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By using microhybrid technology, we produce unpredictable results in closed nose surgeries. You get the face you deserve in just a few days without any pain or bleeding after the surgery.
Rhinoplasty
Before Surgery
When you start researching, you will see that nose and facial aesthetics is a subject of science in itself. In order to master this subject, it is necessary to spare time for the literature, meetings and scientific studies that should be followed. It is necessary to read the past experiences well and to follow new developments and techniques very well. I have many different treatment areas; I know that I do not have enough time to say that I also do rhinoplasty. That's why I put myself into this subject.
Specialized people should do this surgery. Facial Plastic Surgery Specialists in the USA perform these surgeries. Both otolaryngologists and plastic surgeons are specialized in this regard.
So, how do we understand that the people who perform this surgery in our country are specialized in this regard?
The nose is a very important organ both aesthetically and functionally. The rhinoplasty specialist should have a good grasp of the turbinate and lymphatic tissues in the nose, the structure and physiology of the mucosa. In addition, he should be able to evaluate the harmony of the nose with the face and consider the face as a whole. He should be able to offer alternatives to his patients in subjects such as eyebrow-nose line, eyelid aesthetics, under-eye light filling, profiloplasty, chin tip aesthetics, forehead tissue injection and even ear aesthetics. Physician and patient should be able to talk all the details and act together.
You think of the worst-case scenario first:
“I see very bad noses”
“I immediately understand operated noses”
"My friend had it done, I'm not telling her, but it looks very bad"
“I am very afraid that my expression will change”
You are right but…
I think it is very risky to try to make the nose pointlessly smaller, to think that 'upturned nose is always beautiful', to make extremely curved noses.
I see such surgeries around. Nose tip problems are also very common. Those with pinched noses, pointed noses, those with visible nostrils.. I see these often.
But… With MODERN TECHNIQUES, it is possible to change the nasal cartilages and bones as we wish. We can make noses that are closest to nature and that will not be understood as having surgery.
If you have a nose that does not fulfill its functions or that bothers you in the mirror, do not hesitate to have an operation. Of course, after discussing all the details with a specialist specialized in this subject.
There are computer programs, hardware and software designs prepared for this purpose. They have a very important function. Thanks to these, we come to an agreement with the patient. In other words, how much of the nasal ridge the patient wants; the degree of nose lift, etc. We are speaking concretely. But this is kind of a deal; It's not your post-operative state. Do this study with your physician.
But in order to understand and predict your post-operative appearance, especially look at the previous nose surgeries your doctor has performed. There is a very important point here: not only after the operations; See the before and after together. There are 7 classic poses when photographing, look at all of them together and evaluate the photos taken from the same angle and with the same quality. It is very important from which point a nose comes to which point.
To your doctor
-Tell what you want.
-Tell what you don't want.
-Be realistic.
Thus, not only your nose shape after surgery, but also your nose shape and facial expression will start to come to life in your mind.
I think this is perfectly normal. It is obvious how important the operation is, both socially and physiologically. At this point, calculate the profit and loss: what will change in your life if you have surgery? Discuss this in detail with your doctor.
Complications are rarely mentioned when describing rhinoplasty. A rose garden without thorns? not.
So what are the complications?
– Bleeding: A cheesy complication. It can be 1 hour after the surgery, or it can be 1 week later. Okay, it's a nasty complication, but easy to deal with by an otolaryngologist. Contrary to popular belief, when it occurs, the life-threatening risk is almost non-existent.
– Breathing problems, headache and sinusitis: Intranasal adhesions called synechia or cartilage-bone curvatures, nasal concha enlargement can cause this condition. A second surgery may be necessary.
– Aesthetic problems and deformities: The degree of these and how they can be corrected with an intervention are important.
– Risk of reoperation or intervention: Various scientific studies have given rates for the risk of a second surgery. In these publications, there are results starting from 5% and going up to 18%. As far as I can see, corrections can be made in a group such as 2-3%. This correction can be a maximum of 15 minutes of minor interventions. If this is not the case, there is a problem and it is necessary to talk about revision nose surgery.
Related to Surgery
Rhinoplasty surgery can be performed under local or general anesthesia. Unless there is a very special situation, I perform my operations under general anesthesia. I think it's pointless to even discuss it in today's conditions.
Another important point: I definitely do not perform my surgeries in the office environment. The place where this job should be done should be the operating room environment where the surgeon is comfortable.
What we do during the surgery is to create the desired shape by changing the cartilage and bone structures after ensuring the functions of the nose.
At this point, the technical issues begin. Let's go in order:
Contrary to popular belief, there is no big difference between the two techniques. If an incision of about 5 mm is made in the lower part of the nose, combined with intranasal incisions and operations are performed by removing the skin, it is open; If the skin is removed with intranasal incisions without this 5mm incision, it becomes a closed technique.
