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General Information

The most common plastic surgery performed in men and women in the world is “nose aesthetics” namely rhinoplasty.

The sine qua non of an aesthetic image is to provide the right proportion and symmetry. The facial structure of each patient is different from each other. For this reason, a nose image should be planned for each patient according to his/her own facial structure.

When the aesthetic proportions accepted all over the world are provided in harmony with your face, your new nose will integrate with your face and gain a natural appearance. This is the ultimate goal that I have personally wanted to achieve for nearly 20 years.

After rhinoplasty, the patient’s self-confidence increases and his /her quality of life improves. However, the biggest change is the “illusion of rejuvenation” seen especially in patients with long noses. Patients take on an air of looking at least 10 years younger after surgery.

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Age

In various scientific sources, the earliest period when rhinoplasty can be applied is stated as 18 years of age. Today, we see that this surgery is also applied to young people aged 16-17, on the grounds that their facial development has been completed.

Personally, as a result of my numerous experiences, I do not find this surgery appropriate for women under the age of 18 and men under the age of 20. Because I think that the patient should be old enough to make his/her own decisions for this surgery, which will change the person’s image for life to a great extent. As we all know, the reason for the 20-year age limit in men can be thought of as men mature later than women and take longer to get their feet on the ground.

Points to be Taken into Considerations Before Surgery

While coming to the operation, women should not wear make-up and nail polish, and if any, temporary or permanent nail polishes should be removed.

It is extremely important to provide accurate information to your doctor about the use of substances if any including drugs, cigarettes, alcohol, sedatives etc. used before the operation,. Accurate information is essential to prevent complications that may occur during and after surgery.

Limitation of supplements (supportive foods) taken with food at least seven days before the surgery and discontinuation of drugs other than those taken due to chronic diseases (diabetes, hypertension, etc.) are essential to reduce bleeding during the surgery.

The consumption of the following nutrients should be terminated 7 days before the surgery, as they may cause bleeding.

Fruits: Framboise, blackberry, raspberry, pomegranate, apricot, orange, pineapple, strawberry, cherry, plum, pear, grape

Vegetables: Lettuce, radishes, green peppers, tomatoes, cabbage, parsley, onions, broccoli, legumes

Snacks: Walnuts, almonds, peanuts, cocoa and green tea

Seasonings: Paprika, thyme, rosemary, cumin, anise, sage, soy, flaxseed

Duration of the operation

Nose aesthetic surgery lasts between 2-2.5 hours, even in the most experienced hands. Contrary to popular belief, performing the surgery with closed or open technique is not very effective on this period. The presence of a surgeon who has planned the operation in advance and knows what to do and the assistants who assist him/her well are the most important factors that determine the duration of the operation.

Regardless of the duration of the operation, the time the patient is away from the hospital room for the operation is much longer than this. Because it takes a certain time to prepare the patient for surgery in the operating room, to take videos and pictures of the nose in the operating room, to cover the patient in a sterile way, to connect the heaters to prevent cold during the operation, and to administer local anesthetic drugs. Likewise, we try to be very sensitive about not sending the patient to his room after the surgery before he/she fully regains his/her consciousness. For these reasons, the patient stays away from the patient’s room and their relatives for approximately 4-5 hours, which is the sum of the preoperative preparation, surgery and postoperative recovery time.

Preoperative Design (Simulation)

What is important in preoperative simulation is not how well the surgeon uses the program he/she designed, but the ability to create the shape of the nose designed with simulation in surgery.

Personally, the most important issue for design is to create a nose roof suitable for the person’s facial structure, then to decide together with the patient how curved the nasal ridge or how raised the tip of the nose will be.

The simulation is done in order to understand the expectations of the patient and to give the patient an idea about his/her nose after the surgery. However, I should point out, it is inappropriate to view preoperative simulation as a commitment.

During the simulation we do with the patient, if the patient’s expectations do not match the possible outcome of the surgery, I do not perform the surgery. For example, if the patient wants a very small and sharp nose to be created when he/she has a very large and thick-skinned nose, I explain why this cannot happen. If I think that I cannot convey what I want to the patient or that the patient does not understand what I have said, I do not perform the surgery. The patient-physician rapport should be based on mutual trust. This is the most important stipulation.

Our job in simulation is not to market dreams to our patients, but to prepare them for possible outcomes

Open vs. Closed Technique

It is explained at length in various sources that many factors are important in determining the surgical technique. These factors include whether the patient has had surgery before, the structure of the tip of the nose, the size of the nose, history of trauma, skin thickness, etc.

