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Rhinoplasty

Rhinoplasty

Is There a Nose Shape Ideal for Everyone

“The Golden or Divine Ratio”

There is no standard description for an ideal nose shape, that will fit everybody. Beauty standards and preferences for nose shape can vary significantly among individuals and cultures. In South America, some patients may undergo rhinoplasty to augment their nasal bridges, unlike most North American and European patients, who wish to have smaller and more straight noses. In Asia, rhinoplasty primarily aims to eliminate the depressed nasal shape and make it larger. 

However, there is one universal rule that is valid for all beautiful faces: the nose should be in proportion with the other parts of the face such as the chin and forehead, moreover, it should have good proportions within itself, as in the proportion of nose projection to its length. And if you ask a question like ‘What kind of a proportion is required?’, the answer is in Da Vinci’s Golden Ratio.

The Golden Ratio, often denoted by the Greek letter & (phi), is an irrational number approximately equal to 1.618. It has been celebrated for its aesthetic appeal and pleasing proportions. It is found in various natural objects and organisms, in the human body (even in the DNA helix), and in the best pieces of architecture and artworks, as well. In Mona Lisa, da Vinci’s masterpiece, it is often suggested that he incorporated the Golden Ratio into the composition, and the term has begun to be attributed to him.

Based upon the Golden Ratio, it might be speculated that Asian women want to augment their noses because it is too small in comparison to their facial width and squared shape, and vice versa for Caucasian women.

When it comes to aesthetic rhinoplasty, there may not be a uniform definition of a beautiful nose, however, there is one thing that everyone uniformly agrees upon, and that is an ‘operated look’ is not acceptable. There are some commonly appreciated characteristics that are often associated with an aesthetically pleasing nose shape for women and they all contribute to an un-operated look:

Operated look:

Unqualified surgery may lead to over-correction or under-correction in the problematic areas of the nose and the result will fall into a new category: not just funny, but ‘operated’ as well. Therefore a natural result in the range of normality is crucial in every case.

During your rhinoplasty consultation, Dr. Demirkan will consider your specific facial structure, discuss your desired outcome, and work with you to create a personalized surgical plan that aims to achieve your aesthetic goals while maintaining a natural appearance.

The Power of Rhinoplasty

“What can You Change in Your Nose with a Rhinoplasty?”

Rhinoplasty has become a very powerful and detailed procedure when compared to what it was 15 years ago. There is a wide array of surgical techniques available now, which can alter many unfavorable features of a nose with natural and durable results. The following is a list of some problems for which patients commonly seek rhinoplasty:

Nasal Deformities that Can be Corrected with Rhinoplasty:

  • Bulbous Tip
  • Asymmetric Tip
  • Upturned Nose
  • Droopy Nose
  • Crooked Nose
  • Deviated Septum
  • Broken Nose
  • Low Bridge
  • High Bridge
  • Dorsal Hump
  • Narrow Nose
  • Wide Nose
  • Wide or Flaring Nostrils
  • Hanging Columella
  • Nostril Collapse (nasal valve problems)

During your initial consultation, Dr. Demirkan will first ask you what do you not like about your nose, then he will add his suggestions regarding your specific facial proportions. Next, he will work with you on your simulation, to understand what you desire, and if it fits your face and physical properties. There may be features that cannot be changed, but yet affects the outcome, such as the thickness of your skin. 

As a surgeon with tremendous experience in rhinoplasty, Dr. Demirkan will understand all of your concerns, will tell you about any drawbacks present, and will establish a realistic surgical plan that aims to achieve your aesthetic goals while maintaining a natural appearance.

Variables Affecting the Outcome in Rhinoplasty

Things Beyond Our Control

There are a few features in your nose that may not be altered with the current surgical techniques. Having knowledge about these features is important in setting your goals and understanding what will be the possible outcome:

Skin Type

Skin type plays a crucial role in determining the overall aesthetic result of the procedure and can impact various aspects, including scarring, healing, and the ability to achieve desired nasal shape and definition.
  • Thin skin tends to reveal more details of the underlying nasal structure, therefore may require more meticulous surgical techniques to achieve a precise smoothness in bone and cartilage shaping. Otherwise, there may be visible irregularities on the dorsum or the tip of the nose.
  • Thick skin can obscure some of the refined changes made during surgery making it difficult to achieve a fine nasal definition, particularly in the tip region. Moreover, thick skin cannot contract easily and quickly to accommodate the new smaller nasal skeleton yielding a longer-lasting edematous look than normal.

