Rhinoplasty is a continually evolving operation, but the fundamental philosophy and principles have not changed dramatically over recent years. Advances have been made in the refinement of rhinoplasty through a better understanding of nasal analysis, anatomy, function and long-term postoperative healing. Novel surgical manoeuvres and techniques have also been developed that improve the long-term results of rhinoplasty from both aesthetic and functional standpoints. Furthermore, technological advances in computer imaging and innovative surgical tools have widened the choices available to the surgeon performing rhinoplasty.
Anatomy of the nose
Aesthetic surgery of the nose is considered to be the most challenging, rewarding and humbling of all cosmetic surgery procedures. Every rhinoplasty operation presents the surgeon with a diversity of nasal anatomy, contours and proportions, requiring a series of organised and interrelated surgical manoeuvres tailored to each patient’s anatomical and functional needs. The surgeon controls the operation and must also become skilled at manipulating and controlling the dynamics of postoperative healing to attain optimal long-term aesthetic results. A necessary prerequisite is the skill to visualise the ultimate healed outcome while modifying nasal structures.
Such skills require many years of study and experience as the surgeon observes, analyses, and modifies his/her surgical results. With the improved methods of analysis and the increased popularity of open (external) rhinoplasty, surgeons may be able to perform precise rhinoplasty techniques under direct visualisation. The key to continuous improvements through experience is accurate record-keeping using diagrams couples with long-term patient follow-up and evaluation.
The unique anatomy of the nose is the critical factor influencing the final result of each individual rhinoplasty procedure. Differences between individuals in nasal anatomy demands refined diagnostic skills to identify the infinite variety of problems that could be encountered. The aesthetic judgement of the surgeon guided by patient expectation determines the surgical changes planned. No single procedure or technique will suffice to reconstruct every nose in an aesthetically pleasing fashion. Therefore the surgeon must be skilled in many different approaches to handle the wide range of nasal anatomical combinations. The ability to identify correctable deformities and limitations inherent in each patient exists as the single most critical prerequisite to attainment of outstanding results on a consistent basis. Misguided attempts to create changes greater than the tissues will permit, will result in aesthetic and functional complications resulting from overaggressive resection of supportive structures.
Our surgeons utilise the most advanced contemporary and innovative techniques from top centres in Belgium and the USA. In approximately 20% of all patients, the side profile may reveal facial imbalance with a small chin, we may then advise the use of a chin implant to restore balance to make a good result into a fantastic result. Rhinoplasty is considered technically the most challenging cosmetic surgery of the entire body. A great looking rhinoplasty requires a balance of patient’s genetic makeup and healing, surgical technical excellence and the surgeon’s artistic talent.
Rhinoplasty is a day-case procedure performed under general anaesthesia. The procedure may be performed as an open (small skin incision under the nose) or closed (internal incisions) approach. The procedure takes between 1-2 hours and afterwards a splint is placed on the nose that remains for 1-week.
Sculpting and reshaping the nose is a challenging procedure as every nose is unique in skin type and thickness, strength and size of the underlying cartilages and bony support. In addition, each nose presents different functional breathing issues, commonly with a deviated septum and enlarged turbinates. Our facial surgeons use both open and closed techniques, although the closed technique is preferred as there are no incisions in the skin. For some noses, particularly where delicate surgery of the tip that requires millimetre refinement, the open technique is preferred as this gives the best long-term result. We use suture and micro-refinement techniques to maximise tip refinement. We also use the most innovative facial plastic surgery techniques to maintain functional breathing that may involve the use of fine grafts that support the airway of the nose preventing potential collapse. Our surgeons are acknowledged experts in rhinoplasty and take an active interest in researching the latest techniques to keep their skill-sets up to date in the rhinoplasty field.
Many patients who come to see our facial surgeons are concerned about recovery after surgery and downtime. We advise all patients that one week off work is all that is required, for some patients two weeks is preferred, as by this point the majority of swelling has gone down.
We employ fine microsurgical techniques to preserve the nasal cartilages and ensure minimal disruption to the natural anatomy of the nose to reduce swelling and bruising. Most of our patients have minimal or no bruising after surgery and most do not require analgesia after surgery.