Rhinoplasty is one of the most common operations performed by cosmetic surgeons today.
Dr.Surindher and our board certified surgeons have a very keen interest in Rhinoplasties as it involves a lot of artistry and the results are there for everyone to see. The flaws cannot be hidden which makes it even more challenging. Dr.Surindher is one of the few proponents of the Closed Rhinoplasty technique. Most of his procedures are via the closed technique except where extensive tip work is needed. Also because of his association with the large number of cleft patients, Rhinoplasty is a subject close to his heart.
This procedure is designed to improve the appearance of the nose.
Rhinoplasty Types / Procedures Involved
- Reduction of forward projection of the nose
- Removal of humps
- Correction of deviation of the nose
- Narrowing of the bridge of the nose
- Narrowing the tip
- Reduction of nostril size
- Correction of depressed nose
Rhinoplasty in most cases involves modifying the underlying skeleton (bones and cartilage) to produce the necessary changes.
No single nose can be an ideal nose!
A nose which looks beautiful on one person will not necessarily look good on another person. Attempts are made to keep the nose in conformity and harmony with the rest of the face, keeping in mind the necessary specific changes which the patient came to us for.
Many patients feel that the change in shape will be so much that it might be the subject of discussion amongst family & friends. But, neither the patient nor the patients / friends really remember the original shape of the nose a few weeks after surgery.
The operation takes anywhere from 1 ½ to 3 hours for the procedure, depending on what must be done. Patients can go home the same day.
The operation can be done under local anesthesia plus sedation or general anaesthesia.
Procedure of Rhinoplasty
The incisions for closed rhinoplasty are usually made inside the nose. The nasal skin is lifted away from the cartilage & bones. Then the necessary modifications to the skeleton (bones and cartilages) are made. The excess skin redrapes itself onto the new framework and shrinks over a period.
Since rhinoplasty involves correction the framework or scaffolding over which the skin drapes, the results may vary according to the skin type of the patient too. Hence, Caucasians have better results than Asians and Asians have better results than Africans. Similarly, women have better results than men.
Sometimes if the chin is smaller or disproportionate as compared to the nose or the face, as a whole chin enlargement might be needed, which can be performed simultaneously to bring the face into proper balance.
Is rhinoplasty painful?
Pain after surgery is moderate & usually decreases in 24 – 48 hrs. Immediately after surgery a splint is applied to the nose, which will remain in position for approximately 5-7 days. The nose is blocked for 2-3 days because of the swelling & the patient must breathe through his mouth. Even later the patient may feel his nose to be congested for few weeks following surgery because of the internal swelling, which will gradually abate.
Some results of the procedure are clear when the splint / dressing is removed. But, it takes 12-16 weeks for the proper result to be seen. Even after that minor changes occur over a period of 6 – 8 months.
Apart from the usual problems of bleeding infection and scar, the other complications could be residual deformities, breathing problems and some bony irregularities in rare cases. But it is one of the safer cosmetic procedures and the problems if any are amenable to correction in most of the cases.
In some cases the bridge of the nose is depressed whereas the rest of the nose is apparently normal. In such cases an augmentation rhinoplasty is performed. Augmentation is done by inserting either cartilage from the nose / ear or bone from the rib / hip or silicone implants.
Each of the materials which are inserted, have their pros and cons:
A silicone implant is the easiest, gives very good cosmetic results and there is no additional scar on the body from where the graft is harvested. The disadvantage being, the chance of implant rejection. Rejection is a process that can occur anytime, weeks after the surgery or 30 years after the surgery. In such cases, the implant has to come out. This type of rejection is a complication any person undergoing an implant surgery must be ready to accept. Care must be taken post operatively like, in case he or she has an infection anywhere in the body, they have to take proper antibiotics and care to prevent infection of the implant.
It is usually harvested from the hip bone but bone from the skull and elbow is also used. The advantages of a bone graft are that it is not a foreign material, is accepted by the body well. Disadvantage is that it requires an additional procedure to harvest the bone graft and an additional scar. Also the fate of the bone graft is uncertain at times. For the bone to survive it requires to get blood supply once it is put inside the nose. This maybe be unpredictable. Usually some extra bone is inserted to compensate for expected losses of bone due to absorption. Usually takes around 6 months to settle down. In the case of a silicone implant failure, usually a bone or cartilage graft is preferred.
These are harvested from either the ear or nose septum most commonly. These are tied together to the required dimensions and inserted as a graft. This also has the advantage of not being a foreign material but, it requires an additional procedure to harvest it and of course the donor scar, though hidden. The main problem with cartilage grafts is that they can warp or bend because of the natural curvature of the cartilage and its internal memory. Though care is taken and certain procedures are done to prevent warping, there is always a chance it may undergo warping which might require minor revisions later on.
Non Surgical Nasal Augmentation done using fillers and it is a clinic procedure under local anaesthesia.