Aesthetic rhinoplasty – is the corrective operation of the size and shape of nose, which is required to create patient’s psychological comfort. It is one of the most difficult and creative plastic surgeries, as nose takes the central part of the face, it's complex part of body that gives individual look to a person and even a small correction should be made by plastic surgeon who not only has deep sense of art and beauty but also is perfectionist with great knowledge and professional experience.
In our practice, we certainly model the basic facial picture with suitable nose on the computer. More often, in other cases, we provide our patients by same kind of photos before the surgery and after the surgery.
In all cases of rhinoplastic surgery our aim is to achieve a natural structure of face, that does not provoke doubts; when no one can presume that the final look is a resalt of surgery.
Rhinoplastic Surgery – the aptitude of the surgery
Aaesthetical rhinoplasty can be done using the surface method (partial rhinoplasty), in order to add some more characteristic expression of nose while keeping facial traits and individuality. The result: Facial expression gets softer without any important change in the outline of nose.
There are some cases when a small aquiline nose matches facial expression and here we obligate ourselves to convince our patient that current shape of nose actually gives the face noble expression. But still, getting rid of aquiline is most popular surgery. Partly, nose tip surgery and nostril surgery are also considered as rhinoplasty. In this case we correct such deformations as large tip, sharp tip, hilly, tip that is too upturned or vice versa - too let down, asymmetric nostrils or nose wings, nose changes accompanying age and etc.
Other cases of aesthetic rhinoplasty require significant changes in the shape of nose and facial traits (total rhinoplasty). While examining profile, it may turn out that nose with its natural shape - straight and long or aquiline comes out from facial borders. It may happen that nose is too thik in its bone part, or is curved and deformed, or there is tip too large or asymmetric. In the basic outline of face, we may see other disproportions rather than only nose; this requires problem analysis and additional steps.
Partial rhinoplasty – Changing nose shape, which contains surface nose job on just several nasal parts, which does not always include bone tissue (surface rhinoplasty). Examples: small surgery of a nose tip, small correction of aquiline (correction of nose profile). Total cost of partial rhinoplasty (small changes in the nose conture, no reconstruction of breathing function) including price of general unaesthetic is 2200 GEL.
Total Rhinoplasty – this surgery while changing the shape of nose affects all nasal tissues (bone, cartilage, soft tissue) and nose surface structural parts – increasing length, getting rid of aquiline, oppression of back nose (osteotomy), reposition of deformed, nose tip, wings, and nostrils plastic.
Post traumatic rhinoplasty – aims to correct deformations resulted by trauma. Deformations can include nasal septum problems or nasal shells hypertrophy, which is followed by breathing disorders. This surgery is based on rehabilitation of physiological functions rather than just cosmetic intervention. Post traumatic rhinoplasty (rhinoseptoplasty) includes two operations at one stage: nose job and septoplasty. Here doctors use not just aesthetic rhinoplasty techniques but also otolaryngological methods.
Repetitive Rhinoplasty (Secondary Rhinoplasty), aims to correct deformations resulted from first unsuccessful surgery. This surgery is pretty complex as it requires the eradication of the deformation which has arose from initial surgery by a specialist where the nose tissue is already cicatrized.
Surgery based approach of rhinoplasty
Rhinoplasty surgery based approaches are selected individually. In most cases, surgery takes place using the closed approach, without any surface cuts of skin (endonasal rhinoplasty). In other cases open approach is used. Sedative method is also picked individually: rhinoplasty that needs deep intervention is conducted by using general narcosis; for small intervention we use local sedative means with the background of intravenouse potentiality.
In case of general narcosis, excluding the time used by anesthesiologist on manipulation, aesthetic rhinoplasty’s average length equals to 1 hour; rhinoplasty that includes nasal breathing rehabilitation lasts for about 2 hours.
Rhinoplasty – possible risks
Our long-term experience and utilization of modern technologies enables us to foretell, evaluate and reduce risks of undesirable results to minimum in case of complex anatomical form of nose and in most cases fully exclude them.
Nasal surgeries take place using closed approach with minimal cuts. Less traumatic methods and modern technologies make the post surgery rehabilitation and cicatrization processes easier and faster.
