Procedure of Rhinoplasty
Rhinoplasty reshapes the nose by reducing or increasing the size, removing a hump, changing the shape of the tip or bridge, narrowing the span of the nostrils, or changing the angle between the nose and upper lip. This procedure may also relieve some breathing difficulties when combined with surgery performed on the nasal septum.
Surgery takes approximately two hours or more. It is generally done under general anaesthesia.
It can be an outpatient or inpatient procedure.
POSSIBLE SIDE EFFECTS
Temporary swelling, bruising around the eyes and/or nose, and some bleeding and nasal stuffiness.
Infection, asymmetry, unsatisfactory nasal shape and incomplete improvient (which would require additional surgery) are possible.
The patient may go back to work after one week. Activities that are more strenuous may be resumed after two to three weeks. The patient should avoid any activity that could impact on the nose or allow it to become sunburned for at least eight weeks. The use of a sunblock that provides both UVA and UVB protection is useful. The final results may take one year and sometimes longer to achieve.
A dorsal hump consists of a mix of bone and cartilage. When patients view their facial profile, the dorsal hump begins at the top part of their nose near the eyes, and ends before the nasal tip. The majority of patients with a dorsal hump desire a flatter, smoother nasal bridge. There are multiple causes of dorsal humps – genetics, impact or previous injury. The majority of dorsal humps are inherited, which is why it is important to wait until the nose is fully developed before considering a dorsal hump reduction.
DAY ONE – BEFORE AND AFTER
INCREASING TIP PROJECTION
Tip projection is the distance that it juts outwards from where it associates the upper lip to its tip. Acquiring, improving, and maintaining nasal tip relationship and angle with the rest of the nose, face, chin and lips is one of the fundamental factors not only for having a beautiful and proportionate long lasting nose but also helps in defining race and gender. On the off chance that the tip distends unreasonably, it can influence the general appearance of the nose fundamentally.
INCREASING TIP PROJECTION – BEFORE AND AFTER
Augmenting the Dorsum
The dorsum of the nose is where the hump is. Occasionally it can be too flat, such as in Asian noses or after a previous rhinoplasty or just simple where the nose starts is too low. The dorsum can be temporarily augmented with fillers but often would need cartilage harvested either from the septum, ear concha or ribs for permanent augmentation. Sometimes Dorsal augmentation is done to camouflage an irregularity; usually as a consequence of trauma or previous rhinoplasty; that otherwise cannot be smoothened out.
Augmenting the dorsum – BEFORE AND AFTER
Scar after Open Rhinoplasty
Scarring is inconceivable and insignificant. The outside scar from a rhinoplasty normally is placed at the thinnest part of columella; which is the piece of the nose that isolates the nostrils; and its closed with exceptional precision. It usually heals very well and after completely healed it can hardly be seen even under magnification.
Scar after open rhinoplasty – BEFORE AND AFTER
Day one after Rhinoplasty
During the initial 24 hours, try to relax and allow your body to rest and heal. This is typically when the most swelling and bruising will happen. Applying a cold compress consistently (5 minutes every hour) can assist with making you more comfortable and substantially reduce bruising and swelling. Dr. Shahram may apply tapes under the eyes and on the forehead to further minimize the spread of swelling. After a piezo-assisted rhinoplasty usually, there is no bruising, and swelling is also minimal.
Day one after rhinoplasty – BEFORE AND AFTER
Day 7 after rhinoplasty
About 50% of patients will have no or very minimal facial swelling by end of 7 days post-operation; around 40% have just negligible swelling; and around 10% have moderate swelling. The amount of swelling depends on the work done as well as the distinct individual – certain individuals just simply bruise and swell easier. By this time if some bruising had occurred, only yellow traces remain under the eyes which typically completely resolve within the following week. 1 week after the operation typically during the first follow-up, the sutures will be removed, and the cast and tapes also removed. The nose will be cleaned and new tapes applied.
Day 7 after rhinoplasty – BEFORE AND AFTER
Crooked nose is a nose that is not straight. This deviation from the midline might be bony or cartilage or both however it always has a septal component to it which acts as a pillar of the nose and therefore has to be corrected. Crookedness can be congenital, due to trauma or previous septoplasty or rhinoplasty. Correction of a crooked nose is a big challenge in rhinoplasty and although full correction might not be possible due to tissue memory or other facial asymmetries, satisfactory improvement usually can be achieved.
