Total rhinoplasty with osteotomy

Total rhinoplasty with osteotomy

Rhinoplasty with osteotomy

Price from 1044 GBP

Rhinoplasty is one of the most frequently performed procedures in the field of plastic surgery and is among the most complex operations carried out in the area of the head and neck.

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Total rhinoplasty with osteotomy

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Rhinoplasty is one of the most frequently performed procedures in the field of plastic surgery and is among the most complex operations carried out around the head and neck. Total rhinoplasty with osteotomy involves breaking the nasal bones, cutting unnecessary parts and folding the nose again. The treatment lasts usually from one and a half to two and a half hours. The procedure is performed mainly under general anaesthesia. Most cuts are located inside the nostrils, but in some cases small cuts can be made in natural folds on the sides of the nose or at the base of the nose.

Characteristics of total rhinoplasty with osteotomy

Nose is the most visible part of the face. It largely determines its appearance. A large, crooked or humped nose can cause complexes or lack of attractiveness. The nose is in the very center of our face and can give us beauty harmoniously harmonizing with other elements of our face or contribute to the complexes induced by its appearance. The defect of the nose due to its location can not be hidden.
One of the most common treatments is correction of the humped nose. The hump is formed as a result of the relief of the cartilaginous part - the hump - or bone bump - the bone hump of the nose. The most common hump is a cartilaginous bump.

Congenital and post-traumatic defects can affect breathing disorders. Nasal surgery can eliminate breathing problems caused by the incorrect construction of the nasal septum. An aesthetic and health solution can be surgical correction of the shape of the nose. Nasal modelling can change the appearance of the nose, the width of the wings, the angle between the nose and the upper lip, and also remove the hump.

The front part of the human nose is called the outer nose. The back is called the nasal cavity. In the front part of the nose, we can distinguish: nasal bridge, ridge, tip or wings of the nose. The construction of the back part or nasal cavity is much more complicated. The nasal cavity is divided into right and left halves, which separates the so-called septum. The nasal septum is made of cartilage and plaque consisting of a vertical perforated bone and a ploughshare. The walls of the nasal cavity are covered with mucosa. This membrane can be divided into respiratory and olfactory. The outer part of the nose is made of bone and cartilage. The whole nose is covered with skin.
Nose has a lot of important functions. It is used not only for breathing or for the recognition of odors. An important function of the nose is to purify the inhaled air, protecting us from airborne contamination, all viruses and bacteria. In addition, the nasal cavity heats the air we breathe. The nose also affects the timbre and timbre of our voice.

Due to the fact that the nose is in the center of our face, it is significantly exposed to all types of injuries. The nose can be damaged due to all types of accidents, fights and during sports. The nose structure is quite elastic, which is why the more delicate injuries are not able to affect its structure. The most serious injury to the nose are its fractures or cracks. Injuries are manifested by a distorted nose, dislocation to the side or the formation of a depression in the upper part. Each major nasal injury automatically causes hemorrhage, due to its strong blood supply.

When the nose is closed, the wound is invisible, only the displacement of the nasal bone is detectable. Most often the broken nose spontaneously grows. This does not mean, however, that our problems end there. It can be damaged inside. Nothing can even lead to brain injury when the nose is broken. Therefore, careful observation of emerging symptoms is advisable. If you have a hematoma around your nose or under the eyes, you should contact your doctor immediately, as this symptom may indicate a skull base fracture.

In the case of light nose injuries, cold compresses are recommended to eliminate edema and thus maintain a patent airway. The diagnosis of a nasal fracture is based on the X-ray of the nose, which shows the fracture and bone dislocation. A broken nose may require surgical treatment to restore its natural shape.

In addition to breaking the nose, frequent nose problems are associated with nasal septum distortion, which may also occur as a result of perinatal injury. As the nose develops over time, the curvature may become more and more visible and become a distress for us.
The nasal curvature can also occur due to physiological reasons, this happens when the nasal septum forming does not fit and takes the shape of the letter C or S. Nasal deformation can often be caused by various types of diseases, e.g. cancerous.

The main symptoms of nasal septum curvature is manifested by one or two-sided nasal congestion and obstruction of the airways. There may be sinus problems. People with a nasal septum curve often have recurrent nosebleeds or mucosal mucosal membranes. In the case of slight distortion of the nasal septum, no symptoms are perceived.
In the case of frequent sinus disease caused by a septum, difficulties in breathing of frequent recurrent nosebleeds or even aesthetic considerations, they qualify for surgery. Surgical treatment is usually carried out by a plastic surgeon. During such an operation it is also possible to improve its appearance so that after surgery, the nose may look much better than before the injury.

