RHINOPLASTY

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General

Rhinoplasty is a cosmetic operation with reconstructive character and concerns the shape of the nose which may:

  • Have congenital structural deformities (hump, tilted or hooked nose)
  • It is deformed because of a failed operation or injury

It balances the nose in relation to the other facial features with various methods like:

  • Removal of the hump
  • By thinning the cartilage formed in nostrils etc.

Provides solutions in the same operation for all functional breathing problems (like nasal septum, nasal conches).

Each nose is special and in order to have natural proportions, specific features, such as the back and the bone of the nose must not be reduced excessively.

The natural shading of the nose from the internal end of the eyebrow to the top must be distinctive, while the nasolabial angle must not be too obtuse, because the nostrils would otherwise appear lifted.

There must also be no protrusions, protuberances and depressions on the surface of the nose.

When can rhinoplasty be applied?

The patient’s development must have been completed, in which case it is usually applied near his coming of age. Of course, there is no maximum age for carrying out the operation, therefore, if the patient’’ health permits, he can undergo rhinoplasty any time after his coming of age.

A successful rhinoplasty aligns the facial features and offers natural beauty, youthfulness, renewed and improved self-confidence.

Functional rhinoplasty

Often the deformity in the shape of the nose affects breathing and in combination with a tilted septum and enlarged nasal conchae it causes serious breathing problems, headaches and sinusitis.

These problems cannot be corrected by medication. Nose alignment is required internally and externally and enhancement of the support in the area of nasal valves.

Another serious matter included in the concept of functional rhinoplasty is the inclination of the nose tip.

A hawk nose does not facilitate the passage of air. The correction is done with suturing techniques that support the top and suitable grafts (extension), at the nasal septum.

Aesthetic Rhinoplasty

Many people are not happy with the nose they were born with or have observed that their nose changes as they age. In others, an injury changed the image of the nose in a bad way and this fact changes their psychological state.

Even a small correction can make a difference in the whole face harmony.

Rhinoplasty is a work of art which includes the laws of physics and structural engineering in order to function perfectly.

The changes proposed by the plastic face surgeon are determined by many factors like the patient’s height, age, skin thickness, nationality, but also the shape of the face, the inclination of the forehead, the eyes and chin.

The aim is to achieve a natural nose and not a nose that looks operated on.

The philosophy of well-studied modern rhinoplasty is not one of removal as in the past, but it takes care to reduce and make narrow some anatomical structures that are bulky and simultaneously to increase or enhance the weak structures, in order to produce a uniform aesthetic result and above all stability over time.

It is worth stressing that there is not one technique for each stage of rhinoplasty suitable for all noses. We must now consider each operation as absolutely specialized and focused on each case. It is based on the surgeon’s judgement, knowledge and skill.

Remedial Rhinoplasty

Remedial rhinoplasty is a type of rhinosurgery which corrects problems created by a previous operation or problems which were not adequately corrected.

It deals with both aesthetic and functional complications from a previous operation or injury.

Corrective and remedial rhinoplasty has been a big part of the surgical work of Mrs. Kypraiou for many years. With corrective operations in thousands of particularly difficult cases. The first surgeon in Greece to apply total reconstruction of the cartilage and bone skeleton of the nose but also the nasal septum with grafts of rib cartilage. She specialized in this method in America and has applied it in Greece since 2008.

She has great experience, technical dexterity, specialized knowledge acquired in many hours of carrying out successful corrective rhinoplasties during the last 15 years.

Surgical Planning:

Open access requires larger soft tissue detachment, but provides a unique sight of the structural tissue of the nose, leading to accurate diagnosis, but also surgical handling of the tissue with both hands.

Other benefits of the open method are stereoscopic vision, bleeding control, accuracy in placing grafts and sutures.

Strut, spreader, shield grafts are placed with ease and correct planning.

Open rhinoplasty access is preferred by specialized rhinoplasty surgeons particularly for the excellent formation of the nose tip.