In fact, there are other factors that are not talked about much. Some of the surgeons received residency training with open surgery and some with closed surgery during their residency. In other words, the technique that the surgeon learned during his assistantship and applied for many years can be open or closed; In addition, many surgeons do not prefer to learn another technique instead of the technique that they have learned all the details of during long years of residency training. At this point, it may be possible to direct the patient to a certain technique applied by the surgeon, and to highlight the negativities of the other technique. Personally, I have spent many years in order to gain the qualifications to perform surgeries with both open and closed techniques according to the needs of the patient.

There is no best technique, there is the most suitable technique for the patient. This technique can be open or closed. A good surgeon is one who feels comfortable using both surgical techniques.

Bone Fragmentation, Cutting, Filing

In nasal aesthetic surgeries, the bony part of the nose must be cut to shape it. Various methods such as saw, chisel, rasp, micromotor, piezo ultrasonic cutter can be used to cut bone.

As a physician who uses all of the mentioned bone shaping methods, my preference is to have all the possibilities available to each patient, without being blindly tied to a single method. Because, during the surgery, the desired result can be achieved by using several techniques in combination instead of one.

Bruising and Swelling

Bone shaping methods used during surgery are the most important cause of postoperative bruising and swelling.

However, a more important point to be emphasized is often overlooked. Because, in one of our two patients, whom we operated on the same day and shaped the nasal bones with the same method, the slightest bruising and swelling was not observed in one case, while the other patient had a purple and edematous facial appearance. The most important reason for different results with the same technique is “skin type”. In some patients, the skin is transparent and thin, like parchment paper, and bruising occurs more frequently in these patients. Some patients’ skin is more prone to bruising. An example of this is the patients whose arms and legs become bruised at the slightest impact. In addition, bruises occur more easily in patients who have lost weight quickly, and those using blood thinners, painkillers, aspirin, etc. Finally, more severe bruising may occur in patients whose height of the “radix” region, known as the nasal root, is lowered during surgery than in other patients.

In our practice, we use various methods to reduce the bruising and swelling of the patient. The most important of these is the application of ice or ice gel for 30 minutes every hour for postoperative 36 hours to reduce the bruising after surgery. We also prescribe various creams to apply under the eyes every two hours. We are planning to use various edema-reducing drugs and nutritional support supplements for patients who we think will develop a large amount of bruising. Most importantly, we ensure that the patient is mobilized 4 hours after the surgery at the latest and gets up and moving. Edema and bruising will be minimal in the mobile patient.

Postoperative Pain and Ache

One of the most frequently asked questions from patients is “Will it hurt after the surgery?”. In particular, we see that men who are known to have a lower pain threshold than women ask this question more often. Due to the strong painkillers we give intravenously in the first 8 hours after the surgery, our patients do not experience a painful postoperative period.

Packings, External Nose Splint (Plaster)

Due to the buzz of nasal surgery performed without packing that has emerged in recent years, I think that the subject of “nasal packing” should be put forward clearly. Nasal packing is not a procedure that has an effect on the result of rhinoplasty; that is, applying packing does not make the result of the surgery better or worse. Nasal packing is used to prevent swelling caused by surgery in the middle part of the nose, and to prevent blood accumulation between the intranasal mucosa and nasal cartilages. In addition, nasal packing is used to prevent intranasal adhesions after surgery in patients we intervene in the nasal concha. Unpadded nose aesthetics may be preferred in some selected patients, but it should be emphasized that it is not suitable for every patient.

Adhesive aluminum or heat-sensitive (thermal) splints placed on the nose after surgery have replaced the old plaster cast. These protective dressings , which are attached to the back of the nose and removed seven days after the operation, contribute to formation of less edema on the back of the nose and to preserve the shape of the nasal dorsum. Seven -10 days after surgery these protective dressings are removed daily and the nasal strips are renewed. New nasal strips are left on the nose for another seven days.

Suture Removal

Depending on the surgical technique (open vs. closed), the sutures placed outside or inside the nose completely dissolve in about 3-4 weeks. No sutures are removed after our surgeries. The sutures dissolve and disappear on their own.

The sutures placed on the middle part of the nose can come out of the nose with blowing after 4-6 weeks. This situation can sometimes be a source of fear and anxiety in patients, but this is an expected and normal situation.

