Plastic Surgery of Nose (Rinoplasty)
Plastic surgery of nose is the most preferred plastic surgery by both women and men.

PLASTIC SURGERY OF NOSE
The process in rinoplasty is reshaping the nose by changing the structure of bones and cartilages. To acquire a more aesthetic nose shape, we sometimes need to cut the bones and cartilages. Sometimes, unlikely, we need to fill the gaps and change the shapes.
It is better to accept that rinoplasty or plastic surgeries of nose are the most difficult surgeries with a lot of unknowns.

WHY IS PLASTIC SURGERY DIFFICULT?
Plastic surgery of nose is hard because nose is like a closed box and you have to make the operation from just one side of that box. There are lots of unknowns in this surgery because the bones and cartilages that form the frame of nose present as a complete but they are independent from each other and they may act different in the recovery period.
Because of that reason it is the plastic surgery which the revision, namely readjustment operation is implemented the most. A doctor in world class is accepted that he has to make a revision on a patient in every ten. On the other hand, when this surgery is carried out well, it has really good results.

SURGERY
Rinoplasty surgery can be performed by two techniques which is open and closed techniques. By the closed technique all the cutting is made inside the nose.
Surgeon fulfills the surgery by working inside. By the open technique a 3-4mm cutting is made to open the tip of the nose.
The difference between two techniques is related to the domination of the doctor on the technique. The closed technique which is made from the tip of the nose is more like making the surgery in a bottle. There will be no problem if you just plan to extract something from inside the bottle. Nevertheless, it is really hard if you want to build a ship model inside. By the open technique surgeon can see the front 2/3 part. It has been always a discussion among the doctors that which technique is better and there is not a conclusion yet.
As you can understand from the definitions that I made my choice is open technique. The reason for that is that I do not believe it may result well if you perform a surgery like that which you should do no mistake, without seeing. It is already a fact that even the closed technique supporters cannot object, lots of surgical maneuvers and corrections which cannot be even imagined in close technique. I believe that it reduces the possibility of revision after open surgeries.
The greatest handicap of open technique is that it leaves a scar on the tip of the nose. Bur this becomes almost unclear after a well done operation and it remains under the nose. The majority of the patients forget about it afterwards the surgery.
About this topic you should consult to your doctor though and you should trust in him. All the surgeons will take the best results by the methods that they know the best. That I explain above is just my opinions.

I SEE VERY BAD SURGERIES, WILL I BE THE SAME?
I also see noses which are unnatural, very small and when looked across the nostrils can be seen. I told you in another page how you figure out a nose operation that is made bad. Remember that the result of the surgery is dependant on the techniques, skills and the desires of the doctor.
Giving an upturned nose shape just by minifying the nose results an unnatural appearance. With modern techniques, the location, place and shape of fibers can now be changed almost without taking anything out.
If you inspect this pattern, you can see one of the most often done mistakes. This is the method which is mostly used in old techniques. In past, in order to indicate the nose as upturned, the nose was minified as much as possible and the starting point of the nose was taken as low as possible. Thereby, nose would have created an illusion as if it is upturned but the result would have not been natural. What is essential is to start the nose where it should start from the point, namely to start from same level of the pupils and give all the shape with respect to it.

HOW CAN I FIND OUT HOW WILL MY NOSE WILL BE AFTER THE SURGERY
There are computer programs for that purpose. Your doctor will probably make sense about it by one of those programs. But with those programs, a real surgery plan cannot be made but just a common opinion.
Your doctor would want to do some measurements on your pictures he is using one of the techniques that is dependant on measurement. In order to do this, he will do the measurements by making you hold a scale while he is taking pictures or he is going to print the picture in real size.
I do sensitive measurements before the surgery and calculate the golden ratios and ideal face profile. With the results of my calculations I draw a profile picture with my hand. For the details of profile work, click here.

COMPICATIONS AND PROBLEMS THAT CAN OCCUR
The risk of bleeding which is in every surgery can be more serious in rinoplasty. Especially if some operations other than plastic surgery will be done in order to get rid of sinus-if it is necessary, it should absolutely be done- the risk of bleeding increase. Nose is an organ which contains medium size veins inside. But generally this kind of bleeding does not become dangerous and can be stop by simple tampons. After the operation, adherences could occur which is called sineşi in the respiration ways and those could make you inhale harder than before operation. The treatment of it is generally easy but a second surgery would be essential.
There could occur a whole in the part called ‘septum’ which forms the middle of nose. Usually this is not a problem but causes some noise when inhaling. Treatment of it is hard and it needs re-operation.
At nose there occurs almost no infection. This organ is strong to bleed and resistive to inflammation. If there occurs infection then you can get in the medicine literature.
Nevertheless, after the operation, if you have aesthetic problems, deformations or you do not like the shape of your nose nobody will get surprised. So, the most often complication of this surgery is aesthetic.

