Displaying items by tag: nose job
One of the most frequently asked questions in recent 15 years is which one of the open or close methods for nose surgery is preferred and which one brings about better results? These methods are actually 2 different approaches to the operation site otherwise they are not really technics.
In Open nose surgery, an incision is made in the collumella or the middle pike and by making another incision in the internal edge of the wings, the skin is lifted up and the surgeon gains access to the posterior sections and tip of the nose. Then, the surgeon separates the superior lateral cartilage sub-mucosally from the middle septum as follows and carries on with the operation.
In a Closed method of nose surgery, there are incisions made on the inside of the nose in between the cartilages. Through these much incisions, the surgeon gains access to the posterior sections as well as the tip of the nose without making any external incisions. In this method, the view to the tip of the nose is less comparing to the open method so in cases where the tip needs more manipulation, the open method is mostly the chosen course of action.
Usually, the open method is preferred to the closed method in solving the issue and flaws of the tip. Generally, there is no certain preference of the open method to the closed method but in case of reparative nose surgeries, nasal tumors that require operation, meaty and bulky noses, severely large nose tips and noses that are deformed due cleft palates and hare-lips, the open method is mainly preferred.
Surgeons apply the open or the closed method depending on their experience and using either of the methods solely depends on the surgeon’s opinion. In Dr.Kazemi’s clinic the surgeries are mainly done using the open method. Some patients ask if the scare remains in the open method after the operation. Fortunately, with proper caring and healing of the wound, there shall be no scars to worry about after the operation.
The open method is also preferred in operating severely bent and deviated noses since it provides a better view and access for the surgeon to operate with both hands. The closed method is preferably used with bony noses and those which require less manipulation. Dr.Kazemi E.N.T and cosmetic surgeon of the nose, is thoroughly proficient on both technics and has operated many patients using either of these methods but he himself prefers the open method and according to his experience surgeries that are performed under the open method have yielded better results. Anyways, both open and closed approaches are perfectly safe and carry brilliant results.
At present, the open nose surgery or Rhinoplasty is the method of choice. Every nose surgery usually involves the following stages:
- Lifting of the skin, skeletonizing the nose and separating the septum from the adjacent cartilages sub-mucosally.
- Removal/excision of the bony or cartilaginous hump.
- Correction of the septum.
- Correction of the nose tip including reinforcement of the tip, lifting, removal, stitching or other measures.
- If needed, grafting in required areas such as the tip.
- Proper restoration of the necessary areas, including the roof of the nose, with nylon strings.
- Breaking of the bones and reassembling them back in order to reshape the roof of the nose.
- Correction of the wings if necessary.
- Placement of mesh work or silicone tampons inside the nose as well as tapes and splints and proper stitching of the skin and all the required external areas.
Initially or at the first stage, we have the separation of cartilages from the septum which has to be performed sub-mucosally so that it doesn’t cause adhesion or obstruction of airways. Through all these stages, the least manipulation hands out the best results. The following are some of the most common questions from the users of Dr.Kazemi’s web-site along with the answers.
What is the suitable age for having a nose job?
There is no particular age for this operation but the nose must have reached to its complete growth so it not advised to have this operation under the 17 for boys and 16 for girls. On the other hand, it is not recommended in people above the age of 60 due to the loosening of skin and loss of its elastic properties.
Is the surgery performed according to the doctor’s diagnosis?
In cases where the nose is suffering from severe fracture or deviation, the nose job along with the operation to correct the deviation is necessary. However in most cases it is the patient who asks for the operation for aesthetic purposes and the surgeon only considers the possibilities and contra-indications so as for this operation and generally cosmetic surgeries, the patient’s request is most important.
What is the role of Laser in nose surgery?
Laser plays a vital role in many surgeries but it doesn’t have a significant role in nose surgery and the presentation of this issue is solely for advertising. Laser might be effective in treatment or surgeries of the polyps but there is no particular role for Laser in nose surgeries and Lasic nose jobs are not really approved.