Common problems requiring correction are:

  • Reduced nose projection (short nose)
  • Bad nose tip inclination
  • Nose tip asymmetries
  • Excessive upward turn
  • Increased bridge projection (too far from the face)
  • Pointed nose
  • Too narrow and low dorsum
  • Shrunken bridge with wide dorsum

Every particular problem in the shape and structure of the nose is resolved with specific corrective techniques. The use of grafts from the same patient is necessary in every case.

The source and extent of these grafts depend on the case.

Correct evaluation, planning and adequate realization of the operation provide excellent results, functional and aesthetic, which above all last over time.

Operation for Nose Restoration with Rib Cartilage Grafts

The successful restoration of the osteochondral skeleton of the nose is fundamental in remedial nose surgery.

Although cartilage nasal septum is the proposed graft, when it is excessively folded or has been removed at a previous operation, we have to find alternative sources.

When for example we need to restore the nose dorsum large quantities of grafts may be needed with the suitable length, width and volume.

Possible graft sources:

  • Nasal septum
  • Ear cartilage
  • Rib cartilage
  • Hip bone
  • Skull bone

From them, ear cartilage is not strong and it does not exist in abundant quantity for large modifications.

Therefore, reconstructions with ear cartilage have the risk of presenting visible irregularities over time.

Bone grafts are only used to increase the height of the nasal dorsum and for no other modification of the shape, e.g. in the tip of the nose.

Moreover, they only permit small modifications in shape and often bone absorption can be observed after surgery.

Autologous rib cartilage is the material of choice for increasing the height of the nose dorsum, but also for restoring the height in the bridge and the formation of the nose tip.

The grafts it provides are made thinner, in order to get the suitable length, width, volume if needed for the restoration of all parts of the nose.

We will need a small incision below the breast in order to harvest cartilage from the 50th to the 70th rib depending on the anatomy of each case.

We will harvest satisfactory cartilage length of about 3,5 cm and cut it into many thin sheets. Meanwhile, the nose will have been prepared by open-access rhinoplasty and careful tissue dislocations as there are always scar tissue and adhesions.

When the field has been prepared, graft assembly will begin and their connection to the cartilage possibly left over from previous operations.

This stage lasts for several hours, in order to cover completely all gaps where they exist, straighten and give height to the dorsum, improve nose tip asymmetries and deformations, correct the columella and anything else required in order to create a wholly natural nose with the suitable height and inclination that fits and appears proportional to the face. The results are reliable, totally natural and last over time.

Marked and destroyed noses draw the eye of the interlocutor and create huge psychological problems for the patient. With the method of total restoration we provide solutions for many cases which until now had to contend themselves with mediocre to disappointing results.

Nose Sculpting with the Use of Autologous Fat (Mista Technique)

Restorative rhinoplasty with the use of rib cartilage is used more and more because, due to the population’s need for augmentation rhinoplasty and therefore for many graft materials for the support of the nose.

The use of rib cartilage in augmentation rhinoplasty and the nose dorsum are simultaneously art and science.

The art regards the sculpting of cartilage in order to form the new nasal dorsum and support lateral walls.

Science has to do with the graft structure and the connection between them, but also with the pre-existing bone skeleton, so it matches the patient’s wishes.

Bree breathing is ensured.
The use of tiny fat pieces in rhinoplasty offers excellent possibilities for cover, while also benefit the healing of the afflicted skin and subcutaneous tissue.

Using micro-fat technique for the enhancement of soft tissue, the surgeon has the possibility to channel the fat pieces at an open surgical field, but also to proceed to augment soft tissue like those in the temporal fascia.

So, micro-fat technique has great dynamic in a wide range of aesthetic and restorative rhinoplasty and face operations.

Bloodless Rhinoplasty

Injectable hyaluronic acid implants have been used for decades for the correction of small imperfections in a nose plastic surgery.

As regards their use for the nose contours, patients must be selected.