OFFENLY ASKED QUESTIONS

Should this surgery be done by a plastic surgeon or by a specialist of ear-nose-throat (ENT)?
Your doctor can be a plastic surgeon or ENT specialist. I recommend you to have it by a plastic surgeon though, but there are some ENT specialists which do this surgery very well. But this is not a surgery that you can say ‘while we are doing this surgery let us take this bone out also’. Sometimes it is really hard to correct this kind of retouching. Talk to your doctor everything in detail.

Do you break the bones?
We do not break the bones. If we want to reshape or take some parts out, we cut them. For this use, we use thin cutters. Sometimes bones are being rasped.

Can this surgery be done by local anesthesia?
If it is going to be something related to bones- mostly it is necessary- local anesthesia is not appropriate. This is a surgery which general anesthesia is a must.

Is it a must to use tampons? When tampons are removing is it going to hurt a lot?
You do not have to use tampons. Even, after most of the operations there is no need to use tampons. Tampon is just in need if something serious is done inside the nose. Now, modern tampons are not long as meters like they use to say in past. Taking tampon out might discomfort you but it is no more a process with pain. Consult to your doctor about this topic, and find out if you need to use tampons and if it is needed which tampon you should use.

In rinoplasty, is the aim minifying nose and take bone out?
The answer of this question is absolutely no. In this surgery the goal is to give the desired shape to the nose. Unlike it is thought, this is done by magnifying nose but not minifying it. At the back of the nose there is a bone called hump (actually it is mostly cartilage) and if there is extra on it, it is absolutely remove, but mostly in this kind of nose, there is lowness and it needs to heighten. Even if the tip of nose seems fat, the actual matter is the shape of it and minifying it or getting it thinner just exaggerates the problem.

TIPS
• If we say Rinoplasty is the hardest plastic surgery we would not overestimate it. It is a surgery when it is done well you get satisfied and when not, hard to correct.
• The noses that we emulate which is European and upturned, is not tiny but quite high. Thus, noses that made upturned just by minifying, do not seem natural

WHAT YOU ENCOUNTER BEFORE AND AFTER SURGERY
This is a surgery that is between small and medium degree. You have to faint in the operation and I do not recommend you to have the operation with local anesthesia. Surgery must be in an operating room and it does not need to have an intensive care room with full formation.
I do not recommend you to have this operation in a consulting room.
Your doctor can be a plastic surgeon or ENT specialist. I recommend you to have it by a plastic surgeon though, but there are some ENT specialists which do this surgery very well. But this is not a surgery that you can say ‘while we are doing this surgery let us take this bone out also’. Sometimes it is really hard to correct this kind of retouching. Talk to your doctor everything in detail.
There will be a cast after this operation. There might be tampons inside the nose. Now, it is easer to remove new generation tampons. The tampons that your friends call as meters and meters is become history.
I can say that you will have difficulties in your first night. To inhale from the nose would be hard even there is no tampon. You would have a headache, you have to put ice on it regularly and it is hard to sleep. But in the morning you feel better. How much tumescence you will have is dependant on the process in the operation, habit of your body and of course on your doctor. In the second operations tumescence would be more. In the first 24 hours there will be a leakage at the tip of your nose and it is normal.
If you throw up much do not get afraid. Some patients swallow some blood during the operation and it causes to throw up. Do not afraid, if the bleeding is not fresh and continuous but inform your doctor.
After the second day, you can turn back to the routine, for example you can go to a movie. And after casts removed it helps to reduce tumescence to put a small tape on the nose.

THE REPORT CARD OF THE SURGERY

The type of anesthesia: General
Where should the surgery be done: In an operating room of a hospital.
Surgery duration: 1.5 to 2 hours
Duration of staying at hospital: can be discharged at the same day.
Pain after surgery: There can be a light tingle for a few days. Painkiller is adequate.
Tumescence, purpleness: 3 to 7 days, sometimes around the eyes.
Dressing: if there is, it is removed in the following day. The cast is removed at 5th day.
Sewing: If open rinoplasty, sewing of the tip of the nose is removed at 5th day. Can be turned back to work in 3 to 7 days.
Sports: After 2 weeks long joggings, after 2 weeks, sports, basketball, boxing and the sports that are done by body to body after 5 weeks.
Last shape: usually at second week tumescence is almost gone. But for the last shape earliest estimation, 6 months needs to pass. But if there is tumescence between the eyebrows to forehead it lasts for at least one year.