Rhinoplasty means shaping the nose in Greek. Today it is used to describe the plastic surgeries performed for the nose. The intended result in all of these surgeries is to obtain a beautiful nose.
So, what is a beautiful nose?
A beautiful nose is a beautiful car or a beautiful house. All of these contain a number of common features.
• Symmetry (because symmetry is the characteristic of a healthy person, not carrying disease)
• Balance and Proportion (to be in harmony with its surroundings — a small nose for a small face)
• Making you noticeable, enviable, enviable in your environment
• Include cultural or class appreciation (associating wealth, upper socioeconomic class or upper sociocultural class characteristics)
• Fashion or carrying the popular values of that day (it looks like a Swedish nose, not a Pakistani nose).
Apart from these, many factors that we need to add cause us to describe any object as beautiful. The conclusion we need to draw is that beauty actually depends on many different variables. For this reason, I think it is very difficult to establish a general rule about which nose will suit billions of people, each with different frames.
In fact, many rules, angles and ratios have been described about a beautiful nose. These rules are explained in detail in the plastic surgery books in the relevant sections of the nose surgery. All plastic surgeons know these ratios very well. But again, no good plastic surgeon does nose surgery by measuring with protractors and centimeters in their surgeries. These ratios are important only in the educational process. The rules of the beautiful nose in the books may guide you at the beginner level in this regard, but being able to evaluate each person’s unique facial features, the racial distinctions of facial anatomy and even cultural expectations and many factors together and being able to think flexibly and creatively takes us one step further. If you insist that I always apply the same rule, you will make Michael Jackson, who has the facial anatomy of an African person, a small and upturned nose in accordance with the book rules.
If beauty does not have a definite rule for every universal cross, how is the nose that one wants to see on one’s own face be decided with a beautiful or more accurate description? First of all, almost all of the people who apply to a plastic surgery specialist are uncomfortable with a feature of their nose and apply with this complaint. He/she complains about the bridge of the nose, large nose, low tip, transitional base or roof or crooked nose. For me, the patient’s complaint is the most important basic data on which everything will be built. After that, I think about whether the patient’s complaint coincides with my gaze or beauty.
At this point, the most practical solution is to simulate the patient’s wishes through a profile photo. With the help of a computer program, the starting point of the nose, its back, the height and angle of the tip of the nose are shaped based on the patient’s complaints. Of course, during this study, it is very important that the physician and the patient understand each other very well and establish a good communication. An initial example nose is computerized. This is an important tool for the plastic surgeon to better understand his patient. Because planning is almost half of the surgery. But it is not all.
After the planning process, in which the patient and the doctor decide together what kind of nose the beautiful nose will be, comes to the application stage, namely the surgery.
Aesthetic nose surgery or rhinoplasty are different techniques that have been previously described or the flow order has been explained in detail. Again, these techniques have advantages or disadvantages over each other. Closed or open techniques, which are popularly called scarless or scarred, are the basic nasal surgery methods.
In open nose surgery, an incision is made in the lower part of the nose at a point between the tip of the nose and the lip, and the nasal skin is lifted from the back of the nose in the areas to be intervened. Surgery is done by sight. In every attempt to be made inside, not only the touch but also the precision of our eyesight is intervened. In addition, the tip of the nose can be shaped with this technique. In most patients, the scar that occurs in the incision area after 1 year cannot be found.
In the closed surgery technique, no incision is made on the nose. The area to be intervened is reached by incisions made through the nose and cannot be studied by sight. Interventions made on the skin of the nose are evaluated. Interventions on the tip of the nose are more difficult with this technique. Surgery can be performed with this technique in cases where the basic problem that does not require intervention on the tip of the nose can be solved by interventions on the back of the nose.
In the majority of patients who apply to me, the problem is more serious than a small arch on the back of the nose. The tip of the nose often needs to be intervened. I think that the traumas exposed to the nose at a young age in our country and our racial characteristics are the most important reasons for this. For this reason, I perform 90% of the surgeries I personally perform with the open technique.
The nose is a whole with its inside and outside. Curvatures and obstructions in the nose are usually noticed as deformity in the visible part of the nose. An externally crooked or deformed nose is probably not breathing well.
Therefore, the aesthetic and functional status of the nose should be evaluated together. It is a common situation that some of the patients who applied to us with a problem related to the shape of the nose had a previous intervention in the nose.
In surgeries aimed at shaping the nose, some of the cartilage structure in the midline of the nose should be removed to support some points of the nose. For example, increasing the height of the nose tip, shaping it, preventing the narrowing of the nose roof. In patients who have had septoplasty or surgery to correct the curvature in the nose and some of their cartilage has been removed, cartilage may need to be removed from a second area such as the ear or ribs, since there will not be enough support from the inside of the nose. This means a second action. Therefore, it would be more appropriate to perform the two procedures together if the patients with breathing complaints are due to a curvature and if they have a problem with their nose shape.
The first half hour after the operation will be a little troublesome. Nausea and chills may occur. I don’t often insert a tampon in my surgeries. If I have made an intervention due to curvature in the nose, I can place a special tampon that stays for 1 day and does not stick to the nose. In larger interventions, for example, when the cartilage in the middle of the nose has to be completely removed and corrected, I place silicone pads with air holes in them.
After the surgery, you will have plastic splints (support) and bands on your nose. Cold application is made over these for the first 24 hours.
On the first evening, there may be pain that can be reduced with a pain reliever and is usually tolerated. After the 2nd day, there is often no serious pain.
It is necessary to keep the blood pressure under control and to work in a controlled manner during the operation in order to reduce the post-operative bruises. Again, when the ice application is done properly, bruises and edema will occur less. Rarely, bruising may occur for more than 1 week. But even in this case, these bruises are not permanent.
Patients spend the first evening in the hospital. They can go home with the drugs given the next day. At the end of the first week, they come for control and their dressings are removed and their stitches are removed. Strips are applied to the nose, which will remain for 1 more week. In this case, it is possible to return to active business life.
In the first month, 60-70% of the swelling disappears and an acceptable appearance is obtained. It will take 1 year for the nose to reach its final shape to a large extent. However, the changes that will occur after the first month are minimal compared to the first month.