What are the necessary things to do before a nose job?
The patient is definitely required to take blood cells count test, coagulation test, blood sugar test and urine test. It is necessary that smoking is stopped a week before the operation and for a month after it too. Patients should stop taking aspirins 2 weeks before the operation and inform his/her doctor in case of any blisters or catching cold. They should also inform their surgeon if they are allergic to soya beans, eggs or any drugs.
Is it possible to have the operation during menstruation?
Menstruation cannot be a certain contra-indication for the surgery but relatively, since it increases the chances of bleeding during the operation it is better not to have the operation during this period but after all the decision is up to the surgeon.
Is nose surgery painful?
No.The operation itself is not painful at all but there is swelling afterwards so the patient doesn’t have to worry about the pain. E.N.T surgeons prevent a painful operation by using their special technics and performing a high standard operation.
How do we reduce the swelling after the operation?
Regular application of ice-compress in the first five days is very important. Dr.Kazemi who is well known E.N.T surgeon, considers the Intra-Muscular injection of Betamethazone L.A helpful in the second day after the operation.
It is recommended that the splints are removed 10 days after the operation to reduce the swelling to minimum. The head of the patient’s bed should definitely be at a 30 to 45 degree angle. Local injection of Corton as prescribed by the surgeon could be very helpful.
Patients must visit the surgeon once a week for proper taping and to avoid any problems. Careful and proper taping after the operation equals to the reduction of swelling.
Is the bleeding in the white part of the eye dangerous?
There is a slight bleeding in the white part of the eye which is not at all dangerous or worrying and will disappear within a month.
What are the necessary post-operative cares?
The most important post-operative care is the application of ice-pack compress on the nose and around it for the first 4 to 5 days after the operation. Keeping the head in a higher position by means of 2 pillows during rest is another important point which has to be maintained. Other important cares are punctual intake of the antibiotics and cold tablets every 6 hours, avoiding severe physical activity and wearing glasses for 4 weeks. You can also refer to post-operative care section for all the necessary instructions.
Is the operated nose weaker than a natural nose?
Such a statement is absolutely false and wrong. An operated nose is completely same as a natural nose after a year and is not weak at all.
What are the chances of success and satisfaction in a nose surgery?
More than 95% of the nose surgeries reach to the desired and expected results without any problems.
What is the role of taping and how long should it be continued?
Application of tapes after the operation causes the skin to adhere to the underlying bone and cartilage and stabilizes the skin in the desired area and continuing it for a month or 2 after the operation would be sufficient. Some colleagues advise a one month nightly taping period after this. Post-operative taping
How long after a Rhinoplasty or nose surgery can we have a Lasek or Lasic surgery?
The Rhinoplasty operation is allowed almost one month after an ophthalmic Lasic or Lasek surgery since the cornea takes a stable position and doesn’t have any negative influence on the eye.
When should the repairing or retouching take place if required?
The swellings will completely subside after a year so reparative or retouching procedures are allowed after this period. Performing any reparative nose surgeries earlier than a year would carry some adverse effects.
And the most important question is that which surgeon do we refer to?
For nose surgeries only E.N.T surgeons, due to their predominance on the nose anatomy and sinuses, are preferred. Since other surgeons like plastic surgeons or general surgeons and maxillo-facial surgeons do not have level of proficiency on the anatomy or the surgeries of the nose, there might be breathing problems occurring after their surgeries.
Bony noses are those which have prominent bridge that make the nose have curvy and hump-backed appearance. Many people go to the surgeon for their hump-backed nose bridge. This prominence varies in different people and the size is not the same in everyone so the method for the surgery is also different which is based on the size of the deformation/prominence. The properties and characteristics of the nose are also different in women than men so this has to be considered as well.
The nose surgery includes planning, preparation and recovery stages.
