Nose aesthetic surgery holds the top position among cosmetic surgeries performed in Türkiye. Along with the increase in aesthetic operations, there has also been a serious rise in nose aesthetic surgeries. Although performed very frequently, rhinoplasty is among the most difficult aesthetic surgeries.
Alongside achieving a lasting, aesthetic and good result, the main goals are to resolve the patient's existing breathing difficulty or to prevent breathing difficulty from developing later.
In our daily lives, when we face people, the most noticeable area is the nose, located in the very center of the face. The nose is a very important organ both aesthetically and for health, performing functions such as breathing, smelling, humidifying and warming the inhaled air, filtering foreign particles from the inhaled air, and giving our voice its unique character. Following nasal trauma acquired later in life, or genetically, deformities of the nose's shape, curvature or narrowing may occur. Shape disorders can affect normal functions such as breathing and sleep, and can also create situations or feelings such as believing that others are examining your nose while speaking with you, feeling that your nose is ugly and does not match your face, and a need to frequently examine your nose in the mirror throughout the day. These situations and thoughts can cause serious loss of time, lack of concentration and unhappiness in daily life. With changing and developing perceptions of normality and beauty, the demand for rhinoplasty is increasing.
The nasal tissue consists of the skin on the outside, the nasal bones where it joins the forehead region, the cartilages at the tip that form its shape, and the cartilage-bone structure called the 'septum' that supports the nose on the inside, as well as the mucosa lining the inside. Various disorders may occur due to problems in these structures, and the surgical plan is made according to the structure in which the deformity is located. If there is a shape deformity on the external part of the nose, the 'rhinoplasty' operation, which is purely aesthetic, is performed; if there is a problem in the septum on the inside, the 'septoplasty' operation, which is more functional, aimed at correcting breathing problems, is performed; if nasal wings stick together during breathing and cause breathing problems, 'nasal valve' surgery is performed; if there is an enlargement of the turbinate tissues inside the nose, called 'concha', that leads to breathing difficulty, 'nasal concha surgery' is performed; if there is a hole through the septum from right to left, 'septal perforation repair' is performed. However, since most patients have both internal nasal problems and external appearance problems, these operations are performed together in the same session.
Since the structures in the nose are interconnected, a deformity in one reflects on the others. Like dominoes falling as they lean against each other, many deformities are observed simultaneously. Surgery that considers only a single structure may generally cause the other deformity to come to the fore, or perhaps worsen. For this reason, the inside and outside of the nose should be evaluated as a whole, and surgical treatment should be carried out as a whole in the same session. For example, a curvature on the outside of the nose is accompanied by a curvature in the cartilage called the septum inside it. This curvature also often causes concha enlargement in the nostrils. In such a patient, 'septorhinoplasty and concha surgery' should be performed in the same session. Indeed, correcting the external curvature alone is not possible without correcting the septum inside the nose.
Nasal surgeries are performed 'open' or 'closed'.
In open nasal surgeries, an incision is made in the skin of the structure called the 'columella', which divides the nostrils into two from the outside, to reach the internal nasal tissues, and septoplasty or rhinoplasty is performed. Since sutures will be placed in the columella area after surgery, there is a risk of scarring.
In closed nasal surgeries, the surgeon enters through the nostrils and makes incisions in the mucosa at certain points to reach the internal nasal structures, and the surgery is performed. Since there is no incision or suture on the external part of the nose, there is no risk of scarring. For this reason, it is preferred more by patients. The technique to be chosen in surgery varies according to the deformity in the patient, the patient's preference and the surgeon's experience. Nasal surgeries can also be performed under local anesthesia, but for patient comfort, general anesthesia is generally preferred. Depending on the condition of the deformity, surgery may last between 30 minutes and 2 hours. Although generally no hospital stay is required after surgery, physicians and patients prefer to remain under observation in the hospital for 1 night. The first troubling issue for patients after leaving surgery is the inability to breathe through the nose due to the tampons placed inside it, which may have various features, and the resulting need to breathe through the mouth and development of a dry throat. Tampons are important materials for reducing bleeding inside the nose and providing support to the cartilage and bone structures. These tampons remain in the nose for 1 to 7 days after surgery and are then removed.
One of the most important dressings patients fear during postoperative follow-up is the removal of the tampons. With high-quality, oily tampons, patients find that the process is not as difficult as they feared. In patients who report that their breathing problems improved after the tampons were removed, nasal congestion may be observed again within 1-2 days. Because the pressure-applying tampon inside the nose has been removed, swelling and puffiness may develop in the tissues traumatized by the surgery, which may cause breathing difficulty. This swelling may take up to 4 weeks to subside.
Nausea, vomiting and pain are frequently seen after surgery. Some discharge from inside the nose is also normally observed and is not a cause for concern. Infection and septal hematoma are complications that are so rare they are almost never seen. Depending on the amount of skin, cartilage and bone tissue reshaped during surgery and the scope of the procedure, swelling and bruising around the eyes and nose may occur after surgery. Most bruises and swelling resolve within 7-10 days. Patients can return to work within 1 week. However, swelling over the nose takes longer to subside. It is beneficial to discuss these details in detail with the surgeon before surgery.
Especially in rhinoplasty, a cast is placed over the newly shaped nose to help it keep a certain shape. This cast, fixed to the face with tapes, is removed on the 7th day after surgery, and the dressing is applied with thin tapes. Patients are taught finger massage to reduce swelling and help the tissues settle. Ideally, the resolution of all swelling and the settling of the nose's shape span a period of 6 months. After rhinoplasty, the nose area must be protected from all kinds of impacts for at least 6 months. Just as everything exaggerated is harmful and unattractive, unnatural requests and surgeries should also be avoided in rhinoplasty. Rhinoplasty procedures resulting in an excessively upturned tip or a small nose that does not match the facial structure are now considered undesirable outcomes. Instead, rhinoplasty that gives a more natural appearance, suited to the patient's facial bone and skin structure, where it is not apparent that aesthetic surgery was performed, and which does not give the appearance of a standardized nose aesthetic surgery from one hand, is recommended.
Will my nose drop after surgery?
This is one of the most frequently asked questions before aesthetic nose surgery. In rhinoplasty, excess cartilage and other tissues should not be removed and discarded; in particular, the septal cartilage inside that provides nasal support should be preserved, and where necessary, cartilage grafts should be used to support the nose tip. In this way, no collapse is seen at the nasal tip and a stronger nasal structure is created.
In patients who have previously had unsuccessful nose surgery and in whom no supporting cartilage structure remains inside the nose, or in patients whose nasal cartilages have been severely fragmented after serious trauma, it may be necessary during rhinoplasty to reconstruct the nasal bridge, septum or other points using ear cartilage or rib cartilage. This decision is made before surgery together with the patient, following evaluation. Long-term complications that may be seen after nose surgery include septal perforation, intranasal adhesions (synechiae), breathing difficulty, shape deformities and the need for re-operation. Even in the best hands, a surgical touch-up may be needed after rhinoplasty, which is one of the most common aesthetic surgeries performed in Türkiye. Before surgery, detailed information should be given about the patient's wishes, what can be achieved surgically, and the surgical method suited to the patient's face. Whether the patient's expectations are realistic should be carefully evaluated. In this way, patient-surgeon communication improves, and expectations from the surgery and postoperative satisfaction are better assessed.
