty surgery is that it should not be obvious that I had a nose surgery after the surgery. The general belief among the people is that the shape of the nose is the most important element for facial beauty. 

 

Beautiful archless face beautifies the shape of a nose that is not too big in the middle. In order to achieve this result, the advances in rhinoplasty surgeries in recent years have led us to achieve this comfortably and reliably. We can obtain very satisfactory results with the surgery that is suitable for the rhinoplasty surgery technique and the patient’s wishes. While doing this, it is necessary to pay attention to three basic rules. 

 

The first of these is that the nose shape should have a natural and beautiful appearance after the operation, which is a common request of the patients. The second is the absence of deformities that will disturb the patient as the healing develops over time. The third is that the most important function of our nose, which is the breathing feature, is not lost. 

 

Mostly, nasal division curvature, namely Deviation surgery, is added to Rhinoplasty surgeries. If these three basic rules are met, a result that the patients are satisfied with will be obtained after the surgery.

 

In the medical conferences held in Istanbul in recent years, these three features always constitute the main subjects. Discussions and questions take place in these frameworks at the meetings attended by experts from both Istanbul and outside of Istanbul. 

 

The common concerns of both patients and specialists are always centered around these three issues:

     

    1. What does it mean to have a natural nose after surgery? This means that there is not a very prominent shape 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 not raised more than necessary and the nostrils are reduced so that they do not exceed the inner border of the eye. Thus, after rhinoplasty surgery, the patient has a natural nose shape that is not obvious when viewed from the outside.
    2.  It is necessary to pay attention to two important factors in order to avoid deformities that disturb the patient at the end of the healing process. The first is the fracture of the nasal bones on both sides during the operation by a method called osteotomy. The second is that the stitches made while shaping the tip of the nose are done very carefully and symmetrically. Another feature of the fracture process of the nasal bone called osteotomy on both sides is that it affects the swelling and bruising in the eyes and surrounding tissues in the nose after the surgery. I always do osteotomy with the “tunnel” method and after the surgery I observe a very small amount of swelling and bruising on the face and under the eyes. In other words, being careful and attentive in these two anatomical regions ensures that we do not encounter any negativity while sitting in the future.

    3.    Breathing is the most important of these. As an ENT specialist, my first concern is almost always that the nasal breathing feature of the patient is not affected after the surgery and if there is an obstruction, it is opened. For this reason, surgeons generally refrain from entering the nasal septum when performing rhinoplasty against the risk of collapse of the nose. However, if there is a curvature in the septum that affects breathing, it will cause breathing problems even if the nose shape is beautiful. Therefore, the surgical technique is clear. It can be easily done with careful interventions to the septum cartilage. When the reduction attempts to be made on the nasal meats are added to this, the desired result is obtained.

     

    What surgeries can I have with Rhinoplasty?

    In recent years, Rhinoplasty surgery has been started to be performed together with other nose surgeries. The word meaning of Rhinoplasty a surgery means to make the nose more aesthetically pleasing to the eye by changing its appearance. It is performed by otolaryngologists as well as by plastic surgery specialists. However, it may be necessary to include the nose in the surgery as it also concerns the respiratory tract and breathing anatomically. A more comprehensive operation can be performed by not only changing the aesthetic appearance of the nose, but also interfering with it. Therefore, ENT specialists who have more knowledge of intranasal anatomy can also perform Septorhinoplasty by adding nasal division curvature to the operation.

     

    Who Should Perform Nose Job Surgery?

    In cities such as Istanbul, where the number of population is high, this type of plastic surgery is performed more. The reasons for this can be counted as the fact that Istanbul has been accepted as a medical center for years, as well as the advancement of the communication age and the fact that people began to give more importance to visuality in cities where the population is dense. It has also increased the diversity of specialists performing these surgeries. 

     

    While the specialists of this subject used to perform aesthetic surgeries in the past, now with the increase in branching, the specialists of each region are also performing aesthetic surgeries that fall into their own fields. Rhinoplasty is now emerging as a specialty in its own right. The nose is not only a visual object on our face, but also an organ of our respiratory tract. Therefore, surgery to be performed on it is important because it affects some respiratory functions. 

     

    If an operation that will only change the appearance is to be performed, it should not impair the nasal breathing functions. Or, if there is a divisional curvature for the nose that needs to be corrected, such as deviation, it is necessary to include it in the rhinoplasty and perform the operation called Septorhinoplasty in a single session. Therefore, especially in cities such as Istanbul, rhinoplasty surgery has started to be performed not only by aesthetic surgeons, but also by otolaryngologists. In some centers, surgeons from both specialties enter and perform these surgeries.

     

     

    Deciding on rhinoplasty is a difficult process.

