“When the nose is beautiful it goes unnoticed, but when it is ugly it becomes the person”
Rhinoplasty is one of the most complicated aesthetic surgeries and, for this reason, it requires that the person carrying it out has extensive knowledge and training. Not only in the functional part but also in the aesthetics.
When a patient wants to undergo a rhinoplasty, the patient wants to obtain a natural appearance of its nose, that the tip is not too high, that the nasal wings are not too narrow, and that not too much has been resected from the back of the nose. In summary, all patients want to avoid that their “nose looks operated on”.
With this surgery, we as otolaryngologists can provide you with the change you have always longed for, and with the use of artistic surgical techniques we are able to correct everything that does not look good aesthetically. In this way we achieve harmony between function and beauty.
Closed rhinoplasty: This is the one that is performed through incisions only in the interior of the nose. It is the most commonly performed.
Open rhinoplasty: This is the one during which an incision is made in the columella and the skin is lifted to have greater exposure of the tissues. We perform it usually in cases of secondary rhinoplasty (that is, they have already been operated) or in some cases complexed cases.
Functional rhinoplasty: In this nose surgery we only correct what causes the patient not being able to breathe properly.
Aesthetic and functional rhinoplasty: Whenever we perform a nose surgery we always approach the functional part first and then proceed to make the aesthetic changes. It is very important to mention that the nose must go according to the facial characteristics so that there is harmony in the features. The goal is to make the rhinoplasty look as natural as possible and that the person does not look like their nose was operated on.
During the first appointment with the otorhinolaryngologist it is very important that you as a patient are honest with the doctor and indicate the correct respiratory symptoms and characteristics of your nose that you want to change.
Either way, the otorhinolaryngologist will perform an endoscopy to assess the state of the nasal septum, turbinates, and mucosa. As a complementary study of the examination, the doctor will request a tomography to assess the paranasal sinuses. Afterwards, based on their physiognomy and in order to give the greatest harmony to their face, the doctor will discuss which changes are possible to make and which ones are not.
In the case of functional rhinoplasty the age is not a limit; we can perform surgery with the goal to correct the respiratory problem and to avoid further problems in the future development of the face on young children with nasal obstructions. In the case of aesthetic surgery, it is better for the patient to be over 15 years old.
What is the preoperative check-up like?
During this appointment the patient already brings the results of the blood tests that were previously requested, the computed tomography of the nose and paranasal sinuses, and some other preoperative assessment that the doctor may have requested.
The doctor will take a series of photographs that will help you plan the operation well in the preoperative period and try to form a concept as real and as appropriate as possible for the final result. The result can vary due to individual factors like the anatomical and physical response of the patient and, sometimes, the final appearance of the nose.
The preliminary analysis includes the approach the patient has and his / her preference of symptoms, appearance, size, symmetry, etc. of his / her nose, and especially his / her psychological situation with regards to an organic problem.
On the other hand, the objective analysis defines the type of patient wanting to undergo rhinoplasty. There are many techniques to use in rhinoplasty but not all can be used on all patients. There are several factors to consider such as: race, age, height, skin quality, healing, nasal respiratory conditions and, of course, the anatomy of the nose itself.
In addition to explaining what is going to be done exactly during the surgery, the doctor will give you the recommendations about what you can and can not do in the postoperative period in writing. The patient will also be told what it can and can not expect during recovery: what can be considered normal and what will be an emergency. FInally, you will be given the prescription for the medications you will take during the convalescence period, and most importantly you will be given a consent form, which is a written document in which the possible complications of the surgery you are going to have will be explained. The patient must read the consent form, understand, and sign it.
On the day of surgery you must arrive two hours before the procedure, fully fasted, with comfortable clothes, preferably button-down shirt, comfortable pants, shoes that do not need to be tied up, and a coat for the moment you will be released.
The procedure has a variable duration that ranges from 2 to 3 hours. It is performed under general anesthesia. A patient will be in recovery for about two hours and then will be discharged the same day.
There is no internal nasal packing but rather internal silicone splints that have a channel that allows the patient to breathe and keep all the structures in place. You may have a bandage and an external nasal splint. The patient will leave with a little gasket above the upper lips to collect the blood that will be coming out the first two days.