Determining the best time for the operation requires the following considerations:
- Reaching physical maturity:
The surgery should be performed after the complete growth of the nose and not before it. Note the might have reached its complete growth but growth of the components still continues.
- Reaching psychological maturity:
Some people make rushed out decisions and regret them immediately. Such individual should decide to go for the operation after reaching to a certain degree of self-confidence and independence in opinion.
Reasons for the formation of a bony nose:
People who have humpbacked nose suffer in beauty issues as much as those who have meaty noses. The humpbacked nose problem is mainly due to genetic and hereditary issues and also the excess growth of the nasal bone and cartilage. Trauma and severe impact in young ages may also cause the excess growth of the nasal bone and lead to its humpbacked appearance. The prominence of the nose in bony noses may lead to derangement of the face symmetry which is more noticeable in a side view. This prominence can also reduce the harmony of facial components and be the reason for cartilaginous surgeries.
Meaty or bulky noses are those struggling with skin issues and bony noses are called to those which have more of a bony or cartilaginous problem
There are several methods for rectifying the flaws in such type of noses. A recent technic flattens the surface of the nose bridge by injecting certain materials. This is a suitable way to get the desired nose for those who are afraid to undergo an operation.
The traditional/conventional methods could also be used to treat such prominences and other flaws as well. This operation is carried out under general anesthesia and the patient will be sent home in a few days and can use analgesics and sedatives for a week.
Chances for the recurrence of the bony nose after the operatio:
The recurrence of the humpbacked nose is quite rare and its risks could be reduced to minimum taking the necessary precautions and care. The surgeon can predict the possible outcomes of the operation by simulating it in specialized software and patients can see the symmetry of the new nose on their faces.
One should not forget that every operation has complications and adverse effects. In nose surgeries, these adverse effects are classified into 2 categories:
1. Breathing problems
2. Appearance issues
Reducing the size of nostrils may lead to breathing problems and force that person to breathe through their mouth. Reduce the sense of smell, dryness of throat during sleep and noisy breathing could also be among these adverse effects. The obstruction of nasal breathing could be due to follows:
- The obstruction is not corrected during the surgery:
If there is any degree of septum deviation it has to be corrected before the surgery because the nose is going to become even smaller after the operation and this deviation, however small and insignificant, can cause problems which have to be rectified during the surgery.
- Inflammation of the internal nasal mucosa:
This could be due to allergies or sinusitis which may result in obstruction of nostrils.
Over-manipulation during the surgery could injure the internal mucosa and if this injuries or wounds are in a close proximity, they could adhere or stick to each other during the healing process and cause obstruction.
- Tightness of the nostrils.
- Excessive removal of the nasal cartilage.
In recent years, followed by a sharp rise in demand for nose surgery, the number of male applicants for surgery has increased, so special attention is paid to men’s rhinoplasty. There are subtle differences between the Nose Surgery in men and women; in men much removal of the back area of the nose and thus creating a hump towards inside must be avoided, rather the back of the nose or dorsum must be flat. The facade of flat nose dorsum is more beautiful in men.
The angle between cullomella and lip in men is preferred to be about 90 to 100 degrees; this is in contrast to women for whom more upward nose has the priority. In most men, the skin is too thick and it makes the disinflation period longer than women, and in many men the need for frequent injections of triamcinolone is to reduce inflammation.
Keeping breathe according to excessive physical activity of men is very essential.
Because of more nose fractures and frequent nose blows in men there is more chance of crooked nose in them.
Thus emphasizing on more accurate and frequent osteotomy causes moving nose bone and the flatness of nose. Today, for rhinoplasty many patients ask for fantastic and doll nose like nose, I emphasize that in men it can lead to deformity of the nose and the fantastic nose should be avoided as much as possible in men.
Another point that should be examined in men is the emotional and personal issues of the patients who are requesting rhinoplasty. Personality disorders in men applicants is greater than women, therefore sometimes it is good to consult a psychiatrist before doing cosmetic surgery. I must emphasize that men who are seeking Nose Cosmetic Surgery or rhinoplasty should be careful about issues such as obsession and depression and if any of these issues exist they should avoid surgery.
