10 discussing Medical Roll-CIT
The history of rhinoplasty dates back to 3000 BC when the ancient Egyptians first used surgical techniques to repair nasal injuries. Indians were also instrumental to the development of nasal surgery. Their methods date as far back as 800 BC. Aesthetic nasal surgery dates back to the times of the Renaissance period where technological and societal progress helped the advancement of facial plastic surgery. In the 1800’s surgeons in America and Europe helped to proliferate and further develop the rhinoplasty operation. The fifties and sixties saw a great leap in the popularity of rhinoplasty. In the late seventies, surgeons gained a better understanding of nasal function and anatomy. With this, advanced techniques were developed that helped to avoid the characteristic post-operative nose job look that many people developed years after having undergone a rhinoplasty operation.
The look of rhinoplasty has also changed with the times. In the sixties, people often wanted a ski slope nose with a scooped out look and a very thin tip. Today, people seek out surgeons that can create a nose that looks natural and does not stand out. In fact, an ideal nose should blend with the face and bring out the eyes.
IS RHINOPLASTY SURGERY FOR YOU?
The ideal candidate for rhinoplasty is any person who is not content with their nose and would like to have it improved ! Of course, the person should be in a state of good
health and able to go through the surgery. There is no ideal age for rhinoplasty, as patients from ages sixteen and older can undergo the surgery.
The consultation process begins with a discussion with the patient about specific issues and concerns regarding nasal aesthetics. Any functional problems should be discussed at this time. For example, whether there is any nasal obstruction, allergic nasal symptoms, or sinusitis. Theses may require further work up.
Next, a physical examination is performed. The nasal cavities should be examined using a nasal speculum and a light. The external nose should then be carefully examined and palpated. This is extremely important and is performed by all qualified rhinoplasty surgeons. The dorsum, or bridge of the nose, is examined for any humps that may have to be reduced. The nasal bones are then palpated for irregularities, asymmetries, or curvatures. The nasal tip is then examined and palpated. The tip projection, which is the length of the tip from the base of the nose to the end of the tip, is examined. Tips that are too projected, or long, need to be reduced and those that are to short, may need to be lengthened. Tip rotation, which is the angle of the tip in relation to an imaginary vertical line drawn at the base of the nose is analyzed. Tips that are under-rotated, or droopy need to be rotated up, while tips that are over-rotated like Mrs. Piggy need to be de-rotated.
The pre-operative pictures are then taken. These can then be reviewed by the surgeon and the patient. This is another opportunity to discuss particular concerns regarding the aesthetic goals. Some surgeon use computers to image the nose in order to simulate what the post-operative result will look like.
UNDERSTANDING THE SURGERY
The rhinoplasty operation can be performed with either local anesthesia with sedation or general anesthesia. The decision should be determined together with the surgeon. All aspirin and aspirin-like products should be stopped two weeks before surgery, to help reduced the risk of bleeding and bruising.
The rhinoplasty operation can be performed with either of two approaches. They are called approaches because they are simply a method the surgeon can use to assess the areas of the nose that need to be altered. They are not techniques. Techniques are what the surgeon uses to change or alter the specific anatomic areas of the nose. These two approaches are the external approach and the endonasal approach. The external approach involves an incision in the columella, or the area under the tip of the nose. The endonasal approach involves a series of incisions inside the nose. One approach is not better than the other. Results depend on the surgeon, his technique, and the way the particular patient heals after surgery.
Occasionally, grafts may be required to achieve the desired result. Grafts are structural elements, typically made from cartilage. For example, they can be used to define a tip or to fill in depressions. They can easily be acquired from the cartilage in the septum. If the patient has had a previous septoplasty or has had a previous rhinoplasty, the cartilage grafts may need to be taken from the ear.
In the past, the nasal tip was usually sculpted by cutting the nasal tip cartilages. However, experience has taught rhinoplasty surgeons that simply cutting away the nasal
tip cartilages can lead to functional and aesthetic complications. For example, the weakness caused by the absence of cartilage can lead to severe nasal obstruction as well as pointy pinched-looking nasal tips. Rhinoplasty surgeons today use small sutures to change the shape of the cartilages, instead of cutting them. This not only allows the preservation of nasal function, but also allows better accuracy when shaping the cartilages.
Like every surgical procedure, there are some possible complications that can follow the rhinoplasty operation. Bleeding after the surgery is rare, but it occurs, it can be controlled with measures such as cauterization or packing. The risk of post-operative bleeding is about 1%. There is also the risk of infection, which extremely rare, occurring less than 1% of the time. This risk is increased if the surgeon is using implants made of synthetic materials. The remainder of the complications can be divided into functional and aesthetic. Possible functional complications include nasal obstruction from over-aggressive removal of tip cartilages, an incorrectly performed septoplasty, or scar tissue in the nasal cavity. Aesthetic complications can vary a great amount. Aesthetic complications are often the result of either not correctly diagnosing the problem before the surgery, poor technique, or poor healing post-operatively. These can range from slight irregularities of the nasal bones, dorsum or tip to severe irregularities requiring revision rhinoplasty.
WHAT TO EXPECT AFTER THE SURGERY
The night after the surgery should be spent relaxed. The head should be kept elevated using two pillows. This helps to reduce swelling. Iced compresses should be applied to
the eyes for the first forty-eight hours. This is done to help reduce swelling and bruising around the eyes, which typically resolves in five to seven days.
The post-operative period after rhinoplasty is not painful. Some surgeons may place a small gauze in the nose, which may be removed on the first or second day after the surgery. There is typically some swelling inside the nose, which may not allow the patient to breath through the nose for several days. This typically resolves in five to seven days. There is a small cast that is applied to the bridge of the nose. This is removed in the sixth or seventh post-operative day. If an external approach is used, the sutures on the incision are removed in the fifth post-operative day.
There is a variable amount of swelling that occurs on the nose after the rhinoplasty operation. About seventy percent of the swelling resolves in the first three weeks. The remainder of the swelling can take up to four to six months to completely resolve. However, the nose should look better than before surgery once the cast comes off.
THE NEW YOU
While the final results of the surgery may not be completely evident until several months after the surgery, most patients look better than before surgery right when the cast comes off. Patients that undergo rhinoplasty are, by enlarge, extremely happy.