Rhinoplasty

About
The perfect nose is one that is Grecian, or Roman or .................?

For those who wish to have a great-looking nose, a rhinoplasty, also called a "nose job" in common parlance, is the answer. This surgery falls under the realms of plastic surgery or cosmetic surgery.

A rhinoplasty can render the nose not only to be better looking but also in harmonious proportion with the rest of the face. It can be carried out on noses that are too long or too short, flat noses, broad noses, noses that have been deformed after injury or surgery or are causing difficulty breathing.

The operation can be done under local anesthesia or general anesthesia. Getting some laboratory tests and ceassation of smoking are mandatory before the operation.

An opening is made within the nose, as in the 'closed rhinoplasty' or outside in the portion between the two nostrils as in the 'open rhinoplasty'. The surgeon then works on the soft tissue and cartilage or bone. If necessary, cartilage or bone grafts (taken from elsewhere in the body) is used to reshape the nose. If the septum or partition that divides the nose is deviated, or crooked, it can be aligned into the mid-position. Splints may be used to retain the newly-aligned grafts in its position. Then the opening in the skin is closed.

One can expect bleeding, pain, loss of sensation or bruising of the skin over the nose for some time. If the cavity within the nose has been excessively narrowed or the septum has been perforated, the operation may have to be re-done at a later stage, which is then called a secondary rhinoplasty. The healing process over, one can expect the new-look nose in about a year's time. However, caution must be exercised in order not to stress or strain the incision lines.

The nose defines one character whether nosy, snobbish, crooked, or regal. But if you wish to change the way the world perceives you (your nose), go for a nose-job today.

Indications andPreparation
"A great nose indicates a great man-Genial.courteous,intellectual,virile, courageous."—Cyrano De Bergerac

The nose is most prominent part of one’s face. A rhinoplasty can repair deformities of the skin, lining, bone or any part of the nose. The procedure can be carried out to shorten excessively long noses, straighten noses with a drooping tip, smoothen bumps on the nose, lengthen too short a nose, level out depressed noses, trim down the lumpy ones. It can correct deformities due to injuries or previous surgeries. It is also performed when one develops breathing difficulty following a previous nose job. Sometimes a septoplasty or correction of a deviated septum may have to be done along with a rhinoplasty for optimum results.

The nose is always associated with one's character.A man with a large nose is thought to be sinister, small nose weak, red nosed an alcoholic and a crooked nose a criminal or psychopathic behaviour'.¹

One must convey information regarding the desired size, angulation and shape of the nose to the aesthetic surgeon and he will decide on the extent of surgery required. His judgement will also be based on his assessment of the patient’s skin character, the patient's overall facial features, his profile and so on. The doctor may take photographs of the straight as well as the profile view of the patient to take measurements and also for future reference.

A rhinoplasty symbolizes the art and practice of plastic surgery-attention to the psychosocial status of the patient, modification of form and improvement of naso-respiratory function.²

Basic blood tests for hemoglobin, sugar and an ECG for an older patient may be the investigations required before the operation. The patient would be instructed by the doctor to stop medicines such as aspirin or other blood thinners before the operation.

The operation is sometimes done under local anesthesia, although many surgeons prefer to have the patient sleeping with a general anesthetic. A six- hour starvation is required before the operation. The patient is anesthetized before the surgery commences.

Operation
The operation may be called "primary", if it is done for the first time, and "secondary" if a previous nose-job requires a corrective step, or a hole in the septum needs repair.

The closed technique refers to the incision being made within the nostril

The open technique refers to the incision made in the columella or the portion that separates the two nostrils.

The surgeon then inserts his instrument through the incision and reshapes the nose by elevating or working on the cartilage or bone. He may at times use a cartilage graft taken from the ear or the ribs to achieve the desired shape or elevation. Sometimes he may resort to osteotomies or chiseling of the bones of the nose in pursuit of the perfect shape. The tissues are then draped back into position and stitches are applied to close the opening.

Splints may be applied within the nose or outside to stabilize the grafts and prevent movement.

Thus any part of the nose can be changed including its size, its slope, its tip, the width of the bridge, the nostrils as well as the septum within.

Excellent cosmetic results ensure that the incisions are not visible on the face and are usually concealed. There may be a bandage on the nose. Post-op care must be taken so as to not stress the suture lines, and the doctor’s instructions must be followed very carefully.

If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.

Complications
As in any other surgery, complications can be due to surgery or anesthesia. Those due to anesthesia include vomiting, giddiness or shivering.

Some of the common complications possible in surgery of any nature including rhinoplasty are-

• Bleeding,
• Bruising,
• Loss of sensation,
• pain,
• swelling,
• loss of skin over the area.

Other complications specific to rhinoplasty include-

• perforation or hole in the septum,
• excessive narrowing of the nose that requires a redo surgery.

It may take up to a year for the full effect to be seen. After the initial swelling or bruising subsides, it takes a while for the tissues to adjust themselves over the newly grafted bone.

Faqs
1.Can children undergo rhinoplasty?

Children should undergo a rhinoplasty only after their growth is completed. A septoplasty for a deviated nasal septum can however be done on children.

2.Will the doctor be able to make my nose look like Aishwarya Rai’s nose?

It may not be possible to fashion your nose exactly like another person's nose. The doctor will consider how well the desired shape, length etc blends with the rest of your face and will aim for an aesthetically harmonious nose.

Glossary
Rhinos - nose

Plasty - From ‘plassein’- meaning to shape

Osteotomy - Chiselling or adjustment of the bone

References




Compiled by: Dr. Gayathri

Reviewed by: Dr. Reeja Tharu

Uploaded by: Mani