Age

Age affects skin elasticity as well. Patients with good skin elasticity tend to have more favorable outcomes, as their skin can conform to the underlying structures and heal well. In contrast, individuals with poor skin elasticity, such as those with aging or sun-damaged skin, may experience challenges in achieving optimal reshaping and may have a higher risk of postoperative deformities.

Scarring Tendencies

Some individuals are more prone to developing hypertrophic or keloid scars, which are raised and thickened scars that can occur after surgery. While rhinoplasty incisions are typically small and well-hidden, individuals with a predisposition to scarring may experience more noticeable scars.

A Crooked Nose from Childhood:

The cause of a crooked nose may be a traumatic fracture of the nose or constitutional deviation related to overgrown septal cartilage. A septoplasty is performed to correct septal deviations. The chances of having a straight septum after a septoplasty are much higher if it is related to a traumatic fracture that occurred during adult life. Otherwise, any septal deviation originating from childhood problems is much more complex and may be more difficult to correct, totally, or they may have a higher incidence of recurrence after the surgery.

The reason is the growth dynamics of the nose, in which nasal growth follows septal cartilage proliferation. If the septum has deviated in childhood, the developing nose would have a deviated and asymmetric growth in all parts, internally and externally, which may be very difficult to correct.

Facial Asymmetries:

Facial asymmetries outside of the nose can impact the overall appearance of the face, including how the nose is perceived. For example, a significant jaw asymmetry or uneven cheekbones can make the nose appear asymmetrical or more asymmetric than it really is. In such cases, Dr. Demirkan may recommend additional procedures in conjunction with rhinoplasty to address these adjacent asymmetries and create a more balanced facial appearance.

Ethnicity:

Different ethnicities exhibit variations in nasal anatomy, including nasal width, height, projection, tip shape, and nostril shape. For instance, individuals of African, Asian, Middle Eastern, or Hispanic descent often have thicker skin, wider nasal bases, and less prominent nasal bridges compared to individuals of European descent. These anatomical differences need to be carefully considered during rhinoplasty to achieve natural-looking results that respect the patient’s ethnic features.

A large nose with thick skin should never be reduced too much.

Ethnic rhinoplasty often requires specialized surgical techniques that differ from traditional rhinoplasty approaches such as cartilage grafting, tip refinement, alar base reduction, or augmentation to address specific ethnic nasal characteristics.

What are the Types of Rhinoplasty

Which one is Good for Me?

Rhinoplasty is the oldest type of aesthetic surgery, with a centuries-old history of continuous change and evolution in the surgical techniques used.

The current concept in rhinoplasty involves individualization of design, maximum preservation of the anatomic structures and nasal function, prioritization of tip reshaping, and reinforcement of the supporting structures. The technique with which your surgeon chooses to achieve these goals is of secondary importance. Because there may be more than one good way to achieve the same result.

You may find many types of rhinoplasty procedures while searching the internet and this might create confusion about their meaning and value, and sometimes lead comparisons of apples and oranges. Here is a quick guideline for the rhinoplasty types and the jargon:

Based on the Incision Site:

Open vs closed rhinoplasty

Open Rhinoplasty

It involves creating a small incision across the columella, the strip of tissue between the nostrils, in addition to internal incisions within the nose. This creates a small access point, allowing the surgeon to lift and visualize the nasal structures more extensively. 

Open rhinoplasty allows for a wider range of surgical techniques and adjustments, making it suitable for a variety of nasal concerns and complexities. It provides the surgeon with a detailed view of the nasal anatomy, facilitating precise modifications and adjustments when compared to closed rhinoplasty.

