Contrary to what is believed, after rhinoplasty, the patient does not feel pain which disturbs him ver much. On the first day after surgery, a painkiller is applied via intravascular injection. At the same time, oral painkiller is given to all our patients in order to relieve even mild pain after surgery. Another benefit of painkiller is its contribution to regression of edema. Rarely headache may occur due to nasal congestion. Minimal pain can be experienced in small traumas and cold weather. But they are all temporary. At the end, none of the patients complain about pain.
There is a minimal risk of any kind of surgical intervention and drug administration to the body. The most common problems are bleeding, infection and, of course, the need for revision surgery. The patients are informed in detail about the current risks before the operation. Antibiotic treatment is applied after surgery to prevent infection. For bleeding, the patients are informed about the foods and medicines that should not be taken before and after the surgery. Bleeding and infection occur rarely.
Nasal cartilage deviations, nasal concha hypertrophy, nasal polyps and sinusitis preventing the breathing can be treated with rhinoplasty. It is even recommended that the nose-related problems are operated in the same session because the first intervention to the nose is easier than the following interventions. Performing nose-related operations at different times is more expensive and difficult than a combined surgery. In addition to rhinoplasty, face filling, eyelid, jaw and face lifting operations can be done. The most frequently applied intervention with rhinoplasty is the chin implant when the jaw located posteriorly. The most commonly used method is the silicone prostheses placed at the tip of the jaw. Fat injection can also be performed, although it is not very effective. The application of bringing jaw bone to forward by surgical operation is a rarely used method. The proper method is decided after a detailed analysis.
The Social Security Institution (government) and private health insurance do not pay any of the procedures related to aesthetic surgery. It just covers the operations related with the problems which effects the breathing. Some private health insurances can pay the treatment cost of the breathing problems of patients who have aesthetic concerns, while they do not pay the aesthetic part. Some other private health insurances do not pay any procedure with aesthetic surgery. The opinions and permitions are obtained from the private health insurance before surgery.
Both techniques are used in rhinoplasty operations. Open technique has more advantages when compared to closed technique. In open technique rhinoplasty, the cartilage and bones forming the nose are intervened under direct view. Surgical Interventions are performed easily and not predictive. Interventions can be performed more sensitively. The only disadvantage of open technique is the small incision at the bottom of the columella. This insicion does not cause problems when it is properly and meticulously sutured in accordance with aesthetical principles. In closed technique, the nasal cartilage and the bones are reshaped by intercartilaginous incisions inside of nose. Since the interventions are not performed under full vision, it is sometimes unpredictable what kind of problems will be encountered. In my opinion, when there are minimal deformities in the nose, closed technique can be used.
Smoking: Smoking affects the healing of tissue negatively by decreasing blood supply. Smoking should be forbidden for 6 weeks postoperatively.
Glasses: Since some incisions on nasal bones are made during the operations, all weights even it is not very much, applied on nasal bones can cause bone union in an incorrect and undesirable way. Very light glasses can be used not to apply pressure on the nose. In addition, wearing glasses is not recommend for 6 weeks after the operation.
Sunbathing: Sunbathing should be forbidden for 6 weeks after rhinoplasty. In sunny weather, It is advised that to go out by wearing hat and using sunscreen with a high protection factor. If your holiday plan is earlier than 6 weeks, it will be better to have your surgery after the holiday. You can go swimming after taking your nose splint and nasal packing. Contrary to the belief among the public, rhinoplasty surgeries can be performed in every season of the year.
Sport: Sports like walking and swimming can be done after surgery. But the sports including the possiblity of trauma to your nose are not recommended for up to 6 weeks.
Lying position: your head should be slightly elevated and it has positive effects on reducing edema.
Ice application: Ice application is usually recommended fort he first 24 hours. Subsequent application has little effect. When applying ice, it is important not to apply press on the nasal splint for good bone union.
Nose care: Antibiotic ointments should be applied to the stitches at the tip of the nose after rhinoplasty. When drying and crusting are existed, cotton ear sticks can be used by wetting with hydrogen peroxide to remove the clots. After removal of the nasal packings, moisturizing creams and sprays can be used to moisturize the inside of nasal cavity.