Discharge

The patient can return home 6-8 hours after the operation. The most important point here is that the process of putting ice on the eye, which is applied at home for 30 minutes every hour, is not disrupted. When the patient returns home, he or she will tend to sleep because he/she has come out of the surgery, and the patient’s relative(s) will be quite tired and exhausted due to the stress they have experienced. For this reason, hourly applications of ice can be delayed at home, which negatively affects the recovery period of the patient. As long as maximum attention is paid to this issue, there is no harm in the patient’s discharge on the same day.

Nose Bridge Protective Rhinoplasty (Preservation Rhinoplasty)

It is also known as ” Conservative Rhinoplasty”. It is the translation of the “Preservation Rhinoplasty” technique into Turkish. Preservation rhinoplasty is a surgical method that cannot be applied to every patient and provides comfort and convenience to the patient with a fast recovery time in selected patients. Preservation rhinoplasty is mainly performed with a closed technique. The name of this surgical technique is based on the principle of not cutting (protecting) the important ligaments (Pitanguy and Scroll ligaments) that provide nasal bone-cartilage integrity during the operation. In other words, rhinoplasty is performed both with the closed technique, in a very narrow area with a very limited incision, and by preserving many important nasal structures. This is exactly why preservation rhinoplasty is a very difficult surgical technique and is applied by a limited number of surgeons all over the world.

The most important advantage of the preservation rhinoplasty technique is the rapid recovery of the patient. At the end of the first week, the patient can return to his daily work and enter his social environment. Another advantage of this technique is that since it is performed with a closed technique, other people do not know whether or not you have undergone surgery. There is no palpable irregularity on the nasal dorsum of the patient. Since the nasal tip ligaments are protected, the tip of the nose is mobile and soft, not hard like a stone. The most important disadvantage of the preservation rhinoplasty technique is that there is a very limited number of surgeons who can apply this technique in our country. The fact that I was invited to present my experience with this technique to other colleagues in our country at the Turkish National Otorhinolaryngology and National Facial Plastic Surgery congresses during the preparation of this website can be considered as the importance I have attached to this issue.

Preservation rhinoplasty can also be applied to highly curved, large, impacted, traumatized noses, but this requires extensive knowledge and experience.

Preservation rhinoplasty technique can also be used successfully in revision (corrective) surgeries.

Nose Tip Aesthetics (Tip Plasty)

Interventions made only on the tip of the nose are called “tip plasty”, that is, “nasal tip aesthetics”. With this surgery, all kinds of problems in the tip of the nose (drooping, low, wide, etc.) can be corrected.

Tip plasty surgery takes about 45 minutes. No packings are usually placed into the nose after surgery. After the operation, there is no or only a very small amount of swelling is observed on the face, under the eyes. The patient can be discharged from the hospital at the sixth hour after surgery. On the third day, it is possible to return to normal life.

Revision Rhinoplasty

The demand for aesthetic nose surgery is increasing all over the world and this situation dramatically increases the number of patients who apply for revision. In recent years, unfortunately, in most of our surgical practice, we perform nasal revisions (correction, second surgery) of our patients who have had surgery in other centers.

The patient applying for revision is usually under a great deal of stress. The patient is struggling to cope with many stress sources such as not getting the result he/she expected in the previous surgery, being prepared for a new and more risky surgery, and not being able to guarantee the results of this surgery that he/she will undergo again. As a physician who has been doing revision surgery for many years, I try to be beside my patients as much as possible and do my best.

One of the most important problems in revision surgery is the collapse of the nasal dorsum or nasal tip. In addition, there is usually not enough cartilage left in the nose to make repairs. In this case, it becomes necessary to take a piece of the patient’s auricular cartilage or rib cartilage and use it in surgery. Alternatively, according to the patient’s request, we can prefer to use FDA (American Food and Drug Administration) approved artificial cartilage in many of our patients.

Retraction of the lateral wings of the nose (alar retraction) is an important but frequently overlooked problem that we encounter in patients who apply for revision rhinoplasty. There are hundreds of publications in the world medical literature regarding the correction of alar retraction, but since no final solution has been found, it is still being written on the subject. The surgeon should plan the surgical maneuvers that can cope with alar retraction, and should be equipped to switch to another technique in cases where one surgical technique fails.

Nasal Congestion

Preoperative Nasal Congestion (Septoplasty)

A non-breathing nose is not beautiful under any circumstances. This is my basic rhinoplasty philosophy and it is an issue that I am very sensitive about.

