Plastic Surgery | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao

Nose

Plastic Surgery - Nose - Open rhinoplasty

Open rhinoplasty

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The alteration of the shape of the nose is one of the aesthetic factors that cause the most psychological disorders. Its onset is delayed and tends to coincide with the start of adolescence, time at which the acceptance of an aesthetic problem can be more difficult to assume. A rhinoplasty is a surgical intervention aimed at the correction of nasal deformities through the modification of its shape, which brings with it an improvement in facial balance and harmony. It is one of the most commonly performed operations for the plastic surgeon.

On other occasions, the alteration of the shape of the nose may be as a result of an impact or trauma, in the sense of aesthetic or functional sequelae. Each rhinoplasty is a different case and must be carefully evaluated. It is not simply a case of reducing or increasing the size of the nose, but of adapting it to the different factions and characteristics of each individual person. With this type of cosmetic surgery, dialogue with the patient is particularly important in order to compare the patient’s wishes and expectations with the possibilities of improvement offered by the intervention. As well as being a key element in facial aesthetics, the nose is a respiratory organ of great importance. The surgeon must bear both concepts in mind at all times, the functional and the aesthetic, and we consider them to be inseparable elements.

THE BEST CANDIDATE

Ideal candidates for undergoing a rhinoplasty are those who seek an improvement, and not absolute perfection, in their appearance. If you are in general good health, are psychologically stable and realistic in your expectations, you will be a good candidate. A rhinoplasty will improve appearance and self-confidence, but will not make us look like someone else, or make people treat us differently. Prior to deciding whether to undergo a rhinoplasty, think about what you want to achieve and tell us about it.

PRE-OPERATIVE RECOMMENDATIONS

As happens in all interventions, the initial medical examination is indispensable for the detection of any possible anomaly which may contraindicate the operation and will be performed by a full top level medical team, led by a Specialist in Internal Medicine, who will undertake a quick and complete medical check-up, with the most avant-garde medical techniques. The skin of the nose must be free of any inflammation or infection and, obviously, you must take care against contracting colds or influenza which may cause symptoms of nasal congestion.

ANAESTHESIA

A rhinoplasty can be performed under local anaesthetic and sedation or, as is more common, under general anaesthetic, depending on the complexity of the surgery and the preferences of the surgeon. If performed with local anaesthetic and sedation, the patient feels relaxed and the nose and surrounding areas are desensitized from pain; with general anaesthetic the patient remains asleep during the operation.

SURGICAL PROCEDURE

A rhinoplasty is always performed in an operating theatre, in a clinic or hospital. Normally, an overnight stay is required after the surgery, being discharged the next day. A rhinoplasty tends to last between 1 and 2 hours, although in complex cases it can take longer. An Open Rhinoplasty is performed by cutting the membranes on the tip and the top of the nose so that the surgeon can directly access the structures of the nose. This type of intervention leaves a small scar at the base of the columella. A rhinoplasty is not always reductive surgery. There are patients who need to increase the size of their nose to provide greater emphasis to the tip, to raise the sunken top of a nose or to correct deformities of either congenital or traumatic origin. In these cases, the surgeon tends to resort to grafts with tissue from the patient him or herself to provide shape or support to the nose.

HOSPITALIZATION

The patient tends to be admitted on the morning of the operation. Discharge is usually within 12-24 hours.

AFTER CARE

After the surgery and above all during the first 24 hours, your face may feel swollen, with discomfort around the nose, together with a headache, which will cease with the medication prescribed. You must remain supine with your head raised during the first day (except when going to the bathroom) and for 3 or 4 days afterwards you must sleep with your head slightly raised. You will notice that the swelling and the haematomas around the eyes will increase for up to a maximum of 2 or 3 days. Applying cold compresses will reduce swelling and help you to feel better. In any event, you will feel better than you may think from your appearance. Most of the bruising and the swelling will disappear within some 2 weeks (minimum swelling, practically only perceptible by your surgeon, may last for some months). It is normal for there to be slight bleeding from the nose during the first few days. You must not blow your nose forcefully for approximately one week, while the tissues heal. If you have plugs in your nose, these will be removed within 2-3 days, after which you will feel much better. After one week, or at the most two, the plaster will be removed, together with small stitches in the skin, if you have any.

The majority of patients undergoing a rhinoplasty feel well after 2 days, and able to return to work or school within approximately one week. However, some activities should not be undertaken until a few weeks have passed. We will provide you with specific instructions, some recommendations are: avoid strenuous activities (jogging, swimming, press-ups…) for 4 weeks, avoid blows to the nose and sunbathing for 8 weeks, wash your face and apply make-up with care. You can use contact lenses again as soon as you want, but if you wear glasses you must take certain precautions. If you experience any discomfort between appointments or any questions about what you should or shouldn’t do, don’t hesitate to contact us.

RESULTS

The results of these operations are generally very gratifying. The patient quickly forgets their previous image and experiences sometimes surprising changes. They can even change character, displaying a satisfaction which clearly manifests the significant psychological impact to the individual of alterations in the shape of the nose.

FREQUENTLY ASKED QUESTIONS

What is the optimal age for undergoing a rhinoplasty?
When the ossification process has been completed in the bones of the face, normally between the age of 15 and 16. However, it is always better to wait until patients come of age prior to making any decisions about operations, in cases of primary rhinoplasty. In secondary cases (accidents, interventions,…) it is advisable to act as soon as possible.

Will it hurt?
No. Generally, analgesics are not required.

What risks are involved with the operation?
The possibility of complications in this type of intervention is very rare. There may be an infection or bleeding beyond the normal, an anomalous reaction to anaesthesia or little veins may appear on the skin of the nose which are generally transitory (very rare complications, but which may appear in any surgical intervention). Although it should not be listed as a complication, you should know that some 5% of patients require minor subsequent retouching. This is impossible to predict in practically all cases.

Can the patient breathe through the nose?
The first three days you will have small plugs inserted into your nose which will oblige you to breathe through your mouth. Once the plugs have been removed you can then breathe through your mouth although with certain difficulty to begin with, as small internal scabs may form and there will be a certain degree of inevitable post-surgical swelling. After a few days and with the recommended treatment, the problem will progressively be resolved.

When can the definitive result be seen?
Following the removal of the plaster after ten days, the nose will have its correct shape and be good enough for normal everyday life. But the definitive result in relation to details will require longer, generally six months to one year.

Is sunbathing permissible?
Sunshine is harmful to scars, although in this case there will only be a small one at the base of the nose if the access channel has been opened up. Therefore there is no specific contraindication apart from the fact that the heat it produces, during the first two months and due to bruising, is not recommended. However, for 8 weeks we would recommend you do not sunbathe with sun directly on your nose without any protection (SPF 50 cream/gel/lotion)

Is it possible to wear glasses?
Although not visible, the bruising caused by the operation persists for a long time. This can be noted when using glasses as they leave a deep indentation on the point of support on the nose. There is no contraindication, but there is a recommendation to not wear glasses continuously during the first two months following the intervention. They can be worn if removed now and then, allowing sufficient time for the indentation to disappear.

When can I practice sports normally?
From every perspective it is advisable to refrain from physical exercise during the first 4 weeks, principally in relation to strenuous activities (jogging, swimming, press-ups,...) as they can increase post-surgical swelling.