This surgery allows to change your nose shape and size in order to make your face more harmonious and proportionate. If there is a breathing difficulty, due to a nasal septal deviation or a turbinate hypertrophy, these blemishes can be corrected through a septoplasty and / or a turbinoplasty, simoultaneosly to the rhinoplasty.
There are no residual visible scars, because they are inside the nostrils. Rhinoplasty is not a painful surgery. There are no age limits to undergo a rhinoplasty; it is necessary that the bone structures and cartilage of the nose have reached full development, while for adults the general conditions will determine whether the patient is a possible candidate or not for this surgery. During the examination, the surgeon will explain in detail the surgical technique, the type of anesthesia that will suit the best to your specific case, the possible outcomes and possible complications. It is possible to make photographic simulations of postoperative, that, of course, will be roughly predictive. A complete healing will be possible not before 4/6 months and in some cases even beyond.
Pre-operative preparation
Before the surgery you need to inform your surgeon of any drug treatment and stop taking medicines containing acetylsalicylic acid (Aspirin, Vivin C, Cemerit, Ascriptin, etc.). Smoking should be suspended or reduced one week before the surgery, at least. It should be reported to the surgeon about any cold or sore throat, cough, or skin diseases. It is necessary to make a complete cleaning bathroom, to wash your hair and remove nail polish on the eve of the surgeryand to fast as of midnight. It is also necessary a companion for the post-operative period.
The surgery
We will speak about primary or secondary rhinoplasty, closed or open rhinoplasty, full, partial or rhinoseptoplasty, according to the history of the surgery, the technique used and type of the surgery. We talk about “primary” rhinoplasty "when the surgery is performed for the first time, "secondary" when the patient has already undergone a rhinoplasty and you need to correct residual blemishes generated by previous surgery. According to the technique we discuss rhinoplasty "closed" or "open". Usually, "closed" rhinoplasty is suggested for noses that never underwent surgeries or traumas, which have minor blemishes or where deviations are not so severe. In this case the incisions are made inside the nostrils and scars are invisible. On the contrary, "open" Rhinoplasty is used to correct the main defect of the tip, the result of innate malformations (cleft palate), in noses that have already undergone surgeries or in those post-traumatic. In "open” rhinoplasty , the inner incisions joins a small incision in the columella (that part that divides the two nostrils); this scar is usually imperceptible. Rhinoplasty can reduce the size of the nose reshaping the tip, removing the osteocartilagenoid hump and correcting the nasolabial angle. Not infrequently you may need to produce tissue, rather than remove it, especially the cartilage tissue. Usually, it is taken from the cartilage of the nasal septum or, if not available, from the cartilage of the ear or rib cartilage. The taken cartilage will then be shaped in order to obtain grafts of different shape that will be inserted in different places as needed (between the triangular cartilage and the septum, between the alar cartilages, above the back, etc.). In these cases it is recommendable the open way, because this allows a greater vision and greater accuracy into the skin grafts. When the patient‘s nostrils are too wide you can reduce their size by incisions at the base of the nose. Rhinoplasty is performed under general anesthesia with hospitalization overnight. Sometimes small adjustments can be performed under local anesthesia with sedation and day-hospital.
Postoperative treatment
After the surgery you will be applied a plastered splint or thermostable to keep bones and the cartilage in their new form. Usually, but not always, two small sponges may be inserted in nasal swabs that are left in place for 24 to 48 hours. In case of surgery of the nasal septum some swabs are always inserted and, in addition, to the sides of the septum two thin silicone foils, to hold it in axis and avoid the risk of hematoma. The nasal splint is left inside for 7/10 days. Rhinoplasty is not a painful surgery and in any case, if there is any pain, it is manageable by taking simple analgesics. In the first few days after the surgery it is normal the appearance of bruising and swelling around the eyes which will disappear within 8-10 days. It is recommendable to keep the head lifted while resting in the first two postoperative days and to avoid any physical effort. Exposure to the sun, saunas and steam baths, intake of food and boiling drink have to be avoided. For few days, after the removal of the nasal splint, patches will be applied on the nasal dorsum, in order to limit the swelling. The use of glasses should be avoided for at least a month. The aesthetic result, already observable after the first two weeks, will be definitive from 6 months to one year after the surgery, because in this period the nose will gradually reduce the swelling and take the desired shape.
Possible risks and complications
Some minor complications (bleeding, hematoma, localized infection, dehiscence of the sutures, intolerance to sutures and dressing) may occur as in any surgery. Scars are localized inside the nose, and therefore are almost invisible: on the contrary in case of too wide nostrils or in case of open rhinoplasty, scars will be visible. As all scars, it may occur hyper / hypopigmentation, atrophy or hypertrophy in different degrees, depending on the genetic characteristics of each patient; such behaviour is unpredictable. Scars which develop internally can also be exuberant and in some cases may give rise, particularly close to the nasal tip, to swellings (supratip) that can be difficult to treat. Some asymmetries can be expected due to abnormal scarring, to a residual bone or cartilage, to the exuberant callus formation, re-absorption of cartilage grafts or to their changed position. In these cases it will be necessary, if the surgeon agrees, a small revision surgery, usually under local anesthesia.