One of the most basic needs for a healthy person is to get enough air to meet his oxygen needs. It is absolutely impossible for someone who has never had a stuffy nose to understand what a stuffy nose is. In all my patients for whom I plan aesthetic rhinoplasty, I first start the operation by correcting the curvatures in the nose, shrinking the nasal concha and creating a healthy air flow. This is the first, and indispensable step of the surgery. After the intranasal relief is achieved, I proceed to the correction of the nose image.

Postoperative Nasal Congestion

After rhinoplasty, patients may experience temporary nasal congestion for various reasons. The most important reason for this is the nasal packing placed in the surgery. The nasal packing stays inside the nose for 2-7 days and during this time the patient can breathe in a limited amount through the channels of the packing. Another temporary cause of postoperative nasal congestion is the separation of the mucosa from the cartilage and bone in the middle part of the nose during the operation. Since this part will be edematous for 4-6 weeks after surgery, it may cause temporary nasal congestion. Sutures that are put into the nose during the operation and dissolve by themselves can also cause temporary nasal congestion by inducing a foreign body effect in the nose for 4-6 weeks.

Patients who already have a diagnosis of allergic rhinitis before nose surgery may need postoperative treatment of rhinitis, triggered by intranasal interventions during surgery. If the nasal structures(concha, turbinate) are also reduced during aesthetic nose surgery, the crusting that occurs during the healing of these structures can cause temporary nasal congestion.

Frequently asked Questions

After radical septoplasty surgeries performed in previous years, the cartilages removed from the nose were delivered to the patients and their relatives in a container. It was better understood in the following years how much damage this procedure made years ago caused to the nose. These noses collapsed over time and revision surgery was required.

In the aesthetic nose surgeries performed in these years, the nasal cartilages were not preserved, but were removed as much as possible with the same logic. This situation has caused drooping of the tip of the nose or collapse of the ridge of the nose called “Saddle Nose” in thousands of patients who have undergone surgery in the past years. Today, drooping of the nose tip has become a very rare problem with new nasal surgery approaches in which nasal cartilages and even ligaments are preserved.

In our practice, we recommend quitting smoking at least seven days before surgery and not smoking for at least two weeks after surgery. In smokers, recovery is delayed after surgery, bruises and edema are more common, and it becomes difficult to maintain the ideal shape of the nose.

We recommend againts wearing glasses for at least three months after rhinoplasty. Although this period is stated as “six months” in classical books, it has gradually shortened with the new nasal ridge protective rhinoplasty techniques used today.

After rhinoplasty, we recommend that the patient get up quickly and become active at home. The patient will need to wait for a period of 5-7 days for the out-of-home walks to begin. It is necessary to wait at least three weeks for the start of sportive physical activities and 3 months for heavy sports.

After about the tenth day after rhinoplasty, you can return to your sexual life.

There is no such thing as the best season for undergoing nose aesthetic surgeries, but there are some points to be considered in surgeries performed in the summer season:

  • Sunlight can adversely affect wound healing in summer. Darkening of the incision line may be observed in patients who underwent rhinoplasty with vascularization on the back of the nose or open technique. For this reason, it is recommended to apply sunscreens with a factor of 50 protection especially produced for use in the face for at least three months after the surgery.
  • Sunglasses should not be used for at least three months after surgery.
  • You should not enter in the sea or the pool for three weeks after the operation

After rhinoplasty, patient check-ups are carried out in the 1st week, 2nd week, 1st month, 3rd month, 6th month and 1st year, postoperatively.

We carry out check-ups of our patients coming from abroad and distant cities at postoperative 1st week, 6th month and 1st year over FaceTime or Skype applications.

Skin thickness is one of the most effective factors on postoperative recovery. In patients with thick skin, it is difficult for the newly formed nasal skeleton to integrate with the skin on it. This situation can be likened to covering a thick veil over the newly created nose shape. The thick cover will hide the fine lines of the structure underneath, causing a rough appearance.

The following points should be considered before and after surgery in patients with thick skin

  • Patients with thick skin may be prescribed skin-thinning medications made from vitamin A derivatives before surgery. It is worth mentioning a very important issue regarding the use of these drugs. The drugs in question should be discontinued before the operation for the duration of their previous use. For example, after three months of use of skin thinning drugs, it is appropriate to spend at least a three-month drug-free period and to plan rhinoplasty after this drug-free period..
  • In patients with thick skin, the massage, which is normally applied for three weeks after the surgery, will be continued with a stronger intensity and for a much longer time.
  • Since the postoperative swelling and edema in patients with thick skin have a much greater negative effect on the outcome of the surgery, it may be necessary to use anti-edematous drugs and additional supportive treatments.