Correction of the nose (rhinoplasty) aims to improve the appearance and proportion of the nose, enhancing the harmony of facial features and improving self-esteem. Rhinoplasty affects:

• the size of the nose - in relation to the other elements of the face structure,
• the width of the nose on the back,
• nose profile with visible hump or dent on the ridge,
• the tip of the nose, which is too big, "potato-like", sloping or upturned,
• too large, too wide or snubbed nostrils,
• asymmetry and other nasal deviations.

The range of changes in the appearance of the nose can be very large, but usually doctors advise against so-called patients. complete changes of the nose. The smaller the interference will be to achieve a satisfactory result, the better. Determining the proper shape of the nose is a very individual procedure and consisting of several stages. The plastic surgeon during consultation will indicate appropriate and safe methods to improve the appearance. nose.

An exemplary plastic surgery involving the reduction of the nose is performed under general anaesthesia, lasting about 2-3 hours and takes place in several stages:

• administration of anaesthesia by an anaesthesiologist,
• making an incision inside the nose to gain access to the so-called soft and hard parts of the nose,
• removal of cartilage and breakage of the nose bone with a special surgical chisel,
• formation of a new nose structure,
• sewing of wounds,
• insertion of setons into the center of the nose (filter gauze)
• Placing on the outside of the nose a gypsum rail, which will fix the new shape of the nose and protect against possible injuries.

During nasal plastic surgery, you can also set the nasal septum and even surgically treat the paranasal sinuses. It all depends on the patient's needs. Therefore, rhinoplasty is sometimes combined with laryngological surgery.

Rhinoplasty can be done using one of two methods - "open" and "closed". Each of them has its advantages and disadvantages. The open method gives easier access to the operated part of the nose, the surgeon has greater possibilities of modelling the future appearance of the nose. An "open" approach is a technique by which the nasal surgery is done through the incision of the tissue between the nostrils leading to the tip of the nose. In the case of surgery requiring tissue replenishment, the use of the closed method causes many difficulties and it is often impossible to perform the treatment using this method. By seeing the nasal tissues, it's easier to form them properly. However, the open method remains a scar and the swelling lasts longer. Due to the fact that the closed method does not leave any visible traces of surgical intervention, usually this method in planning is taken into account in the first place.

With the "closed" method, the entire procedure takes place inside, without the need for surgical cutting of the skin. We are dealing here with less dissection of nasal tissues, smaller postoperative edema, lack of visible scars. There is also a lower risk of accidental damage to the nose during the procedure. With the closed method, the treatment time is much shorter and the patient recovers faster. An exception to the choice of a closed technique is the secondary nasal surgery, which is usually performed using the open method.

Choosing the right method has a big impact on the final result of the procedure.

The benefits of total rhinoplasty with osteotomy

Total rhinoplasty with osteotomy brings mainly benefits of emotional and psychological character. Total rhinoplasty with osteotomy improves mood and increases self-esteem of the patient. The patient, by getting rid of his imperfections, feels satisfied with his own appearance. In the case of rhinoplasty, the nasal hump was removed, and the crooked nose became symmetrical and straight.

Indications for total rhinoplasty with osteotomy

The main indication for a total rhinoplasty with osteotomy is the deformation of the tip of the nose (the tip of the nose, prominent, sloping tip of the nose, etc.) and the shape and dimensions of the entire nose (nose, curved nose, humped nose, etc.).

Total rhinoplasty with osteotomy can only be carried out when nasal growth and development have been completed and its shape is stabilized. Therefore, a plastic surgery of the nose can be carried by women aged around 15 years and boys around 18 years of age.

The patient deciding to have a total rhinoplasty with osteotomy should enjoy general health, preferably to be one of the non-smokers. The patient should not have contraindications for which we can include diabetes and thromboembolism.

It should also be remembered that after the age of 35, the regenerative capacity of the skin decreases, therefore, the wounds are longer healing and more frequent infections occur. Healing occurs slower in people with oily and mixed skin.

Contraindications to total rhinoplasty with osteotomy

No persons who do not cure hypertension, who struggle with anemia and purulent sinusitis can not use total nasal surgery with osteotomy. The surgery should also give up diabetes, but in some cases this is not a contraindication.

Before the treatment of total rhinoplasty with osteotomy

During the consultation, the doctor may ask us about the reasons for the decision to correct the nose. The doctor will also ask about general health, whether we are allergic to any medicines, or previous surgical procedures. It is important then how we reacted to anaesthesia, how the postoperative wound healed and many other information that depend on the nature of the earlier surgery. The surgery will also be discussed, the surgeon will discuss the risk involved and the type of anaesthesia to be used during the procedure.

