SURGERY OF THE NOSE

RHINOPLASTY


The nose is the central point of the face. The rhinoplasty searches the aesthetic balance of the face, without leaving apart the functional aspect of the nose. Technically, a proportion between the nose subunits and their balance with the face is searched. Before anything, the doctor must tell the patient each and every possibility and guide her/him about which type of nose would fit better on her/his face, always warning that the aim is an improvement, not perfection. It is usual to use computer programs in order to project on the patient´s face the more adequate nose, giving her/him a previous idea of how her/his profile could be after the surgery. One of the benefits of rhinoplasty is not leaving visible scars. It is indicated from the age 14 or 15, because before this age the nose is still growing.

RHINOSCULPTURE

The rhinosculpture is a new philosophy on the approach of rhinoplasty, as it doesn´t follow the classical methodology. It is a technique based on multiple procedures, associated to grafts, rasps, resections, among others. The combination of these procedures varies according to each patient´s needs and it is determined after a careful photo and computerized study of each case. The planning is always made after doctor and patient come to an agreement. The rhinosculpture is a complex technique , but it allows more natural results than conventional rhinoplasty does, because it personalizes the patient´s nose. The aim is to scape from the nose called “surgical nose”, as artificial as easily identificated. For patients over 40 years of age, for example, a radical change of the nose format is not recommended as, besides being too evident, it may affect the person´s own identity. In those cases, rhinosculpture guarantees a natural aspect, only improving the imperfections and keeping the patient´s self image. Besides that, in the majority of cases where the rhinosculpture philosophy is used, there is no need of breaking the nose bones, a rhinoplasty usual procedure. Like that there is less aggression to the organism and the recovery is faster and more comfortable.

PREOPERATIVE PREPARATION

Ten days prior to the surgery the patient must stop taking any medication based on acetylsalicylic acid, such as aspirin. The doctor must be informed about any medication that the patient is taking, as well as about being a smoker. On the eve of the surgery, it is necessary to carefully wash the hair followed by a careful cleaning of the face and the inner part of the nose. The patient must have a soft diet and it is not allowed to drink alcoholic beverages.

SURGICAL PROCEDURE

Each type of nose asks for a different technique. The most common surgeries aim for reducing the size of the nose, reshaping the tip, removing the dorsal hump or correcting anaesthetical angles between the nose and the superior lip. The first step of the surgery is the correction of the nose functional deficiencies, like deviated septum and turbinate bones. After that the aesthetic corrections are started. The most complete rhinoplasty consists in removing the bone prominence of the nasal dorsum, lifting and narrowing the tip and also the lateral narrowing. There are more simple cases where only the dorsum scratch and the tip narrowing are performed. Others where only the tip is lifted. In the majority of nasal surgeries, the work is done through internally placed incisions. It takes from 40 minutes to one hour and half. The rhinosculpture is a more detailed and individualized procedure, which length varies depending on the complexity of the case. Anesthesia may be local or general. This decision is taken together between the patient and the doctor. The length of hospitalization depends on the type of anesthesia chosen.

POSTOPERATIVE CARE

An adhesive tape protection and a plastic splint will be placed to help keep the format of the bone and the cartilage on the desired position. Packing is necessary for 12 hours, or for 72 hours if the septum was treated. The patient must sleep with her/his head lightly raised avoiding lying down over the nose. Ice compresses may diminish the swelling. The postoperative period is normally painless and infection is rare. Physical efforts and sun exposition must be avoided for the first weeks. After 72 hours the patient is allowed to use make-up in order to disguise ecchymosis that may last 15 days. It is usual that the swelling of the nose lasts sometime, but the edema disappears gradually and around the sixth month it is possible to verify the final result.


"The Regional Medicine Council doesn´t allow the exhibition of pre and postoperatory images".

 
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