Closed Rhinoplasty

It, so known as endonasal rhinoplasty, is performed using incisions made entirely within the nasal passages. No external incisions are made on the outside of the nose. Due to the preservation of the vessels in the columella, it offers a potentially faster recovery compared to open rhinoplasty, particularly in the tip region.

Based on the Surgical Philosophy

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Structural Rhinoplasty

In structural rhinoplasty, the emphasis is on addressing structural issues, such as excising the nasal hump and recreating a new nasal dorsum, correcting a deviated septum, refining the nasal bones, or strengthening weak or deficient cartilage. The goal is to create a more stable and balanced nasal framework. Therefore it often involves using cartilage grafts, taken from the patient’s own septum, ear, or rib, to reinforce or reshape the nasal structures.

Preservation Rhinoplasty

It aims to preserve and maintain the existing nasal structures as much as possible, rather than making extensive modifications or grafting. For instance, a bulging nasal hump is not excised but taken down by removing an equal part of the underlying septum, the aim is to preserve the natural dorsal shape. A deviated septum may not be tried to be corrected thoroughly but it is made look straight, externally.

Based on the Area Focus:

tip rhinoplasty drawing

Tip Rhinoplasty

It is a specific type of rhinoplasty procedure that focuses on altering and enhancing the appearance of the nasal tip. It aims to achieve a more refined, balanced, and aesthetically pleasing tip shape without any interference with the nasal bones, dorsum, hump, or septum.

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Septoplasty

It is a surgical procedure that aims to correct a deviated septum, which can cause various nasal issues, including breathing difficulties, congestion, recurrent sinus infections, and nasal blockage. The deviated portion of the septum is then straightened, reshaped, or removed to create better alignment and improve nasal airflow. It does not involve any shape-changing procedure in the external nose, maybe except in the columella region.

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Septorhinoplasty

In cases in which the septal deviation is reflected externally as a deviation in the axis of the nose, then a rhinoplasty has to be added to correct the deviated nasal bones and asymmetric nasal soft tissues.

Based on the Number of Previous Surgeries

Primary Rhinoplasty

It refers to the first-time nasal reshaping surgery performed on a patient who has not undergone any previous nose surgeries.

Secondary Rhinoplasty

Also known as revision rhinoplasty, it is a corrective procedure performed after a previous rhinoplasty surgery. It is conducted to address unsatisfactory outcomes, complications, functional issues, or aesthetic concerns that may have persisted or developed following the initial surgery. Revision rhinoplasty can be more complex than primary rhinoplasty because it involves working with altered nasal anatomy and scar tissue from the previous surgery and frequently requires cartilage grafting from different sources.

Tertiary Rhinoplasty

This refers to a subsequent corrective surgery performed after a previous revision rhinoplasty. It is typically conducted in cases where further modifications or corrections are required due to persistent or recurring issues following previous surgeries. It is much more complex and may have limited success.

Non-Surgical Rhinoplasty

Non-Surgical rhinoplasty
hyaluronic acid formula

Non-surgical rhinoplasty, also known as liquid rhinoplasty, is a procedure in which the shape of the nose is altered without the need for surgery. Instead of making incisions, injectable fillers are used to modify the nasal contours and achieve the desired aesthetic outcome. It is a quick and minimally invasive procedure that typically takes less than 30 minutes to perform. However, it is useful only in a small group of selected patients with suitable nasal anatomy to:

  • Correct small bumps or irregularities on the bridge of the nose.
  • Enhance the projection of the nasal tip.
  • Give a lifted appearance to a drooping nasal tip.
  • Reduce a prominent nasal bridge.
 
It should be noted that a filler injection does always add volume to your nose, and a successful result is always an illusion rather than a real change. Non-surgical rhinoplasty does not correct the functional problems in the nose. Hyaluronic acid fillers will eventually disappear and may cause allergic events. The nose is one of the danger zones in the face where inadvertent intra-arterial filler injections may occur creating serious complications. 

Male Rhinoplasty

It needs a Different Approach

Male rhinoplasty can differ from female rhinoplasty in terms of facial evaluation and planning to protect the masculine look.