Once the patient is discharged and arrives at home, the patient will be able to eat soft food. It is recommended to place a lot of ice or cold compresses on the cheekbones and eyes to help reduce inflammation.
What can the patient expect during recovery?
- Toothache on the upper part of your teeth
- Increased tearing
- Mouth dryness
- Mild nosebleed during the first two days
Since it is a very relative rest, the patient does not have to be in complete rest. There are even patients who decide to work from home. Sleeping position will be on the back or on the side. Face down can be dangerous and is not allowed. A patient can return to daily exercise after 2 or 3 weeks after the surgery.
As mentioned before, the patient does not have any type of nasal packing but silicone splints are placed to allow him / her to breathe and at the same time allow us as doctors to keep the nasal structures in place. These splints can be left between 4 and 7 days, depending on the surgery that has been performed on the patient. At the first post-surgical appointment we will remove the splints and usually after the removal of the splints we see the patient 1 or 2 times per week depending on the requirements.
After the first month, follow-up appointments are the third month, sixth month, ninth month, and a year after the surgery. Yes, it takes 12 months for the nose to reduce inflammation and show all the aesthetic changes the patient so much wants to see. During all these appointments we will take photographs to show the patient the progress.
Complications of the surgery could be: Bleeding, infection (which we try to avoid by giving antibiotics after surgery), asymmetry between one side compared to the other side of the nose.
It is important that the patient knows that if a corrective retouch is necessary, he / she will not be charged any medical fee, but there might be a fee for the use of clinic or hospital. It is not recommended to get corrective adjustments in the first six months after the surgery.
Before talking about costs, there are many variables that come into play, and it is better to list them so that it is perhaps easier to understand them. The cost of a surgery will depend on the following:
- Degree of difficulty of surgery. For example, there are patients who do not require large changes in their nose and others that require a complete transformation.
- Some patients whose needs are only functional (bone correction to ease breathing) and others that require functional but also aesthetic changes.
- Duration of surgery. Some surgeries can last approximately 2 hours and another 3 hours or more.
- Costs of Medical Team. We must also take into account the fees for the full medical team that is involved, like the main surgeon, the assistant- surgeon and the anesthesiologist. We can say that the fees for the medical team start from $ 3,000 dollars.
- Costs of Clinic / Hospital Facilities. The clinic or hospital expenses involve the supplies used in the operating room, the time the patient is in the operating room, as well as the operating room staff, and these costs must all be taken into consideration as well.
As you can see, as there is no standard surgery for all patients; there is no standard price. Each patient in particular requires a prior price-assessment, during which we can calculate the price.
- Is the surgery painful?
Normally patients do not complain of pain after their surgery. Usually a single painkiller is enough to cope with post-operative pains.
- Is it true that it takes a lot of time to recover?
It takes between 10 days to two weeks after surgery to resume normal daily activities, but to be able to see the final aesthetic changes; it takes between 9 months and a year.
- What’s the difference between Open and Closed Rhinoplasty?
It is the same surgery but the way to enter the nose is different. During the Closed Rhinoplasty all the incisions are internal, and during the Open Rhinoplasty the incision is made in the columella or skin portion that separates the nostrils externally at its base.
- Does it concern an outpatient surgery?
Yes, the patient will arrive at the same day of the surgery and will leave after a short-recovery period after surgery, on the same day.
- Can surgeries be performed on kids?
Children can only receive surgery to correct breathing. Aesthetic rhinoplasty is only allowed on patients older than 14 years.
- What are the benefits of an ENT Surgeon / otorhinolaryngologist to operate my nose?
The ENT Surgeon knows all the structures of the nose, both the internal ones that allow us to correct mainly respiratory problems and the external structures that we modify the nasal aesthetics. The ENT surgeon knows the nose as a whole and is therefore the ideal doctor to perform a rhinoplasty.
- Do I need a specific study before surgery?
In order to make sure you are fit for a surgery, we will undoubtedly require blood tests to know about a patient’s current condition. In many occasions we request a Computed Axial Tomography of the nose and paranasal sinuses.