Before qualifying for the procedure, basic laboratory tests will be required. The doctor will show you the list of tests. Most often, before the treatment of total rhinoplasty with osteotomy, each patient performs the following tests:
• blood groups,
• morphology,
• blood sugar level,
• APTT, INR levels - blood coagulation markers,
• HBS antigen level (HBsAg), for the presence of hepatitis B,
• the level of Anti-HCV (hepatitis C),
• for the presence of HIV

Sometimes the doctor may order imaging tests, ie ECG and chest X-ray. It happens that you need to perform X-ray of the nose and paranasal sinuses or go to consult with an ENT specialist.

If the state of health allows for surgery, the next step will be to analyze the nose and visualize the effects of total nasal artery. The physician determining the most appropriate shape of the nose that will harmonize with the face draws attention to many elements. Analyzes the shape of the face, the position of the nose relative to the axis of symmetry, the width of its base, the height of the cheekbones or the width of the mandible, the ridge of the nose and the tip, also looks at the place where the nose connects to the forehead. During the test, the basic functions of the nose are also checked, i.e. there are no breathing disorders.

At the first consultation, the plastic surgeon and the patient should sit together in front of the mirror. The patient says what he would like to change in his nose, and the doctor helps him to name it and informs him about the aesthetic canons of the nose on the face. If the patient wants to, for example, reduce the tip of the nose, the doctor clarifies whether it is the length, width or projection forward.

Remember that according to the canon of beauty, the length of the nose should be 1/3 of the length of the face - the same as the length of the forehead and the mouth and chin together. However, the width of the nose (at its widest point) should be as the distance between the inner corners of the eyes. Therefore, a long face requires a longer nose and will not look good with a short and slightly upturned nose.

During the consultation, some doctors demonstrate to patients their future image, developed by a computer picture. However, it is known that in about 50% of cases - this computer image blurs with this postoperative. Why is it like that? Because in the real world influencing one element of the nose, it always changes its other elements, which is not included in the computer. For example, lifting the tip of the nose causes the hump to decrease, leaving the tip of the nose - increasing the hump. Meanwhile, the computer just raises or lowers the tip without affecting the other elements

Therefore, it is better when the doctor presents the effect of surgery to the patient on a hand-drawn drawing. It is also worth seeing the results of the surgery in the pictures of patients previously operated by a given doctor. Each case should be presented before and after. However, it is important to see the nose in different in several standard projections, so from the front, from the bottom from the top ("view from the helicopter"), two slants and two profiles (left and right). Presentation of only one projection is not very objective. In the pictures you can also show how the nose after surgery changes over time. Therefore, it is worth asking about the patients' photos a year after the nose correction. This is important because only after such a time can some of the imperfections of the surgery and healing processes appear which you have not seen before.
During the consultation, the surgeon should also ask the patient about the freedom of breathing his nose. During aesthetic correction of the nose, problems associated with nasal obstruction can also be removed. After collecting the interview, the doctor examines the nose with a touch and a speculum. In this way, you can evaluate the anatomy and create an operation plan in terms of obtaining a new form and improving the function.

If the patient accepts these suggestions, the next step will be the surgery itself.

If you get a positive opinion on the total rhinoplasty with osteotomy, you should also remember that:
• you should quit smoking or reduce the number of cigarettes smoked for four weeks before the operation you need,
• two weeks of taking medicines containing salicylic acid, taking aspirin and its derivatives, and herbal supplements that affect blood clotting (ie, thinning blood).
• it is not recommended to perform the treatment during the menstrual period (2 days before and the first 2 days of menses)
• Garlic, ginger and ginseng should be avoided from foods
• for a minimum of 3 days before the procedure, do not drink alcohol
• do not tan your face for 14 days before surgery
• on the day of surgery, one should remain on an empty stomach (do not drink, eat, chew gum)
• in the case of facial treatment, do not make make-up and do not use foundation, mascara or creams
• test results should be performed about 14 days before the procedure - treatments are performed only with the correct test results.

Type of anaesthesia during total rhinoplasty with osteotomy

Total rhinoplasty with osteotomy is performed under general anaesthesia (so-called full anaesthesia). Full anaesthesia causes that the patient sleeps throughout the procedure thanks to which he does not feel anything during the operation. If general anaesthesia is used, the patient is hospitalized one day after surgery. Planning the administration of general anaesthesia involves not taking food or drinks at least six hours before the planned surgery.

How is the treatment of total rhinoplasty with osteotomy?

