Nasal aesthetics is the general definition for the operations made to correct deformities of nose caused by past traumas or operations or appeared because of structural reasons. Nose is the structure that stands right at the middle of a face and the focus of unconscious first looks to the face. Therefore deformities of nose cause aesthetic concerns with or without presence of a disease. There are pre-ideal ratios for nose that are defined by doctors, but the important thing
about the decision is the person’s own expectations with the perspective of his/her doctor.
What is nasal deformity?
Nasal deformity is the expression that is used by doctors for external nasal shape disorders. These shape disorders are originated from different parts of bone and cartilage structures. Humps on nose, longer nose, lower nose tips, wider nose flarings are most common aesthetic problems about nose.
What is deviation?
There is trouble of breathing on most of the patients who have nasal deformities. Healthy and normal breathing is provided through the nose. When the nose can't do its job properly because of the internal curve called deviation and growth of chonchas called choncha hypertrophy, permanent nasal blockage appears and breathing is provided through the mouth.
Deviation is the curve of the tissue called septum, which begins from the front and reaches until the nasal passage, dividing the internal nose to two sections. Septum is made of cartilage and bone structures covered by the internal skin called mucosa. Deviation can occur structurally or as a result of trauma. Localization, severity and number of these curves vary depending on the patient. Choncha growth is the tissue growth of chonchas and called choncha hypertrophy. Inferior chonchas are the biggest; they adjust the amount of air that will be inhaled by changing their own volume and heat the breathing air; they increase the rate of nasal blockage with the existence of a nasal deviation.
What is rhinoplasty?
Rhinoplasty is the surgical operation that is made to correct deformities of cartilage and bone that cause nasal shape disorders. Each person has a different nasal shape and post-operational expectations are different likewise. Therefore there isn't a standard procedure technique for nasal aesthetics. Skin, bone and cartilage structures are assessed separately on the evaluation of deformities. The patient’s facial shape and ratios are certainly considered with the patient’s expectations about his/her nose when the operation plan is being made. In rhinoplasty, different techniques such as hump resection (removal of the nasal hump), osteotomy (removal of a piece of nasal bone), alar cephalic resection (narrowing of nasal flaring), application of suturing techniques and placement of cartilage support (elevation and narrowing the nose tip) are used in variety of combinations.
What is a deviation surgery?
In cases with nasal deformities; if internal curve disorder also exists, deviation correction surgery (septoplasty) is added to nasal aesthetic surgery plan (rhinoplasty). Doctors use the expression of septorhinoplasty to define this combined operation. In cases with choncha hypertrophy that plays role on nasal blockage, inferior chonchas are also interfered. To reduce inferior chonchas, techniques such as chonchaplasty, radio frequency and cauterization are used. Chonchaplasty operation is a classical surgical method that includes removal of excess tissue with condition of preserving the medial sides. Radio frequency is a general surgical procedure that is made by transmission of radio waves to the target tissue through a fine needle; this energy causes the tissue to shrink, become smaller and taut at the process of healing.
How is the postoperative phase?
A plaster and thin bandages are placed to nasal dorsum after rhinoplasty or septorhinoplasty. After surgery cold application is done around eyes. Intermittent cold application with classical methods with 10-15 min each hour lessens bruising and swelling. Patient is discharged the next day. Nasal plaster is removed at the end of the first week. Thin bandages can be kept for one more week if it seems necessary. Deviation correction surgery and choncha surgeries that are combined with rhinoplasty don't have a much troubled postoperative phase. It is possible not to put anything inside of the nose if bilateral suture technique is used. But tampons that contains small pipes for breathing can be used for a day if necessary.
Continue of cold application with declining periods of time for 1-2 days after discharge from a rhinoplasty surgery is beneficial. Mild bruises and swelling begins to decrease after 3rd day of surgery. At first weeks nose can be more swelled in mornings and swelling can reduce during the day. Most of the swelling meliorates after 6 weeks. But taking nose its final shape takes 1 year. Traumas to the nose at early stages of postoperative phase can result with permanent nasal shape deformities. Therefore contact based sports are unfavorable for the first 8 weeks. Exercises such as brisk walking and swimming can be done after 3rd week. If an operation is done for a nasal hump, usage of eyeglasses is not convenient. Again, intense sunlight, solarium, sauna and Turkish bath should be avoided for first 8 weeks. Especially it is important to use hat to avoid sunlight and high factored sun creams which is beneficial to prevent permanent color changes around eyes at the period of bruising. After early postoperative phase, controls are made at 3rd, 6th and 12th months. At most of the cases, patients achieve the desired nasal shape when some of the cases a second limited minor operation is necessary to achieve the optimal result.
Copyright/Main Edition 2012 Limited Revision 2022 Prof. Dr. Z. BURCAK TUMERDEM ULUG
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