Nutrition: Soft and watery foods are recommended for the first 2 days after surgery. Solid foods difficult to chew are not recommend. Bleeding-enhancing foods (herbal teas, broccoli, cucumber, spinach, potato, mushroom, olive, tomato, cherries, avocado, apples, tangerines, apricots, blackberries, grapes, pine nuts, pistachios, almonds, cumin, dill, rosemary, thyme, turmeric, mustard etc) and medicines(aspirin, coumadin, etc.) should not be taken, especially in the first week
Gesture: Excessive facial mimic should be avoided.
Nasal obstruction and bleeding: You may feel like flu, when there is nasal packing inside of your nose after the surgery. This situation is completely normal. This problem will be solved when the packings are removed. Some bleeding can occur, it is common, there is no need to worry about it.
As all surgeries performed under general anesthesia, some preparations are made before the rhinoplasty. A number of tests are performed prior to surgery and the anesthesiologist examines the patient. If the anesthesiologist appoves, the patient can get the operation. Eating and drinking should be stopped for 6-7 hours before the operation. Bleeding-enhancing foods (herbal teas, broccoli, cucumber, spinach, potato, mushroom, olive, tomato, cherries, avocado, apple, tangerines, apricot, blackberries, grapes, pine nuts, pistachios, almonds, cumin, dill, rosemary, thyme, turmeric, mustard etc) and medicines (aspirin, coumadin, etc.) should not be taken before the surgery. If the operation day coincide with the first day of menstrual period of female patient, surgery should be postponed due to the possibility of bleeding during the operation.
After surgery, patients generally stay at hospital for one night. If the surgery is performed in the wee hours of the morning, the patient is discharged within the same day. In addition, if the patient has an additional disease that requires to stay in hospital, I take action by consulting to relevant doctors. It is better for patient to come with a companion.
It is recommended that you should not drive for first 24 hours, more ideally you shouldn’t drive until your nasal packings are removed.
After rhinoplasty operation, removal of nasal packings can vary from 1 to 7 days depending on the type of surgery performed. Thermal splints on the nose is usually removed at the 1st week and white or skin color plasters are applied to the nasal dorsum to provide the nasal skin to adhere to the underlying cartilage and bone structures and to help decrease of surgical edema more quickly. The sutures used for nasal tip (if the non-absorbable sutures are used) can be removed after the first week. Since the sutures used in the nose are absorbable, there is no need to remove them.
In the past, nasal packings made of fabric had been using after the nose surgeries and while removing them they had been causing bleeding and pain. I prefer two types of tampons for my patients, silicon (doyle nasal splint) and merocell nasal packings. Almost never a pain and bleeding occurs when removing both nasal packings. During the surgery, I decide the type of nasal packing to be used according to the structure of patient’s nose. You can feel yourself like a flu when you have a nasal packing, it’s normal and you don't need to worry.
After the surgery, if the nasal packings are needed to be removed in the early period, I usually call for follow-up examination in the 2nd and 3rd days. In addition, at the first postoperative week nasal splint and packings are needed to control. Generally, for the first six months, it is needed to be come for follow-up examination bimonthly and after the first six month you should come at first and second year.
The lower limit of age that rhinoplasty is performed for women is 16 and for men is 17. Because up to this age, nasal bone continues to grow. If surgery is performed before these ages, the results may be affected negatively. There is no upper age limit for rhinoplasty.
After rhinoplasty, problems such as bruising, swelling, difficulty in smiling, nasal congestion may be encountered. Generally, it is possible to have an idea about the final shape of nose at the end of first postoperative month. Bruise and swelling may increase on the 2nd and 3rd postoperative days, but thereafter it will recover quickly. Bruises around the eyes generally recover at the end of first week. Almost no bruises occur after deglowing, piezo (ultrasonic) and osteoblastic surgery. Bleeding may occur rarely in the eye but it recovers between 3 and 6 weeks. Edema usually recovers in 2-3 weeks. But the slight edema may continue up to 1 year. Tip is the part of nose where the edema stays the longest. Edema at the nasal dorsum dissipates earlier. You can breath easily after the nasal packings are removed, but then there can be some temporary nasal obstruction. Intranasal solutions are used to overcome this obstruction.