For men, a more masculine appearance is typically sought, which may be obtained by:

  • Maintaining a straighter nasal bridge without a prominent supra “tip break-point“
  • A higher-located nasofrontal angle (the deepest part of the transition between the forehead and nose) between the brows
  • A stronger nasal profile by preserving a slightly wider nasal bridge and ensuring adequate nasal width
  • Less projected or refined nasal tip
  • Chin and/or mandibular angle augmentation with implants if necessary 

Female rhinoplasty, on the other hand, often aims for a softer and more feminine nose, with a slightly curved or sloped nasal bridge and a more delicate, defined nasal tip.

There is no standard nasal shape when it comes to men and the operation may be planned just to elevate a drooping tip while maintaining the nasal hump, or just to make the nose a bit smaller without changing the shape at all.

If a smaller nose is desired then this should be balanced with other stronger anatomical features and facial proportions of the male gender, such as prominent cheek and jaw bones, low-set eyebrows, and a prominent chin (like the man on the left side in the upper photo). In a face that does not have these strong features (like the man on the right side), a smaller, finely defined nose may cause feminization.

While there are some key differences in the desired outcomes, the overall principles and surgical techniques of rhinoplasty apply to both men and women.

Simulation in Rhinoplasty

Is What You See What You Get?

Simulation plays a valuable role in rhinoplasty by providing a preoperative visualization of potential surgical outcomes and aiding in surgical planning. Dr. Demirkan would like to communicate with you visually over your computer-generated simulation, to help you better understand what can be achieved through rhinoplasty. This will also enable you to express what you really want and understand what should you expect.

before rhinoplasty
after rhinoplasty
simulation before rhinoplasty
simulation after rhinoplasty

A simulation should never be seen as a guaranteed post-operative result. It is a visual draft over which both the physician and the patient can discuss an operative plan. However, a well-done simulation may have an 85 to 90 % resemblance to the real late postoperative result. Interestingly, the immediate intra-operative result is also a good indicator of the late outcome. In open rhinoplasty, the immediate result will be lost temporarily due to swelling in the tip region.

The simulation also allows Dr. Demirkan to evaluate the proposed changes in the context of your overall facial harmony. By visualizing the virtual nose alongside other facial features, he can assess the balance and proportionality of the anticipated result with your cheekbone, upper lip, and chin, and discuss the necessity of additional corrections in these areas if necessary.

Simulation is valuable in assisting the surgeon in planning the surgical approach and techniques required to achieve the desired results, as well.

Rhinoplasty and Breathing Problems

A Remedy or a Cause?

Rhinoplasty is an aesthetic procedure aiming to improve the nasal shape. However, the nose has an important role in breathing, and conditions deteriorating the breathing function such as septum deviation, allergic polyps, or sinusitis are not rare in people searching for an aesthetic improvement.

Performing aesthetic surgery without paying attention to these functional problems may deteriorate your breathing capacity. Therefore, a thorough evaluation of nasal obstruction history and symptoms should be done before any aesthetic rhinoplasty procedures.

Dr. Demirkan will take a detailed history of your breathing problems during your initial consultation. He may order additional tests or ask for a consultation from his ear-nose-throat surgeon partner, if necessary.

After finding out the exact cause(s) of your nasal breathing problems, Dr.Demirkan will create an individual treatment plan for you that includes solutions for both your aesthetic and functional issues. According to the reason(s) of your nasal obstruction, this plan may include a one-session surgical treatment, a surgical treatment that is preceded by a medical treatment or a surgical procedure followed by a medical treatment.

Some examples of the treatment plans in cases with breathing problems is as follows:

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If you have only a septum deviation, Dr. Demirkan will perform a septoplasty during your aesthetic rhinoplasty.

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If you have an internal or external valve insufficiency, Dr. Demirkan will treat it with cartilage grafts during your rhinoplasty.

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If you have a concha bullosa, which means that one or more of your nasal turbinates have a bony cystic malformation from your birth, an ENT surgeon will perform a turbinate reduction in the same session with Dr. Demirkan, during your rhinoplasty.

