When is this procedure indicated?
This intervention is indicated in cases where the patient and the surgeon share the opportunity to correct an aesthetic defect of the nose; the imperfections are usually accompanied by functional respiratory defects also deserving, in the same intervention, a surgical solution.
How is it performed?
Surgery performed under general anesthesia involves two possible approaches that are chosen depending on the clinical case and at the discretion of the surgeon: "closed" technique consists in making all the incisions inside the nose and "open" technique that uses a small incision in correspondence of the hidden part of the nasal columella (the region that divides the two nostrils); contrary to what one might imagine, the open technique represents a more modern and reliable approach to rhinoplasty.
The whole osteo-cartilaginous structure of the nose is reshaped, with correction of defects of the back (hump, flap, wide nose, twisted nose), of the tip (globular tip, hypo or hyper rotated, hypo or hyper projected), of the root of the nose and of the nostril orifices in order to give the nose a harmonious, natural and pleasant appearance. It is improper to think that the nose can be corrected by the mere removal of a hump or with a small touch-up of the tip, since the final aesthetic result derives from the harmony of the various elements that make up the nasal pyramid. Therefore, the correction of only one of these elements would highlight previously inconspicuous imperfections. The operation also includes the simultaneous correction of any functional defects such as deviation of the septum, hypertrophy of the inferior and middle turbinates, inflammation of the sinuses.
The procedure is not painful. The patient is discharged the morning after surgery, with a total hospitalization time of 24 hours, with a dressing including nasal patches and a thermo-moldable resin headband positioned to protect the nasal pyramid. No nasal swabs are used, which made post-surgery particularly uncomfortable and painful in the past. Thin silicone films are placed between the septum and turbinates to prevent the formation of abnormal post-operative scar adhesions. An 8- to 10-day home convalescence is recommended to reduce the risk of postoperative bleeding. The operated patient needs outpatient dressings performed twice a week, useful for the control of healing and suction of endonasal secretions. On the tenth postoperative day, the nasal patches, the headband and the antisynechia parasitic plates are removed.
- Hemorrhagic complications: related to diffuse bleeding of the mucosa; in the current technique they are very rare.
- Local infectious complications: cellulitis (infection of the subcutaneous loose cell tissue), abscess (circumscribed collection of pus), periostitis (infection of the bone lining tissue), granuloma (formation of granulation tissue of an inflammatory nature) from a foreign body; these are also very rare.
- Traumatic complications: from improper osteotomies (bone incisions) (maxillary or frontal sinus injuries, angular artery and vein injuries, internal cantal ligament injuries, lacrimal drainage system injuries, intracranial injuries).
- Functional complications: anosmia (loss of sense of smell), hyposmia (decreased sense of smell), hypogeusia (decreased sense of taste), ageusia (loss of taste), nasal respiratory obstruction, vasomotor rhinitis, paresthesias (altered sensitivity) of the upper lip.
If the design part and the patient's expectations will be realistic, the result is usually very satisfactory. Aesthetically inadequate results may be related to scarring disorders or highly complex anatomical starting conditions. These resulting complications may concern the back with excessive felling or residual hump, the symmetry of the nose (that not even in the best faces is perfectly aligned), the shape of the tip, which is the nasal component of more difficult remodeling.