In summary, rhinoplasty in men requires special attention and in terms of technique and psychology it needs more subtlety as compared to women.
Rhinoplasty is the most difficult plastic surgery. Since the structure of the nose is very complex and three-dimensional and the final result of rhinoplasty depends on the collection and relieve of scars after rhinoplasty, for these reasons, the primary rhinoplasty in some patients can lead to less ideal results.
On the other hand, due to increased awareness of patients through the Internet, it is very difficult for rhinoplasty surgeon to satisfy patient. Not surprisingly, eight to fifteen percent of patients with primary rhinoplasty surgery undergo second surgery. Since after the initial rhinoplasty, nose anatomical structures are disoriented due to fibrosis, secondary rhinoplasty or reconstructive nose surgery is more challenging. In many cases, the surgeon is forced to change the technique completely and perform a complete reconstruction of the nose. Taking pictures before and after surgery is necessary.
Problems caused by rhinoplasty are divided into several groups:
One group comes from a poor removal or insufficient modifications, such as in patients with a bulbous tip or Poly Beak deformity (Photo One)
In some patients, the removal is excessive such as patients with dents in nose alae (wings of nose) (Photo two and three). Sometimes minor asymmetries or displacement of existing structures and graft in the right position is caused by small technical errors. When there is excessive removal from the nose and if the patient's skin has improper quality, because of replacing the area with soft subcutaneous tissue and fibrosis a challenge is made for the surgeon.
The final category of surgical problems results from incorrect judgment of the surgeon. In these cases, an inexperienced surgeon gets out of conservative mode and for example, excessive removal of soft tissue and subcutaneous which is caused by an error of surgeon’s judgment and leas to deformity is sometimes impossible to repair.
In general, reconstructive rhinoplasty (secondary rhinoplasty) is one of the most difficult plastic surgery and the patient should not think that the second operation is easier than first one but it is much more difficult and requires a complete reconstruction.
What is the rhinoplasty of fleshy nose and how is it done? Does fleshy nose return to the state before operation?
First we should define the fleshy nose. Noses with thick skin and plenty of sebaceous glands and open holes in the skin are called fleshy nose. In this type of nose usually cartilage is weak and major part of the nose consists of skin and fat under it and sebaceous glands. In this nose type usually the tip of the nose is down and the alae (wing of nose) are open and thick. Because of the male sex hormone and oily skin in men, these types of noses are commonly seen in men.
In the past, for correcting this type of nose and for rhinoplasty they excessively removed parts of cartilage. The result of this operation is dents and scarring of the skin due to the empty space beneath it. Usually patients think that skin removal is helpful but it seems that skin removal can cause severe scars, so it is not advised. In doctor Kazemi’s experiences, strengthening cartilage and using middle blade cartilage or septum for strengthening nose tip, and generally cartilage tissue has best effect. Cullomella strut is a piece of septal cartilage that surgeon makes it in the form of spiky and it is placed under the tip of nose and hereby it is trying to raise the tip of the nose and strengthen it.
One of the helpful things in the rhinoplasty of alar base fleshy nose is the exact removal of alae in order to make the alae small. The best method for rhinoplasty of patients with thick skin is open surgery; in close surgery because nose tip is not seen very well and access to the nasal tip is limited, the result of rhinoplasty for fleshy nose is not so good. Patients with thick skin should have a reasonable expectation towards the surgery, and they should know that their nose never will be like the nose of patients who have proper skin.
Do fleshy noses return to the state before the operation?
One question that is frequently asked from doctor Kazemi is that does in rhinoplasty of the fleshy nose the nose return to the state before the operation or not? I should answer that in case of getting the perfect result, after six months no major change will happen on the nose and it will remain in the same form.