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If you have a sinusitis problem, an ENT surgeon will join your rhinoplasty and perform an endoscopic sinus surgery. If you have allergic rhinitis with polyps, which means that it is really advanced, then you will need medical treatment for about 6 weeks prior to your rhinoplasty. You need to continue the anti-allergic treatment after the surgery as well unless you identify and remove the allergen(s) totally from your life.

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If you have mild allergic rhinitis you may have your rhinoplasty and continue with the anti-allergic medication after the surgery.

Rhinoplasty with Chin Augmentation or Reduction

A Fantastic Combination!

Chin augmentation or reduction can be performed in conjunction with rhinoplasty to achieve facial balance and harmony. There is a close relationship between our perception of facial beauty and the chin-nose proportion. A nose that is too prominent or too recessed can change how the chin appears. For instance, a large or protruding nose may make a moderately projecting chin appear smaller, while a small nose might make a weak chin seem even weaker.

Exemplifying Dr. Demirkan's skill in rhinoplasty, this photo displays the elegant and natural-looking nasal reshaping for enhanced facial harmony. Choose Rhinoplasty by Dr Demirkan

In a similar fashion, a weak or receding chin can make the nose appear more prominent and throw off the overall facial harmony. Therefore Dr.Demirkan will always check your facial proportions and offer you a concomitant chin surgery, when necessary. It may be best to analyze the possible outcome in a facial simulation.

A simple aesthetic rule to understand whether your chin is in balance with your nose is to look at the relative position of the nasal tip to your lips and chin. If you draw an oblique line in front of your face such as this, it should be the tip of your which touches this line first, next should be your upper lip, then your lower lip, and finally the tip of your chin. If your chin is way back in this alignment you may need an augmentation with an implant. If the chin is touching this line together with the tip of your nose, then most likely it has to be taken back.

Chin Augmentation

The treatment for a weak chin is an augmentation genioplasty. Most of it is performed by insertion of a bone-like synthetic implant to the tip of the chin through a small incision under the lower teeth. There are different sizes and shapes of these implants for men and women. Another way of correcting a recessed chin is to inject hyaluronic acid fillers. However, the correction done by this method has a limited effect as the protrusive force exerted by fillers cannot be as strong as a solid implant. If overdone, the chin may look funny due to the flexibility of the filler augmented part.

Chin Reduction

A prominent chin deformity may be treated by a setback genioplasty, in which the tip of the bony chin is cut horizontally and set backward, and fixed with a plate. Smaller problems may be solved by bone shaving by piezo devices.

When there is a weak or protruding chin, which is going to be treated by surgery, it is important to rule out any associated dental occlusion problems. If the closure of the upper and lower teeth is disturbed as well, then the treatment plan may change completely.

Piezo and Microsaw Use in Rhinoplasty

Techno Rhino

Piezo devices have revolutionized the field of rhinoplasty by offering precise and controlled bone sculpting during the procedure. These devices utilize ultrasonic vibrations to cut through bone while minimizing trauma to surrounding tissues. This creates a huge difference when compared to the chisel-hammer bone fracturing of old times.

The impact of piezo devices in rhinoplasty results can be significant:

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Enhanced Precision in bone cutting and shaping leading to better results with fewer complications.

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Minimal trauma to the surrounding tissues during osteotomy (bone cutting) as this energy is selectively targeted to the bone.

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Less edema and bruising after the surgery due to decreased fracture trauma.

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Increased the ability of surgeons to perform extra moves that were not possible before the piezo era, such as multiple bone cuts, bone narrowing, and polishing.

The impact of piezo devices ultimately depends on the surgeon’s skill and expertise, as well as their ability to combine this technology with other surgical techniques to achieve optimal results. Dr. Demirkan uses this technology successfully in all of his cases since 2016.

Microsaw devices, also known as oscillating saws, reciprocating saws, or micro-motor devices are another technological advancement used in rhinoplasty procedures. These instruments employ high-frequency oscillations to perform precise bone cutting. Their benefits are similar to those of piezo devices. However, their precision is a bit less than the piezo devices and are not selective for bone, and may cause more collateral tissue trauma.