    Patients will have a lot of questions in their minds, especially if Rhinoplasty surgery will be added to the nose surgery. First of all, what should I do before the operation? I usually tell my patients not to be afraid of facial conditions such as pain, swelling, bruising after surgery. In the surgical technique we perform, swelling and bruising under the eyes is minimal. 

     

    We recommend them to rest well beforehand, not to smoke or drink alcohol, and to come one day in advance for those coming from outside of Istanbul. We recommend that they do not take blood thinners such as aspirin, especially until three weeks before the surgery, and if they have regular medications, they should be taken until the morning of the surgery.

     

    The biggest fear of patients is the presence of a tampon placed in the nose in the days after the surgery, discomfort and bruising and swelling on the face. We have eliminated the fear of nasal packing with some materials produced in recent years. After rhinoplasty, we put air silicone pads inside the nose so that it can both shape and mold. 

     

    It can stay in the nose for up to a week, and it also helps to breathe thanks to the holes in it. This is also touted as an unbuffered nose surgery. In fact, there is no nose surgery without tampons. It is necessary to use materials that minimize the discomfort of this. Air Silicone Pad is one of them. It is a material that can be easily found in centers such as Istanbul and is available in all hospitals. The other fear is swelling and bruising in custody.

     

    If an ENT specialist performs rhinoplasty surgery, he can minimize this problem because he knows the tissue anatomy very well. If it is done by separating the membrane called the periosteum that adheres to the bone between the bone and the soft tissue, the bruising and swelling will be minimal and will immediately improve within a day or two after the surgery. If all these are taken into consideration, we can eliminate the fears of our patients before the operation.

     

    One of the most common questions my patients ask during Nose Job Surgery consultations is whether their nasal bone will be broken.

     

    During my rhinoplasty surgery interviews, one of the most curious questions of my patients is will my nasal bone be broken? I would like to reduce this fear of our patients a little by explaining in detail how we do this most frightening procedure. Ear, nose and throat specialists know that the nasal bone is always broken, whether it is rhinoplasty or simple deviation surgery. 

     

    In deviation surgeries, bone and cartilage fragments forming the midline wall are formed. In order to correct the dividing curvature, when this section is separated from the mucosa over it, the curved bone fragment underneath is definitely broken and removed. This is the reason why patients sometimes have pain in the anterior teeth of the upper jaw after the operation.

     

    As a rhinoplasty specialist, we also perform another bone breaking operation. This is so that the bone and cartilage tissue removed from the dorsum of the nose does not form a flat plateau-like structure that will form. For these reasons, the bone forming the roof of the nose is broken from both sides to cover the part from the inner side of the eye to the forehead.

     

    In fact, this is the most crucial attempt of rhinoplasty surgery. Because we give the full shape of the nose thanks to these fractures. In these surgeries I have performed outside of Istanbul, I pay great attention to the fact that patients will experience bleeding and bruising around the face and eyes as a result of this fracture procedure. Because if I am performing rhinoplasty surgery in a place other than Istanbul, I would not want the eye and face swelling to be excessive since I will leave the patient to my specialist friends there.

     

    That’s why I break the nasal lateral bones with the canal technique. Since this method separates the bone tissue and the soft tissue adhering to it beforehand, the soft tissue is not damaged much during the fracture. Thus, 3-4 hours of ice application after the surgery causes very little swelling of the face, around the eyes and under the eyes, and a very rapid improvement in healing.

    As a result, breaking the nasal bone in nose surgeries is a method that forms the basis of the essential surgery. It is important that this is done in appropriate and experienced hands, respecting the anatomy and surrounding tissues.

     

    Photographing Before Nose Job Surgery

    Peoplee asks a lot of questions about the shaping processes made on pictures before rhinoplasty. What advantages or disadvantages does doing this have? I would like to give an answer to this based on my experience, as it is the subject that patients ask the most questions before preparation for surgery. I am absolutely against making pre-operative illustrations and editing with programs such as Photoshop. First of all, I would like to address the issues that seem to be advantageous and actually disadvantageous, one by one.

     

    First, since there is no mathematics in the tissue, the shape to be taken with photoshop may not match the shape that will emerge after the surgery, even if the same methods are applied. Even the opposite image may emerge. This may be a result that the patient likes, or it may be the opposite. We may encounter unpleasant situations as it will increase the expectation of the patient.

     

    Secondly, when a shape is agreed on in the digital environment, it may leave the doctor in the position of ignoring the physiological characteristics of the nose in an effort to achieve that result during the surgery. Especially in the nose type, a shape that will be difficult will change the angles at the nasal entrance and cause permanent nasal congestion. Thus, although the desired result is approached, results such as nasal congestion may occur that bother the patient for a very long time.