Crooked nose – BEFORE AND AFTER
The septum is a wall inside the nose that separates the right and left airways. It consists of bone and cartilage. It’s extremely important in both the shape and function of the nose. Almost no septum is completely straight and its deviation, as long as it does not cause any functional or structural problem, there is no need for its correction. It usually happens when the growth of the septum continues after the nose has been completely over with its growth. The vast majority with a deviated septum have one nasal entry that is a lot more modest than the other. This can cause difficulty breathing. Septoplasty is a surgery to address a strayed or a deviated septum, where it causes breathing difficulties or crookedness or asymmetry of the nose and/or nostrils.
Septoplasty – BEFORE AND AFTER
Reduction of width of the nose
The width of the nose may be bony, cartilaginous, base, or all. The aim to reduce the width of the nose is to give a more refined and proportionate look from the front. Sometimes bones need to be shaved with the piezo machine or cut and placed closer to the midline, cartilage as well can be reduced. Sometimes the alar, which are the wings of the nostrils, need to be cut, reduced, or even sometimes the base of nostrils approximated with special sutures. Correct placement of alar reduction incisions and minimizing suturing reduces the visibility of scars after alar reductions.
Reduction of width of nose – BEFORE AND AFTER
Rhinoplasty in males needs a different aesthetic approach as its important that although the shape and size have to be corrected it should maintain the male features and by no means feminize the face of the individual. It also has its own challenges as the skin of the males is usually substantially thicker then the females and the underlying structures should be placed in a way to sustain this weight and show the definitions which are aimed to be shown. It can likewise address breathing problems and fix the impacts of injury, like a damaged nose – frequently called a ‘fighter’s nose’.
Male rhinoplasty – BEFORE AND AFTER
Revision rhinoplasty is another challenging chapter in rhinoplasty and it certainly needs experience. Often tissue is lacking and skin is scarred and more rigid. It often requires cartilage for structural support. When septal cartilage has been severed in past operations or has been removed, inevitably cartilage has to be taken from other parts of the body, namely the ribs. Ear cartilage is not useful for structural reconstruction and only may be used for augmentation or camouflage. The rib cartilage is taken from 4-5cm incision under the breast folds and it heals very well and does not cause any functional or aesthetic impairments. Occasionally dried or hydrated radiated cartilage can be bought and used.
Revision rhinoplasty – BEFORE AND AFTER
Ethnic rhinoplasty is a type of cosmetic surgery that aims to create a more balanced and refined look that supplements the patient’s face but also respects their ethnic identity. A nose should not stand outside of a face and should mend beautifully with other facial features in a way that no suspicion of an operated nose can be observed or suspected.
Ethnic rhinoplasty – BEFORE AND AFTER
Lowering the Radix
Radix of the nose is where the nose starts from the forehead. When a large hump is removed, the radix disappears and the result is that the nose is starting from a much higher point on the face like on the old Greek statues called “The Greek Nose”. With help of piezo, Dr. Shahram can recreate a natural and pleasant radix both in primary and revision cases. The radix cannot be addressed as well and delicate by any other technique.
Lowering the radix – BEFORE AND AFTER
Scar after rib cartilage harvest
In some cases, especially in revision rhinoplasty, there is not enough structural cartilage that can be used from inside the nose (septum) and therefore for the reconstruction of the structures of the nose, a piece of the rib cartilage may need to be harvested, typically through a 4 – 5 cm incision under the right breast. The remaining scar is inconspicuous and heals well in women is placed under the breast fold and therefore not visible in a standing position. The recovery from such an added procedure is quick and apart from some tenderness while changing position during the first days, there is no sharp pain involved. Dr. Shahram will numb the area before you wake up from recovery so you will not feel it at all when you wake up from the procedure which is done at the same setting as your rhinoplasty. Ear cartilage is weak and curved and cannot be used for structural support and is mainly reserved to be used as camouflage or augmentation grafts.
Scar after rib cartilage harvest – BEFORE AND AFTER