Microsaw devices were available earlier than the piezo devices in rhinoplasty. Dr. Demirkan used them intensively between 2010 and 2016 but now prefers piezo.

Preparation for Rhinoplasty

A Few Tips

Preparing for a rhinoplasty operation involves several important steps to ensure a smooth and successful procedure. Here are some general guidelines:

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Consultation with your Plastic Surgeon: You may arrange a live online consultation with Dr. Demirkan from this website. But before that, we advise you to send in your full medical history, your goals and concerns about the surgery, breathing problems if there are any, and facial photos (see guidelines for rhinoplasty photos). Dr. Demirkan will prepare a simulation before your consultation to provide you with a visual clue for the expected result while answering all your questions.

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According to the results of this initial consultation, Dr. Demirkan may ask for some tests or radiologic examinations. He may also suggest you an ear-nose-throat surgeon consultation depending on the extent of your breathing problems. 
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When you decide about the surgery date, then you should quit smoking at least 15 days prior to this date, as smoking can increase the risk of complications and impair the healing process.

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You need to quit certain medications and supplements before the surgery, as they may interfere with the blood clotting mechanisms in either direction. Oral contraceptives, blood thinning medications such as aspirin, its derivatives, coumadin, heparin, and its derivatives should be stopped 1-2 weeks prior to your surgery. Supplements such as Vit E, DHA, and ginseng should also be quitted before the operation date.
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You may need to use certain anti-allergic sprays or medications before the surgery if indicated by your surgeon.

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If you are using glasses, they are not allowed for the first 6 weeks after a rhinoplasty due to the weight they exert on the fractured nasal bones. Therefore, it would be better to replace them with contact lenses, temporarily. 

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It is suggested that you should arrive in Istanbul, 1 or 2 days prior to your surgery, to acclimatize.

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When you arrive in Istanbul, there some blood tests will be performed at the hospital and an anesthesiology consultation will be performed. And Dr.Demirkan will see you once more in his office, where you will finalize your treatment plans. An ENT consultation may also be arranged if the ENT surgeon will also participate in your operation for breathing problems.

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You need to stay at least for 6 more nights in Istanbul, after the surgery, You will stay at the hospital for 1 night after the surgery. 
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You may not need a companion for this surgery, however, the presence of a friend or a family member will be quite supportive when you are undergoing surgery, in a foreign country. 

Postoperative Period

A Quite Individual Period

The postoperative period following rhinoplasty is a crucial time for healing and achieving the desired result. Compliance with the medications prescribed, nasal cleaning, keeping the nasal cast or plaster safe, tuning your daily activities to your recovery pace, sun protection, precise application of the post-operative massages (if given), and protecting your nose from trauma, all have significant effects on the final result.

The reaction to the operation is quite variable in each and every patient, depending on individual body responses. However, it should be noted that with the introduction of piezo devices, the collateral tissue damage is much lower during osteotomies (nasal bone fracturing), which is reflected in less edema and bruises in the postoperative period. The use of drainage in the osteotomy sites, silicone nasal stents with airways, and effective cooling devices following surgery have also contributed to decreased edema and bruising.

Here is an overview of what patients can generally expect during this period:

Immediate and Early Recovery Period:

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Right after the surgery, you will be taken to a recovery area where you will be monitored until the anesthesia wears off. You may experience some grogginess and discomfort during this time. It may be difficult to breathe from your nose due to internal packing or splints in your nostrils. They may create a pressure sensation as well.

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Your nose will be bandaged or have a cast. The internal splints will usually be removed on the 3rd postoperative day. The nasal cast will be replaced with a new one or removed on the 7th postoperative day.

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It is common to experience swelling, bruising, and nasal congestion in the first few days following the surgery. The best precaution to control swelling is the frequent application of cold packs to the nose and eyes. Arnica and bromelain tablets may also be useful for decreasing edema. To help reduce swelling, it is recommended to keep your head elevated while resting or sleeping and avoid activities that can increase blood flow to the face, such as strenuous exercise and straining.