     

    Thirdly, as the features of the programs used, the conditions in which the nasal tissues and cartilages are shaped inside cannot be entered as a factor, so only the shape of the outer skin is decisive. In other words, we can see the shape of a cartilage in the nose, for example, only when we open it during the surgery. We only see the shape it creates with the skin. We cannot see the shape of the angles that differ from each other on both sides. These factors emerge during the surgery and are almost always among the factors that affect the course of surgery and what will be done. Therefore, the absence of these features in the program may give deceptive results.

    In fact, such programs are easy to access and use and are a plus during the patient interview. It helps the patient to accept the surgery and prepare him psychologically. 

     

    Although it also has a benefit in increasing the popularity of the doctor, it should not be overdone when using it, and situations that will increase the expectations of the patient should not be entered. In practice, I do not use such programs during the patient interview, but I use photos of the previous state of the nose and face shape during the operation from the beginning to the end of the operation. While performing the surgery, I perform the surgery by looking at the photos taken from the front and the side on a screen, paying attention to the places spoken to the patient. This helps more than anything. Thus, I get a result that cannot be understood as an aesthetic rhinoplasty in accordance with the patient’s expectations.

     

    Secondary (Revision) Rhinoplasty

    The biggest fear of my patients who have rhinoplasty surgery is to have a second surgery. Although all applications are done in the first surgery, a second surgery will not be needed, but sometimes this may be needed. The reason for this is not the inadequacy of the first surgery, but the varying response of the tissues during the healing process.

     

    Sometimes you can’t prevent the deformities that occur while healing, even though you make the bone and cartilage placement perfectly. Although some experts tried to prevent this with methods such as filler or cortisone application in this process, significant statistical results could not be obtained. In such cases, I am in favor of applying the natural waiting process and recommending nothing but massage before six months. 

     

    The reason for this is that I never do any attempts to disrupt the breathing physiology during the first surgery and I always leave tissues such as cartilage that come out of the patient in the operating field of the patient and never waste them. Thus, instead of giving an unnecessary foreign material load to the healing tissues for the first six months, we wait for physiological recovery and if a second surgery is required, we have the chance to use the patient’s own tissue, which is sufficiently original and natural.

     

    If the surgery was performed in another center or by another physician, it is necessary to encourage our patients not to be hesitant to have the surgery again, and to look at the amount of cartilage that can be used in the patient’s nose area by performing a detailed and tomography-supported examination. If there is not enough cartilage, I inform our patients that we can use the closest ear cartilage and the very solid rib cartilage.

     

    The second fear of my patients is that the healing process will be worse. Since I have taken the necessary precautions in this regard, I will inform them that they will have an easier process than the first surgery. Indeed, second surgeries are a more comfortable post-operative process.

     

    Nose Bone Fracture in Nose Job Surgery

    During my rhinoplasty surgery interviews, one of the most curious questions of my patients is will my nasal bone be broken?

     

    I would like to reduce this fear of our patients a little by explaining in detail how we did this procedure, which I heard in my first meetings with my patients, which is the cause of the bruising and swelling on the face after the surgery and which is frightening to them.

     

    Ear, nose and throat specialists know that the nasal bone is definitely broken in rhinoplasty or simple deviation surgeries. In deviation surgeries, bone and cartilage fragments forming the midline wall are formed. In order to correct the dividing curvature, when this section is separated from the mucosa over it, the curved bone fragment underneath is definitely broken and removed. This is the reason why patients sometimes have pain in the upper jaw anterior teeth after surgery.

     

    As rhinoplasty specialists, we also do another bone breaking. This is to prevent the formation of a flat plateau-like structure that will be formed by the bone and cartilage tissue removed from the dorsum of the nose to shape it. For this reason, the bone forming the roof of the nose is broken from both sides to cover the section from the inner side of the eye to the forehead.

     

    In fact, this is the most crucial attempt of rhinoplasty surgery. Because we give the full shape of the nose thanks to these fractures. In these surgeries I have performed outside of Istanbul, I pay great attention to the fact that patients will experience bleeding and bruising around the face and eyes as a result of this fracture procedure. Because if I am performing rhinoplasty surgery in a place other than Istanbul, I would not want the eye and face swelling to be excessive since I will leave the patient to my specialist friends there.

     

    Therefore, the lateral bones of the nose are broken with the canal technique. 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. Since this method separates the bone tissue and the soft tissue adhering to it beforehand, the soft tissue is not damaged much during the fracture. 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. The excess of the number of surgeries performed by the doctor and, accordingly, his experience is of great importance here.

    Op. Dr. Tamer Haliloğlu
    Op. Dr. Tamer Haliloğlu

    This blog post is written by Op. Dr. Tamer Haliloğlu.

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