Displaying items by tag: rhinoplasty
People who have already had a nose job or those who are planning to have one should read these important issues:
- In the first couple of months after the nose surgery, the tip of the nose would have the most inflammation or swelling so they will have to be patient.
- The tip of the nose stands in a bit more elevated position for a short time after the surgery and it will gradually drop 1 to 2 millimeters. This might take up to 6 months to reach to the desired level so patients should not worry about the elevation in the tip.
- The asymmetry is natural to some extent after the operation. It will gradually improve within 3 months as the swelling subsides and hardly noticeable after a year.
- The final shape of the nose appears after 6 months to 1 year so one has to be patient to see the final results.
- Those who have thick skin should wait a little longer for the swelling to disappear because the thick skin leads to more inflammation and swelling.
- In noses with severe deviation there should be minor revision surgery after the Rhinoplasty as the deviation main remain to some extent after the surgery.
- Those patients who complain from post –operative deviation should keep in mind the asymmetry in the two halves of the face could be the cause of this issue which should be addressed before the surgery.
- If you intend have a revision nose job it is better to refer to the surgeon 1 year after your operation since the final shape of the nose and the complications appear after 1 year.
- After 1 year the, the flaws are distinguished and rectified with a revision surgery.
- The weakened sense of smell after the surgery is due to inflammation of the lining on the inside of the nose which prevents the scent molecules from reaching the olfactory nerve endings. This is temporary and reversible.
- Bleeding doesn’t happen frequently after the nose surgery but there is a possibility that the patient may have severe bleeding during and after the surgery which may be due to: coagulation disorders, high blood pressure, use of aspirins, vitamin E and garlic.
- Too much reduction in the size of the nostrils could cause problems such as over closure of the wing of the nose to the septum during breathing. This is because the wing was weak from the beginning and has become even weaker by the operation or the surgeon has failed to reinforce the retaintive structure of the nose. In such cases a revision surgery is needed to enlarge the nostrils. For this, a cartilage has to be taken from the septum and grafted to the nostrils.
- In case of any infections, which are not very common, anti-biotics should be taken. If nostrils are not cleansed properly, the secretions remain inside the nose which leads to the accumulation of microbes and onset of infection and lack of treatment would result in adhesion.
- There is a possibility for numbness and permanent loss of sensation after the operation which, of course, is not predictable.
- The allergies may worsen for weeks or months in patients who have had history of allergies prior to the operation. Some patients may even be required to breathe through their mouth for a while after the operation.
- It is highly recommended that patients start walking the same day or from the day after the operation.
- Patients should try to avoid sports like martial arts, football and volleyball which may involve direct contact with the nose for at least 8 weeks after the operation to allow for the complete healing of the nasal bone.
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.
The most common fracture in the body is the nasal fracture. Fracture is more common in men than women (due to sports activities or accidents and occupational activities). After nasal fracture, swelling and inflammation of the nose and face are common.
The best way to detect the nose and facial fractures, contrary to the popular belief is examination of the nose, not radiography. Since the nose has small bones, radiography does not help much to diagnosis.
After replacing the fracture we should wait for about 48 hours until the initial swelling and inflammation is reduced. At this time the best thing to do is to use ice packs to reduce inflammation. Nasal fracture in adults is joined in seven to ten days after fracture and in children it is welded 5 to 7 days after fracture. So replacing must be done in this time range, if the nose doesn’t take the appropriate form, after about six months the patient should undergo the rhinoplasty.
One of the main causes of nasal and facial cosmetic surgery is ill-treated or untreated fractures. In people with a deviated middle septum and nose fracture it is better to do septoplasty along with replacing to achieve the desired result.
What should we do reduce the inflammation after the nose surgery (rhinoplasty)?
First I must say that the inflammation after nose surgery (rhinoplasty) increases from the third day and on the fifth day it reaches to its peak. Observing the following items contributes significantly in reducing the inflammation:
- The use of ice packs in seventy-two hours under the eyes and around the nose and even on the nose
- There must be two pillows under the head of the patient
- Avoid intense physical activity.
- Stay away from sunlight, heat, light of computers and low-energy bulbs because UV radiation highly creates inflammation.
- Injection of betamethasone LA ampoule on the third day after surgery in the muscle somewhat reduces the inflammation.
- Frequent use of adult cold tablets every six hours is very helpful.
- Sometimes, especially in fleshy noses, local injection of triamcinolone ampule is very helpful and it is usually done by the doctor after the first month.
- Accurate taping also helps to reduce inflammation and twice a week taping is done by the doctor.
Sever inflammation is in the first three weeks and after that inflammation is reduced but slight inflammation can be seen up to six months after nose surgery (rhinoplasty).