Successful rhinoplasty does not only depend on the experience of surgeon and his/her aesthetic taste. It is essential for the patient to follow doctor’s recommendations during the pre surgery preparation period, to minimize the risks of nose swell and to achieve operation without blood and so to decrease post surgery rehabilitation period.
Big attention is paid to examining the general conditions of body in pre surgery period, individual peculiarities of body cicatrization and allergic reactions development risks. In case of doubtful results, the patient is haing additional preparation for surgery. These measures are taken to decrease the period of operation and post operational rehabilitation.
To evaluate the degree of nasal cavity entirety and nasal breathing disorders, also to estimate negative influence of rhinoplasty on nasal cavity architectonic, it may be important to apply additional computer based examination.
While operating youngsters, their age should be considered – for girls minimal age to became adult is 16-17 years and for boys – 17-18 years. Nose sugery can take place at the age of 17.
According to our experience we can diagnose the problem from the first glance, but in some cases more time and repeated consultation is needed for the patient to fully realize and understand the issue.
From our experience, we can tell that 30% of rhinoplastic surgeries take place after the age of 40 and the decision of surgery mostly depends on patient’s general health conditions. Rhinoplasty is often made at one stage accompanying other plastic surgeries on face and body – facelift surgery, blepharoplasty, lip surgery, mentoplasty, mamoplasty, liposuction and etc.
Plastic Surgery consultation
Plastic surgeon fully examines patient during the first consultation process, identifies nasal anatomy and analyses rhinoplastic intervention possibilities on the basis on facial structure. In case if the decision is made to operate, the specialist observes nasal cavity, learns the degree of nasal breathing disorders, considers probable negative influences of rhinoplasty on nasal cavity architectonics, and studies nasal breathing disorders; additional examination may be needed.
In case of repetitive rhinoplasty (secondary rhinoplasty), patient should provide pre surgery photos in order to help doctors in working out the right tactics for the next surgery.
We should remember that, in case of nasal trauma (e.g. recent nasal back bone fracture) it is essential for the patient to address qualified specialist as soon as possible, to avoid more serious surgical intervention in the future, breathing disorders, and undesirable nasal shape deformation. When patient addresses a specialist on time, the treatment takes place in ambulatory conditions and mainly implicates nasal back bone replaced section correction without any surgical cuts.
Post rhinoplastic rehabilitation period
Usually post surgery period goes on without any pain. After the nose job we put on gyps cover on nose for 6-8 days, which is replaced several times during these days. According to the complexity, two types of tampons are used after the operation, basic one that restricts breathing and provokes sense of discomfort and tampon with tube, which enables free breathing all the time unless removed.
Initial swells and bruises slowly disappear during 7-14 days from the surgery; hypodermic toughness, which is unnoticeable for others, finally vanishes from 5 months to 1 year.
In the beginning patient has to follow all the temporary restrictions, even if they are insignificant, and all the individual recommendations given by plastic surgeon. Patients are being examined in 3, 6 months and 1 year after the operation.
Aesthetic rhinoplasty and other joint surgeries
During my years of practice, among other plastic surgeries aesthetic rhinoplasty is my number one priority. Long term experience in otorhinolaryngology enables me to run parallel operations - for rehabilitating nasal breathing and restoring nasal cavity normal architectonics.
After evaluating whole aptitude of surgical intervention, rhinoplastic surgery is often held jointly with other plastic surgeries.
Septoplasty (procedure done to straighten the nasal septum) often accompanied by turbinate reduction
Mentoplasty (increasing or decreasing the size of chin)
Lip surgery (correction of the size and shape of lips)
Blepharoplasty (aesthetic reshaping of upper and lower eyelids)
Facelift surgery (rhytidectomy, procedure to improve visible signs of aging in the face and neck)
Lipofilling (Lip surgery, correction of size and shape - lip’s, face, body)
Otoplasty (Correction of ear’s shape)
Liposuction (Correction of body shape)
Mammoplasty (Breast augmentation, reduction, Breast lift)
Abdominoplasty (Reducing the size and correction of abdomen)