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Surgery : Nose surgery
The following pages were written as a guide for patients wishing to obtain further information on rhinoplasty. Although this text offers general information on rhinoplasty it does not necessarily cover all aspects of the operation. As it may not deal with your particular case, you will need to consult your plastic surgeon for further clarification.
You can also obtain more information on the specialized Dr Laguarde website on rhinoplasty
Dr Yann Laguarde is active member of the reknown "Rhinoplasty Society, inc"
Rhinoplasty is comestic surgery of the nose and generally consists of reducing its volume. There are two types of rhinoplasty:
? Primary rhinoplasty: an operation carried out on someone who has never undergone surgery.
? Secondary rhinoplasty: an operation correcting a former rhinoplasty.
Thankfully, primary rhinoplasties are the more frequent of the two.
The operation which lasts for about one hour is performed under a general anaesthetic and requires an over-night stay in hospital.
The operation is carried out entirely through the inside of the nostrils and consists of pulling back the mucous membrane and the skin in order to reach bony and cartilaginous structures of the nose. Results are obtained by moulding the interior of the nose until the desired form is obtained.
In general, if the septum (the wall dividing the nostrils) is deviated it is straightened during the operation. If this is the case, the operation performed is a septoplasty associated with a rhinoplasty, otherwise known as a rhino-septoplasty.
It is not a painful operation and on awakening, the patient will find him or herself with a type of plaster on the nose. This isworn for one week accompanied by a small compress which is worn underneath the nostrils for a couple of days.
For two or three days following the operation it is normal for a pink-coloured liquid to ooze slightly from the nose. The patient will also have the sensation of having a blocked nose for a couple of weeks.
The plaster is removed one week after the operation. Once the plaster is taken off, the nose is far from its final shape. From the front, it will take on a large aspect, that is to say, the tip of the nose is almost as large as the bridge. The nose will be slightly bruised and traces of the plaster can be seen, just as if the patient had been wearing glasses.
The profile, or the highest part of the nasal pyramid, will be swollen giving a Greek aspect to the nose from the frontal axis. It will appear to be too straight but will subside a few days later. The tip of the nose is also a little higher with regards to its final position.The patient is usually happy with their profile but the front view will only be satisfactory from three weeks to two months after the operation. It is around this time that the patient will feel for the first time that the nose is beginning to reduce in swelling. In fact, the swelling of nose will continue to reduce for a year following surgery. After one year the Doctor will take post-operative photographs. Pre-operative photographs are always necessary. They are taken in black and white, in a laboratory indicated to the patient. These black and white photographs on mat paper are life-size and allow the surgeon to make precise indications prior to the operation. They are then used during the operation as an accurate guide.
A second consultation is thus indispensable as it allows the patient to express what is desired and the Doctor to establish what exactly can be done during the operation. The sketches made on the photographs are very close to the final results which can be seen months after the operation.The after effects of the operation are described below. However, the patient must be aware that complications can arise in relation to the operation, particularly :
Respiratory difficulties may arise and can last for many months, especially if the patient has allergies or already has small nostrils. Breathing at night is frequently noisy and can last up to two months following the operation.Once the plaster is taken off the nose, partial loss of sensation is normal for a couple of months. The skin remains fairly sensitive, however, sensation is regained after a few weeks.
THE SHAPE OF THE NOSE
If the skin on the nose is thick it usually cannot be made as fine as one would like. In fact, the thickness of the skin determines to a great extent the final result. Therefore, if the skin is particularly thick, a fine and small nose is not a realistic goal.However, if necessary your surgeon can propose a cutaneous treatment to thin the skin one year after the rhinoplasty. This is done through abrasion of the skin, either by laser or by mechanical abrasion. This procedure is nonetheless very rare.
RESIDUAL DEVIATIONS
If the nose is extremely deviated before the operation, it is usual for the tip of the nose not to be completely straight after surgery. This is due to the ?memory? of the nasal wall, which being cartilaginous, and hence very rigid, has a tendency to move back to its original position.
Even if a surgeon tries to make a nose as straight as possible during an operation, in nature noses are never completely rectilinear.
IRREGULARITIES
As is often the case with surgical procedures, rhinoplasty is an operation which relies more on touch than it does on vision.Because of this, it is possible that the surgeon is unaware of a cartilaginous irregularity which may become evident a few months after surgery once the oedema has been reabsorbed.
In the event that this does occur a ?touch-up? is necessary. Touch-ups occur in 5% of all cases. This is a short and banal operation, lasting sometimes only a few minutes, and most of the time consists of using a rasp on the ridge of the nose into to perfect the results. It is like a seamstress?s touch-up, and is not associated in any way with a failure. It is something that a patient must be prepared for and is practically and integral part of the operation.
Although the plaster is only worn for a week the nose must be protected for the month following the operation. As the nose is not yet solid it is advisable to avoid violent sports such as ball-sports. It is also advisable not to carry small children for the first month as they tend to wave their arms about and may hit your nose. Glasses should not be worn on the ridge of the nose unless the nose is protected by a small and rigid piece of card called a ?bristol?. This prevents the pads of the glasses from deforming the nose. Diving and ski goggles must also not be worn during the first month. At the end of the month the nose is consolidated and should not risk any damage. Often, the nose is more solid than before the operation.
Finally, one should not forget that this operation will modify your apearance and that it can interfer with breathing.
The following pages were written as a guide for patients wishing to obtain further information on rhinoplasty. Although this text offers general information on rhinoplasty it does not necessarily cover all aspects of the operation. As it may not deal with your particular case, you will need to consult your plastic surgeon for further clarification.
Contact Dr Laguarde by email or by phone +33 (0) 1 41 31 31 31 - 13, Rue Le Corbusier, Grand place, 92100 Paris - France.
Feel free to make an appointment or ask any questions you may have.