To give an example about this we can say that it is like a soccer ball, when soccer ball deflates, because of the thickness of the leather around it, the complete depletion and wrinkle takes a long time. The same thing happens in the fleshy nose because the skin is thick, the reduction of the size of the nose takes a long time, therefore patients must wait at least a year to obtain the final result, but usually after six months the result is stable and does not return to the pervious state.
How to Tape the Nose after Rhinoplasty?
1 - First you should go to the bathroom and wash the tape with water; you should be careful not to remove the tape while taking bath, wash the area with plenty of water and let the tape become completely wet. Then while the water comes over the face you should carefully remove the tape, while removing the tape you should prevent injury and subcutaneous bleeding.
2 - Then carefully dry the place. Sometimes due to the presence of adhesive tape the skin becomes oily, we can put some alcohol on it and let it dry, so the oil of skin is removed and pimples are reduced.
3 – Prepare German Micropore Surgical Tapes and then cut it carefully to two and a half cm dimensions, also provide four cutting length of 15 cm, now you can proceed to your taping.
4 - First start taping from the top of nose, when you are taping the back of nose, you should carefully tape in a way that the adhesive tape covers the next fifty percent of the previous tape, and you should tape two layers of adhesive tape from the top to the tip of the nose, according to provided order.
5 - Now it’s the time for taping the nose tip, tape 15 cm of adhesive tape to both sides of nose in a way that the nose could completely be gathered at its tip and be sure to make the tip of nose upward. Twice in two slightly different places do the same thing and then with 15 cm of an adhesive tape bring the tip of the nose upward, now the only remaining task is to tidy up adhesives and picking up its excessive parts.
6 - Keep in mind that in nose surgery (rhinoplasty) taping is very important and it is better to tape your nose twice a week for two months under the supervision of your doctor.
Video Tutorial of Correct Way of Taping after Rhinoplasty
One of the frequently asked questions from doctor Kazemi is about the way of anesthesia in nose surgery (rhinoplasty); I must say that nose surgery can be performed both with local anesthesia and under general anesthesia.
In local anesthesia, primarily sedation medication are injected to the patient through intravenous, the surgeon then performs simultaneous local injection at the place which creates a heavy burden on the patient's nose and at this time the nose surgery can begin.
Currently with the advent of new anesthesia drugs such as propofol and remifentanil, general anesthesia is completely safe and without nausea and bleeding and the duration of recovery after surgery is a minute or two.
Therefore most of the clinics have tendency to use expensive drugs and a way of anesthesia which is without pain and nausea. Sometimes there are rumors among people about that the medicines are fake and Chinese, that here I should comfort all my friends and say that currently the drugs available in Iran, are appropriate and all of these are rumors.
In the first week after nose cosmetic surgery (rhinoplasty) due to plasters and taping and bandages by no means the bandages should become wet, because adhesives come up and lose their value, thus in the first week use telephone shower and tub to wash down the neck.
Before visiting the doctor at the end of the first week in order to remove bandages and taping take a shower and thoroughly wash the face and head with shampoo and even pour water on the adhesive to be ready to be taken by the doctor in his office.
After taping by the doctor, the patient can shower normally. But after the bath and soaking adhesives, the patient should slowly take off them and tape them again according to provided instructions. I emphasize that accurate taping by doctor in his office for twice a week for two months is necessary.
1 – Before surgery photographs should be taken of the different views of your nose. There must be five views from the face and the profiles while smiling and when the head is upwards and also from the right and left sides of the face.
2 - Before surgery, you should go to the bathroom and wash your face and head; you should shave your beard and mustache with a razor.
3 - Blood cell count test before the surgery is necessary.
4 - The day of surgery, go to the clinic with identification documents for fast blood test at the specified.
5 - Do not worry! Tell your doctor if you have stress before the surgery, so the necessary drugs will be prescribed.
6 - If you smoke, a week before and up to a month after surgery strictly avoid smoking.