There is a possibility of failure after any kind of surgery. Failure rate is slightly higher in rhinoplasty operations. The doctor who says 100% of my patients are satisfied with every surgery I have done, make sure that he hasn't either operated or he doesn't tell the truth. Before the operation, it is needed to talk about the operation, the results of the surgery and the success in the operation in a honest and detailed way. This kind of talk not only increases the patient's confidence in you and also informs the patient that they should not have misleading and high expectations. Any reasonable and correctable problems that do not meet the patient's expectations after the surgery should be accepted by the surgeon and the patient's surgery must be performed again. I do not charge additional fee for my own patients who have problems caused by my own surgery. At least 6 months, ideally 1 year period should pass for a revision surgery after an unsuccessful operation.
In rhinoplasty, the nose should be shaped in harmony with forehead, eyebrow, eye, cheek, lip and chin while keeping the nasal functions well. In addition, the patient and the doctor should be satisfied with the result. Despondency related with the patient's nose shape should be eliminated. After surgery, the appearance of nose should be natural and untreated, for men more obvious lines are desired, while transition of the nose lines should be soft for women, attention should shift from nose to eyes. In the case of ambitious nose demands, requests should be met to a reasonable degree. Nose should seem well not only from the profile, but also from the frontal and oblique view.
In recent years, men also get rhinoplasty frequently. For male patients, tip of the nose should be less rotated and nasal dorsum should be straighter than that of females. If the nasal dorsum is extremely curved and the nasal tip is too rotated, the appearance becomes feminine. For female patients, the nasal tip can be slightly rotated and a slight curvature on the nasal dorsum is desirable. The average nasolabial angle of the nose should be 90° for men and 105° for women.
Male patients’ skin is thicker and oily. Therefore, this should be taken into consideration when planning the surgery. After the surgery, it may be necessary to provide additional treatments by consulting dermatologists.
Postoperative bruising and swelling are more common in men, and it takes longer time for nose to take its final shape.
I prefer to use both classical surgical equipments and piezo (ultrasonic) device when performing rhinoplasty. It is impossible to perform every phase of rhinoplasty by using piezo. Therefore, classical surgical equipments are needed. During the operation, I have both devices ready in my operating table. Surgery technique (deglowing) is more effective on the bruising existing after the surgery rather than the equipment used in operation. But in traumatic noses it is more appropriate to use piezo instead of osteotomes in order not to break the bone from previous fractures.
Droppy nose deformity is a common pathology in Turkish population. These noses are also long noses. It becomes more apparent with laugh. The nasolabial angle is normally between 90° and 105°. In patients with droopy nose, this angle is below 90°. Droopy nose deformity also causes breathing problems. It is possible to solve these problems by surgery. There may be some reduction in the nasolabial angel after surgery. The operation should be performed considering this condition. According to the chosen technique, the amount of drop at the tip of the nose becomes different. In patients operated with Kolumellar strut, the decrease of nasolabial angle is slightly higher than that of the patients operated with tongue in grove technique. Surgery plan should be done according to this situation. Extremism should be avoided when the nasal tip is shaped.
There is no objection to have shower after the first day of surgery as long as the external nasal splint is not wetted. After the removal of the nasal splints, special drapes are put on the nasal dorsum which are water resistant. So you are allowed to take shower.
Everybody has different face structure and nose shape. A nose which fits someone’s face may not be suitable for someone else. Besides, rhinoplasty is an operation performed according to the current nose of the person. Everyone's nose should be unique. I give detailed information about surgery to the patients who come with a photo and try to direct them based on the basic features of nose which they desire. If their requests are not within reasonable limits, I try to explain that they will not be happy after the surgery and that it will be better if they do not have surgery. I advise them to get psychological support if I feel that they have other problems under the rhinoplasty demand.
Since everyone’s face and nose structure are different, personalized planning should be done for rhinoplasty. Photoshop study has a great importance both in terms of understanding the patient's expectations and the physician's surgical plan. Rhinoplasty is a surgery that requires very good planning. All kinds of details should be taken into consideration while planning. Photoshop and other simulation studies are one of these details.
Rhinoplasty is not an operation that requires inpatient healing. If you have a desk job or a job that does not require direct contact with people, you can start to work 3 days after the surgery. For jobs that require one-to-one communication, you can start to work after taking the nasal splint.
I rarely recommend massage after the rhinoplasty. I don't recommend patients to decide to massage themselves. Surgeon support should be taken about how to do massage.
Copyright © 2019 Prof. Dr. Şaban ÇELEBİ - Ear, Nose And Throat Specialist