It is therefore suggested in cases of:

  • Nasal dorsum augmentation
  • Corrective for small faults from injury or previous rhinoplasty
  • Asymmetry or small cavity
  • Bridge projection
  • Normalization of a nasal hump

Advantages

  • The duration of injectable implants is small, from 12 to 18 months
  • The result is reversible in case we do not like it
  • The results are immediate on the application day
  • No anesthesia or hospitalization is needed
  • The person concerned does not interrupt his work or activities

Risks and limitations

Implants are nor permanent and patients must return every six (6) months approximately for re-evaluation and treatment. Non-surgical rhinoplasty does not decrease the size of the nose, the width of the nose is not narrowed, the tip of the nose is not narrowed, tilted displaced nose is not treated. There is always the risk of edema, bruising or redness with the use of injectable materials.

Usually good-quality hyaluronic acid is used. If we use hydroxyapatite, the results last for 12 – 24 months. As the material is absorbed by the body, the shape of the nose will gradually return to the previous one, and this is true about all injectable materials.

The use of permanent materials like silicone in not indicated in the nose because it is accompanied by the possibility of inflammations, granulomas and skin reactions with a possibility of deformities. Small corrections – if we want to make them permanent – are preferably done with the use of a fascia or cartilage from the same patient.

Contact Dr. Argyro Kypraiou in Athens to find out the prices (cost). Useful advice is provided for a quick recovery after the operation.

Frequent Questions

Are there many different ways to have a rhinoplasty?

There are many different techniques we use in order to change the appearance of the nose. One hears open or closed method, but it only describes access, i.e. how we will use the skin.

However, the substance is below, in the cartilage and bone skeleton, which affects the shape of the nose.

The technique will be determined by the specific aims of each surgery, the anatomy of each case and the surgeon’s preference.

When can rhinoplasty be applied?

The patient’s development must have been completed, therefore it is usually applied near his age of majority. Of course, there is no maximum age limit for undertaking the operation, therefore, if the health of the interested person permits, he may undergo rhinoplasty at any time after his age of majority.

Will I have external sutures?

Sutures inside the nose are absorbable. If there is an external incision in the columella and it has thin sutures, they are all removed in the first week together with the splint.

How long will it take for the nose edema to subside?

The initial edema will last for about 4-6 weeks. During this period the nose will have the desired shape, but an almost complete reduction of the edema will take place at the first year approximately.

The surgeon’s experience and dexterity, the way he handles tissue are highly important regarding post-operative edema.

What kind of pain is there after rhinoplasty?

Many patients describe congestion and a sense of pressure but no pain at all after rhinoplasty.

When is breathing restored?

It is normal to have an edema also inside the nose after the operation.

In the first 1-2 weeks we prescribe physiological serum washes and special creams which help with the quick restoration of breathing.

Why are grafts used in rhinoplasty? What are they?

Often we need support, change in the inclination of the flap cartilage of the nose tip. The grafts are from the patient’s cartilage septum, the ear or the rib. They are particularly useful in corrective and remedial rhinoplasties and with their help we achieve substantial recreation of the destroyed nose. Mrs. Kypraiou believes it is important to use materials from the same patient for the formation of the nose.

What is the procedure before the operation?

  • A conversation is needed between the interested person and the surgeon in order to clarify what needs to be corrected, so that the patient is satisfied functionally and aesthetically.
  • The surgeon will study the cartilage and bone skeleton of the nose. Then he will also examine the nasal septum and undertake an endoscopic check.
  • Photos are taken of the nose from various angles and they are consequently stored in the computer. Via a program, an imaging projection is produced with the result of the operation.
  • The surgeon will collect the data and based on their analysis he will determine the planning part of the operation and decide on the techniques to be used in order to ensure the best result which will appear natural.

Selection of the suitable surgeon

A basic part of an operation is the knowledge of specialized techniques. However, the provision of an excellent result depends on the surgeon himself and his abilities. Therefore, aiming at the best, the responsible doctor must:

  • Be experienced
  • Have surgical competence and aesthetics

The successful rhinoplasty harmonized the facial features and offers natural beauty, youthfulness, renewed and improved self-confidence.