Surgical Procedure – Nose (Rhinoplasty)

Rhinoplasty is the name of nose plastic surgery. For many years this surgery was basically a reduction surgery, the techniques reduced bone and cartilaginous structures in order to create harmony with the patient’s face.
As every branch of medicine evolves, the more we know the anatomy and physiology of a given structure, the more clearly it becomes clear what is right and what was wrong. The nose surgery that used to subtract, now evaluates the patient individually in order to obtain the best result!

The nose suffers the action of forces such as scar tissue (fibrosis), the weight of the skin, the natural weakening of the cartilages, in addition to the air pressure during breathing, these forces act slowly and can change the result of plastic surgery in short and long-term. Because of this, we currently use what we call structured rhinoplasty, bringing a nose with a strengthened structure, with more predictable and lasting results.

The so-called “structured” technique aims to preserve the naturalness of the face, keeping a large part of the bone, cartilaginous and ligamentous structures and also strengthening the existing structures, giving a new nasal contour in order to support the weight of the skin and allow the passage of air flow to the lungs.

Respiratory function is always kept in the foreground and can be improved by correcting deviated septum, turbinate hypertrophy or strengthening valve structures weakened by previous surgeries.

The open pathway allows you to view all structures in order to achieve better symmetry, use the septum to structure the nose and correct deviations, strengthen ligaments in order to achieve more predictable and lasting results.
The closed approach will be used in cases where the aesthetic deformity and the surgeon’s skill allow such an approach and will bring less postoperative edema as a benefit.
Nasal structuring will bring more predictable and consistent results, whether for primary cases or for secondary, tertiary… (second, third corrective surgeries). In this case, the visualization of the structures is fundamental and, only in this way is it possible to sculpt symmetrically, strengthen the nasal skeleton and even improve the respiratory system.
In almost 100% of the surgeries, the nasal septum is approached, being the main source of cartilage to structure the nose, when this is not possible, cartilage from the ears and ribs can be used.

There is an aesthetic balance between the nose and the face, a balance that the surgeon must observe in order to preserve the naturalness and authenticity of that face.

Each case is carefully studied in order to give the nose the best possible shape, within the requirements of the face.

The anesthesia used is a combination of general anesthesia and local anesthesia, this reduces the depth of general anesthesia and the post-operative period is practically painless.

Surgery Duration

Rhinoplasty  usually takes around 120 minutes, which may exceed this time when circumstances so require.

Host Period

The hospital stay will be from 8 to 12 hours, that is, hospital discharge occurs without the need for an overnight stay.

Guidelines Before and After Nose Plastic Surgery (Rhinoplasty)

Days before plastic surgery

In the 3 days before the surgery, try to have a healthy diet, avoid participating in hectic parties, go to bed early and drink plenty of fluids (prefer water). If you experience any symptoms such as fever, sore throat, cough,… notify your doctor immediately. If you have any doubts, try to resolve them with your surgeon as soon as possible.

On the day of plastic surgery

On the day of surgery, plan not to be late in your hospital stay, whether you are at the hospital or clinic 1 hour before the scheduled time for surgery. Don’t forget about the 8-hour fasting period before surgery. Do not take or eat anything without the consent of the surgeon or anesthesiologist during this period.

If you use medication, take them the night before and/or bring them with you during hospitalization.

Do not apply creams on the body, do not use nail polish or foundation on the nails of hands and feet. Bring personal items (brush, folder, slippers,…). Do not bring jewelry. Don’t forget to pack loose clothing with an opening in the front.

Immediate post-operative

You will remain in the recovery room for a few hours and then be taken to the infirmary room. During this period, it is important for the companion to be aware that you can still experience the effects of sedatives and anesthetics applied during surgery. You will have intervals of drowsiness, feel colder than the companion, sometimes shivering, talk and ask about the same subject over and over again, you may feel sick or vomit (rarely).

It is important that the companion does not take hasty actions, always call the nurse if you have any questions or if the patient has any symptoms that she wants to report. Do not change bed position without authorization.

After finishing the surgery, the nose is kept immobilized with a dressing that completely covers it. This dressing remains for about 5-7 days, after which it is removed in the office. It is not normally necessary to use a nose pad!

Aesthetic nose surgery presents little pain after the operation.

For the first 10 days, you should always lie down with your head slightly elevated on the headboard, mimicking the position of the hospital bed. Around 45 degrees.

Getting out of bed

Usually you will remain in bed for a few hours until it is time to get up which will be authorized by the surgeon through the nurses.

When you are going to get up for the first time after surgery, you may feel dizzy, lie down immediately if it is severe. While standing without dizziness, you should walk a few meters down the room or hallway. Before being discharged, the dressing below the nose will be changed if necessary. The surgeon or nurse will give you the prescription and make other recommendations if necessary.

Return Home

The companion must always be beside the patient, if at any time you feel dizzy or faint, the companion had to sit or lay down the patient wherever she is, never hold the patient standing.

Do not lower your head, picking up objects on the floor or similar effort.

Try to wear face towels wrapped around the sides of the head so that it does not turn sideways while sleeping.

Usually you will need to return 1 week later to remove the dressing. During this period, use plenty of cold compress and perform mouth breathing.

Do not tamper with the dressing in any way or try to dislodge it. The dressing, in addition to molding, protects the nose. If necessary, change only the gauze over the lip.

Do not remove crusts, crusts, etc. from inside the nostrils, this will be done by the surgeon during the dressings, avoiding bleeding. Just drop several drops of saline into the nostrils several times a day.

Baths: do not use very hot water and do not wet the dressing for 1 week.

If you get a cold or flu, tell your doctor. Sneezing and coughing strain the nose and can compromise the surgical result.

In the immediate postoperative period there will be swelling. Your regression will start slowly after 4 days, getting a full result within 6 to 12 months.

The bruises also tend to fade slowly after a period of 3 weeks.

You should not forget that, until the desired result is achieved, several evolutionary phases are characteristic of this type of surgery. Thus, edema (swelling), purple “spots”, respiratory difficulty in the first days, are common to all patients, evidently, some have these phenomena with less intensity than others.

There is usually a period of euphoria, as soon as the 1st dressing is removed (7th day). In rare cases, a slight anxiety arises, due to the transitory aspect of the edema and bruises. This is temporary and generally reflects the desire to achieve the final result as soon as possible. Be patient. Remember that no results of plastic surgery on the nose should be evaluated before the 6th month after surgery.