A treatment involving total rhinoplasty with osteotomy may include, but is not limited to, the deformation of the tip of the nose (the tip of the nose, prominent, sloping tip of the nose, etc.) and the shape and dimensions of the entire nose (crooked nose, prominent nose, humped nose, etc.).

The plastic surgeon performs cuts in the nasal vestibule - they are completely invisible on the outside and in the correction of the curvature of the nose (so-called osteotomy) - small skin incisions near the root (top) of the nose. The appropriate cartilage modelling is made to form the tip of the nose. Correction of the back of the nose is made through squaring and the curvature of the nose through osteotomy. Osteotomy involves breaking the nasal bones, cutting out unnecessary parts and folding the nose again.

In addition, it is also possible to correct the curvature of the nasal septum. In this case, the presence of an experienced ENT specialist is necessary.

Wounds are sutured with absorbable sutures - there is no need to remove them. Nasone sets are assumed for the nasal passages - they are removed in the second day. A plaster cast for 2 weeks is fixed on the nose.

The entire total rhinoplasty with osteotomy is usually performed under general anaesthesia. It should be remembered that for a planned operation with general anaesthesia, the patient should drink and drink for 6 hours. The whole operation usually takes 1-2 hours and the patient stays in the clinic one day.

After the treatment of total rhinoplasty with osteotomy, the so-called setons, or greased tapes that oppress damaged vessels and support the cartilage-bone skeleton. On the outside, a rigid dressing (gypsum, plastic or metal) is placed in order to immobilize the nose. Setons are removed after a week, dressing after 10 days. After removing the dressing the nose is swollen to varying degrees. Under the eyes appear hematomas, bruises that disappear after 3 weeks. A normal facial appearance is obtained after approximately 2 weeks. Total healing lasts about 3 months. The final shape of the nose is obtained at the earliest after six months.

Time and course of convalescence after total rhinoplasty with osteotomy

Total nasal surgery with osteotomy is a highly invasive procedure, which is why we must reckon with the fact that the recovery period will be quite long. After surgery, you will most likely experience swelling of the nose, cheeks and around the eyes, which may persist for several weeks. Bruising around the eyes may also appear. For a week, breathing through the nose may be difficult. A slight swelling lasts up to 6 months - only after this period the final shape of the nose will be visible.

On the first day after surgery, stay in bed with your head raised. For 24 hours after the operation, the patient has setons in the nose holes that prevent bleeding. After 8-10 days, the immobilizing dressing (rails) is removed.

For 2 weeks after the procedure the patient struggles with swelling. The use of cold compresses reduces hematomas and edema. You should also not use the solarium and sauna. The nose after surgery is particularly sensitive to injuries, so be careful when doing sports. It is also inadvisable to wear glasses before 3 weeks. Ailments after correction of the nose usually require about two weeks of absenteeism at work.

For many months after surgery, the nose changes. The retching swelling causes the nose to become more subtle, and its aesthetic subsets become more and more pronounced. The tip of the nose drops slightly, and the skin barrier becomes more delicate and less pronounced. The quickest swelling disappears on the back of the nose, and the longest it stays on the tip.

The effects after total rhinoplasty with osteotomy

Most often the effects of total rhinoplasty with osteotomy are permanent. However, during the following years, the skin, soft tissues and nasal cartilage may undergo further changes, which may require further corrective measures in the future.

Recommendations after total rhinoplasty with osteotomy

It is suggested that after the procedure a patient should be accompanied by a close person who, among others he will drive the patient home. The position lying during the day is contraindicated for 6 weeks after the procedure. At night it is recommended to use a cushion to raise the head above. Avoid sleeping on the side, recommended supine sleeping. Protect the nose from injury for 3 months. Avoid heat, exercise and sports for 3 months. In the area of galling and swelling, it is recommended to use Lioton 1000 gel or ointment with Arnica. It is also suggested to moisten the nasal passages after removing the setons.

How to avoid complications of total rhinoplasty with osteotomy?

After the procedure, we will also receive precise guidelines for further treatment. Observing the doctor's instructions carefully, the recovery period will be gentle and we will avoid possible complications. We should remember that some complications require a second operation.

Possible complications - total rhinoplasty with osteotomy

Complications after total rhinoplasty with osteotomy are rare. Complications that may occur are:

• rupture of small superficial nasal vessels,
• infection,
• worse wound healing,
• the risk associated with anaesthesia,
• excessive bleeding,
• nasal asymmetry,
• changes in skin sensitivity (numbness),
• a change in the air inhalation process may occur after a nasal surgery or plastic surgery of the nasal septum,
• inequalities of the septum - they appear rarely and require corrective surgery,
• scars,
• changes in skin color,
• edema,
• the probability of a second operation.

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