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Pain and discomfort levels can vary among individuals, but it is common to experience some degree of discomfort usually due to the pressure of the internal nasal packing, and decreased ability for nasal breathing, especially in the first few days. Dr. Demirkan prescribes effective pain medication to relieve the pain related to surgery, and a prophylactic antibiotic.

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It is important to strictly follow the prescribed medication regimen, taking the medications as directed by your surgeon.

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Following the removal of your nasal packing, Dr. Demirkan will show you how to clean your nose and may prescribe nasal saline sprays to keep the nasal passages moisturized and promote healing.

Late Recovery Period:

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In this later recovery phase, you will experience a gradual reduction in nasal edema, however, it usually takes at least 2 or 3 months to reach the optimal phase. During that period Dr. Demirkan may ask you to do a nasal massage, if necessary. Please note that, if you have a thicker skin, your swellings will take more time to resolve.      

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As there are controlled bone fractures during a standard rhinoplasty, your nose will not be structurally stable until after 6 weeks after the surgery. So, you have to protect it from any kind of trauma, should not use glasses, and should not sleep on your side or prone, during these 6 weeks period.

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Your nose may be numb for about 6 months after the surgery. It is normal, however, numbness may increase your chances of accidental nasal trauma.

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During the first 6 weeks after the surgery, activities that involve bending over, lifting heavy objects, or strenuous exercise should be avoided for a certain period, as they can increase swelling and affect healing.

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You should be using effective sunscreens from the post-operative day 1 to the end of 6 weeks recovery period, to prevent any post-inflammatory hyperpigmentation. This happens particularly in darker skin and in individuals who are exposed to the sun right after the surgery, and it usually settles under the eyes.

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The final shape of your nose will become to be visible at about the third month, following the resolution of the edema, however, changes in the nose shape continue till the end of the first postoperative year, at a much slower pace. Therefore, Dr. Demirkan advices you to wait until the end of the first year to see the final result.

Possible Complications in Rhinoplasty

This is quite Individual, as well

Rhinoplasty is generally considered a safe procedure with a low risk of complications. However, as with any surgical procedure, there are potential risks and complications that can occur. It’s important to note that the occurrence percentages can vary depending on various factors, including the complexity of the surgery, the surgeon’s expertise, the number of revisions, and individual patient characteristics which are explained in the section of Variables in Rhinoplasty

The informed consent form about the rhinoplasty procedure is available at the Rhinoplasty Surgery Informed Consent link. It is a list of all possible complications, however, it does not mean that each one of them will occur in your case with an equal probability. We will send you this consent form when you are looking for the surgery and ask you to read it and return it to us if you do not understand any part. 

When you arrive in Istanbul, Dr. Demirkan will tell you which one(s) of this complication may be more likely in your case, following your physical examination. If your nasal anatomy and function are quite suitable for rhinoplasty, none of them may be likely to happen, as well. He will also explain to you the variables affecting your surgery, in order to set your expectation at a realistic level.

However, if you have an external nasal deviation that is coming from your childhood, have thick nasal skin, or if this is not your first rhinoplasty, you have more postoperative complication risk.

FAQ

Frequently Asked Questions in Rhinoplasty

Is rhinoplasty a painful procedure?

Rhinoplasty is not a really painful operation although a bone procedure is involved, the pain can be effectively managed by a range of painkillers. The main discomfort related to rhinoplasty usually arises from nasal packing, as it causes some pressure and obstruction to breathing. Following the removal of nasal splints, on the third postoperative day, most of the discomfort ends.

Do I need a nasal packing in my rhinoplasty?

Nasal packing is necessary when a septoplasty is performed or the septum is explored for some other reason (such as to harvest cartilage grafts). By compressing the septum from both sides, nasal packing prevents blood accumulation around the septum, which may endanger septal cartilage, if happens. Instead of packing, a series of tacking sutures over the septum may be used as well, for the same purpose. However, with the introduction of silicone nasal splints with airway tubes, most surgeons prefer to use these splints because they are much more comfortable for the patient when compared to other packing materials, and are quite easy to insert and remove.

How long will the external splint stay after rhinoplasty?

It usually stays for three days. Rarely a 5-day splinting will be necessary when conchal surgery is performed.