The important point here is that the surgeon can apply both techniques and choose whichever technique is more suitable for the patient. Because if there are no big problems at the tip of the nose, minor problems can be solved with a closed technique.
On the contrary, it presents an even more dire picture. If you insist on the closed technique and do not prefer the open technique in necessary patients, problems will be inevitable.
Everyone knows that the nasal bones need to be shaped during surgery. The word “break” connotes an uncontrolled operation and is a somewhat vulgar term.
While shaping the nasal bone, chisel, osteotome, rasp, micromotor, ultrasonic bone cutter etc. available. Keeping all of these at hand provides convenience to the surgeon and he can make his choice according to the patient's condition.
It is unnecessary to use an osteotome instead of a rasp in a patient with only a small belt. The use of micromotors or ultrasonic bone cutters called powered instruments gives us a great advantage in a very curved nose.
Appropriate instruments should be selected for the appropriate patient. I'm having a hard time understanding how to insist on one tool.
A Chinese proverb that has been used a lot lately also applies to this situation:
“If you only have a hammer, everything looks like a nail.”
Let me tell you from the beginning, saying "we don't use those meters long bumpers" is no longer a luxury. It's ridiculous to use them nowadays. I think it's pointless to even mention it. I hope this matter is no longer discussed.
Let me briefly describe the buffers:
The most commonly used silicone splint, as the name suggests, is a silicone structure and leaf-shaped materials. It has a groove in it, you can breathe a little from here.
Others are like sponges. You can't breathe in them. While some of them melt spontaneously; the other part needs to be removed after the surgery.
My most frequent choice in my practice: No buffering at all. Silicon is in second place. I use these silicones mostly for precautionary purposes so that there are no adhesions in the nose after the surgery. I remove it on the 2nd or 3rd day after the surgery. These are not really painful, but when they are removed, it feels like a huge mucus is coming out of your nose. If I prefer the ones with sponge structure, I use the self-melting ones. that is, there is no need to pull it after the surgery. These patients are the ones I have done both aesthetic rhinoplasty and endoscopic sinus surgery together.
Content is under preparation.
Postoperative
Post-operative pain is almost non-existent.
There may be bruising and swelling around the eyes. There is a misconception about this: "There is no bruising, depending on the tool or technique used, and the patient returns to normal immediately". I don't fully agree with this. There are 3 main factors that affect bruising and swelling:
1. The patient's blood pressure values during anesthesia
2. Surgery technique and instruments used
3. Personal factors
Yes, there may be less bruising and swelling in some patients, and more bruising and swelling in some patients.
It should be noted that bruising and swelling do not affect the outcome of the surgery.
The subject of tampons and silicone: The most commonly used silicone splint, as the name suggests, is a silicone structure and leaf-shaped materials. It has a groove in it, you can breathe a little from here.
Others are like sponges. You can't breathe in them. While some of them melt spontaneously; the other part needs to be removed after the surgery.
My most frequent choice in my practice: No buffering at all. Silicon is in second place. I use these silicones mostly for precautionary purposes so that there are no adhesions in the nose after the surgery. I remove it on the 2nd or 3rd day after the surgery. These are not really painful, but when they are removed, it feels like a huge mucus is coming out of your nose. If I prefer the ones with sponge structure, I use the self-melting ones. that is, there is no need to pull it after the surgery. These patients are the ones I have done both aesthetic rhinoplasty and endoscopic sinus surgery together.
Length of stay in the hospital: After the surgery, you can recover within hours and do simple activities. Eating yourself, using the phone, etc. . It is possible to be discharged on the same day. Sometimes, you need to stay in the hospital for 1 day, especially in revision surgeries. I recommend my patients to take a shower the day after the surgery. This makes the patient very comfortable. With the appropriate tapes and splints used, there is no problem with water contact with the nose for a few minutes.
Plaster-Splint: I remove the plastic splint placed on the back of the nose after a week after surgery. After that, I use skin-colored thin strips to reduce the edema in the nose faster and keep them for a few days. At the end of the second week, a beautiful image emerges. Sometimes it takes 6 months for the swelling to go away completely. But the patient or those around him cannot even understand these swellings.
Glasses: The important factor here is the structure of the nasal bone. Sometimes I can allow the use of glasses even after 10 days. This period can be extended to a maximum of 2 months. I don't think you need to wait 6 months.
Sunlight exposure: It is necessary not to be exposed to direct sunlight for about 3 months. This may cause staining on the skin. Hats or sunscreens can be used when necessary.
Revision Rhinoplasty
- Why would there be a need for a second surgery?
- What kind of process is followed in those who have had nose surgery before?
- Shaping the nose in revision nose surgery
Revision rhinoplasty is the nasal aesthetic surgery performed in cases where one or more nose surgeries have been performed before and the desired result cannot be achieved. There are different nomenclatures: such as secondary rhinoplasty, secondary rhinoplasty..
It is generally accepted that these operations are more difficult than the first operation. Because there is a nasal skeleton whose structure has been changed and has not been successful, there is a skin that has adapted to it, and when you start the operation, you will encounter surprises.
But if the operation is performed with adequate preparation, these operations are no different from the first operations. By adequate preparation I mean:
1. Problems should be presented clearly and concretely
2. Expectations should be realistic
3. There should be enough tissue, especially cartilage tissue. This is the issue that patients find most difficult to understand. Actually, the matter is very simple. We try to create the anatomy closest to nature during nose surgery. For this, we need some tissues, especially cartilage tissue. In the first surgeries, this cartilage reserve is present in the middle roof of the nose called the "septum". However, in revision surgeries, the cartilage tissue here is sometimes not enough. In this case, either some costly but reliable materials obtained from a cadaver called ready-made cartilage and undergoing various processes can be used, or it can be obtained from cartilage tissues elsewhere in our body. Behind the ear is an alternative for this. But I don't use ear cartilage much. Because it is not enough and it is not useful due to its curved structure. Another option is to take approximately 3 cm of cartilage from the rib at the level of the breast line. This is the most reliable and useful way in my opinion.
If adequate preparation is made and these surgeries are performed, the difficulties of the surgery are minimized.
I can easily say this: The need for revision rhinoplasty has decreased with new techniques.
There was excessive extraction in previous surgeries. These are surgeries in which the back of the nose is too hollow and the tip of the nose is excessively raised. Nose tip problems with asymmetries, where the tip of the nose is pinched, are also not few.
These problems are less in recent surgeries. But now there are problems due to putting too much graft, that is tissue, or over tightening the tip of the nose with stitches.
Among the most common problems I see are; There are surgeries in which the bone arch is removed and the cartilage is not removed, the nose looks like a parrot's beak when viewed from the side, the ridge of the nose remains pointed, and the tip of the nose is asymmetrical. Often they can be together.
In rhinoplasty, we respect the natural anatomy and surgical tissues and reshape them. In the first operation, the cartilage tissue in the middle roof called the septum may be sufficient for us. however, this reserve is mostly lost in revision surgeries.
We need to get cartilage from another part of our body. This cartilage can be taken from behind the ear. Patients show a half-jokingly half-serious reaction saying "Let's not be out of our ears". If this procedure is done with appropriate incisions, this does not cause a deformity in the ear. I do not find ear cartilage useful. I don't prefer it because of its curved and irregular structure.
Taking cartilage from the rib is very useful for creating the desired skeletal structure. We make an incision of approximately 2-3 cm from the level of approximately 5 cm below the right nipple. This then creates no trace problems. We take a cartilage tissue with a diameter of about 3 cm from here and use it to form the nasal skeleton.
The scar remains below the bikini line in women. When it is properly closed, a vague trace remains after weeks or months. When the appropriate technique is used, there is no pain.
Profilplasty
Although all aesthetic purposes and results are relative in facial aesthetics or aesthetic applications and surgeries performed on any point on the face, there is one thing that is certain; should be considered as a whole. At this point, the concept of profile aesthetics comes to the fore. Profile aesthetics, which has gained much more importance especially in nose surgeries, draws attention as a subject that both the physician and the patient should be informed about.
When we say profiloplasty or profile aesthetics, as the name suggests, it is aimed to improve the profile appearance aesthetically and to obtain a more aesthetic and proportional profile appearance. It is important to ensure that the forehead, nose, lip, chin and neck structures are compatible with each other in profile plasty or profile aesthetics, which has an important place in holistic aesthetic surgery applications.
The structures that need to be evaluated in order to improve the profile appearance and obtain a proportional beauty are as follows.
-Forehead height and hairline
-Forehead-nose relationship
-Nose lip relationship
-Upper lip lower lip relationship
-Ratio of upper jaw to lower jaw
-Position of the tip of the jaw
-Under the chin area
-Neck-chin angle
Profile aesthetics After evaluating all the structures we mentioned above, in accordance with the planning made according to the needs. Nose surgery, lip aesthetics, chin tip aesthetics, jowl aesthetics, neck aesthetics One or more of the applications can be performed in combination or as separate operations.
Non-surgical aesthetics with applications profile aesthetics corrections can be made. Of course, the result of these procedures are temporary results lasting 12-18 months. However, sometimes it is temporary because patients have reservations about surgery or want to see the result before a possible surgery. filling aesthetics These operations can be performed with
Profilplasty can be performed under general anesthesia or local anesthesia depending on the applications to be made and the preference of the patient.
It varies according to the operation to be performed. Filling aesthetics While normal life is resumed after a period of 15-20 minutes in applications, after surgical procedures, there are times that vary between 2-3 days and 7-10 days, depending on the procedure.