How do I know if I need septoplasty?

If you see an external deviation in your nose or notice a deviation or an asymmetry in the columella (the area of the nose in between the nostrils), you will need a septoplasty. Even when none of these are present, there may still be a deeper septal deviation in your nose which will require a septoplasty. Usually, any type of septal deviation is associated with some nasal obstruction. During your physical examination, Dr. Demirkan will explain to you if you need a septoplasty or not.

What can I do to decrease swelling and bruising after rhinoplasty?

To decrease nasal and facial edema following rhinoplasty, cold application to the face is very important. This may be performed continuously with cold application devices that can control the temperature, or periodically with cold packs. The swelling will start right after the surgery and may increase till the end of the third postoperative day. Therefore cold application should last at least four days. The use of non-steroid anti-inflammatory drugs, arnica, and bromelain tablets will also help in controlling the edema.

When can I get the result after rhinoplasty?

It takes at least three months to see the initial results of rhinoplasty. This is related to the long healing period in nasal surgery. The time required for the shrinkage of the nasal skin and the resolution of the edema, particularly at the tip region, are the two main factors for this long recovery time. However, remodeling continues at least to till the end of the first operative year with some cartilage resorption and skin contracture, so it is best to wait until after 1 year to evaluate the result as permanent.

Is the result I get in my rhinoplasty stable?

Rhinoplasty results are quite stable after the first year if performed meticulously with time-tested techniques. During the first year, edema, skin contraction, and cartilage graft resorption may create some changes. A relapse of septum deviation, if occurs, usually happens during the first year.

Why is revision rhinoplasty more difficult to perform than primary rhinoplasty?

Revision rhinoplasty is always more difficult than primary rhinoplasty because the prior surgery will alter the nasal anatomy, create scar tissue and fibrosis making surgical dissection very difficult, diminish available grafting material, and weaken or alter the nasal support. Revision rhinoplasty patients often have heightened expectations and concerns due to their previous surgical experience. So the surgeon has to understand the concerns and set realistic goals for the patient. The complexity of revision rhinoplasty requires the expertise of an experienced and skilled rhinoplasty specialist.

Is there an age limit for rhinoplasty? What is the best age?

Rhinoplasty may be performed at the end of age 16, in females, and 17, in males. This is determined by the age of termination of the growth period in the nose. There is no high age limit to perform rhinoplasty, however, skin elasticity will be less than optimal after the age of 40 years. The change in the facial identity will also be less welcome by the patient’s social environment after this age, as well.

Is open or closed rhinoplasty better for me?

It is possible to obtain the same results with either open or closed rhinoplasty when performed by a master surgeon of the given technique. Therefore it may be better to check the surgeon’s results and not bother about the surgical techniques, which are too complicated to comprehend and compare by an ordinary patient.

Will my breathing problems diminish after the rhinoplasty?

The extent of amelioration in your breathing problems with a rhinoplasty depends on its cause or causes. If the only problem is the septal deviation it will be resolved completely with a septorhinoplasty. If you have associated conchal and sinus problems, there may be more variable results, depending on your bony anatomy and allergic status.

Do I need grafts in my Rhinoplasty?

If this is your first rhinoplasty operation, usually you do not need any cartilage grafts from an external source such as your ears or ribs. Because any graft requirement may be supplied from your septal cartilage which is the best and most compatible type of cartilage to be used in rhinoplasty.

What is the difference between ear and rib cartilage for a secondary rhinoplasty?

Ear cartilage is much softer and has an inherent rounder shape when compared to rib cartilage. So, they are more preferred as tip grafts or for more subtle dorsal augmentations. The amount that can be harvested is limited and the consistency is too soft for providing any structural support.

On the other hand, costal cartilage grafts are harder and longer grafts that are preferred for nasal tip support, major dorsal augmentations, and nasal reconstructions after major nasal damage. However, they have a tendency to revert to their original curvature which may create external deviations after the surgery. Therefore the way a rib cartilage is prepared for grafting is very important and oblique cuts are now preferred (Eren Taştan technique) to minimize this risk.