Rhinoplasty - Nose surgery - Surgeon approach
Surgical modification of nose, called rhinoplasty, is not only aesthetical operation, but it improves, or modify also one of the functions of this organ, which is respiring. Aesthetical and functional meaning of surgery is noticeably improving the psychical condition of operated patient, it's removing his complexes and adds to his physical and mental harmony.
Patient and his decision
The first and fundamental step before the decision about surgery execution is personal consultation with experienced surgeon. Patient should trust to the doctor not only with problems concerning his nose and breathing, but mostly with psychical reasons, it means the motivation, with which patient comes to the surgery and what he expects from it. That's why it's significant the part of presurgery analyse, pscyhological analyse, by the form of questionnaire at best. Every operation is individually specific and this corresponds also the individual approach of surgeon. The doctor has to carefully evaluate patient's health condition, age, he will complete local evaluation of nose shape or deformation, respirating, type of tissues, skeleton, character of skin and similar. He will get familiarized with patient's psychical condition and his motivation for surgery. On the base of his whole condition appraisal will practised surgeon decide, if the patient is suitable for intended form of surgery, or not. If he decide for performing of operation, he will explain to patient the problems of surgery and its plan. Sometime is the imperfection of the external nose complicated by deviated septum, asymmetry of nose hulls, or with chronic tumefaction of mucosa of nasal breathing way, and that's why it's on its place in these cases to cooperate with ORL specialist (ear nose neck - otorinolaringology) in the form of another examination, or also the partnership at surgery. In all of these phases is possible only approximately to estimate the end result of surgery, patient have to be aware of risks connected with surgery, that are not identical, but individually large. Every surgical operation, hence the nose operation too, has own specifics and the good result doesn't only depend on the surgeon's professionalism. Surgery is only the first phase, that the surgeon directly influence. The second phase, that is the healing process, does depend on the patient also and the surgeon could influence it only indirectly by his isntructions and advises. The phase after surgical operation and convalescence is long term process and individual to every patient. More or less you can say, that we can evaluate firstly the result of surgical operation after two months and definitely is beeing the postoperative phases ended not until one year.
Patient's appraisal
Every patient have to undergo internal and laboratory pre-operative examination, at best by the personal general practitioner, that knows well the patient's anamnesis. If the patient doesn't want to know his near surroundings about his surgery, is the best that internist, that is suggested by the surgeon, because it's also important the surgeon's trust to the honest internal examination. At some workplaces does also patient fill up and hand over the psychological questionnaire, that is evaluated by psychologist. The meaning of this is the objective judgment of mental condition of patient, because even this has important effect to the progress of surgery.
Surgical patient's assessment
1. age
Optimal age range for doing rhinoplasty is the time period from the end of the growth and puberty to thirty year of patient's life. The reasons are several:
a. Don't interfere intrusively to the growth of the patient by too early surgery.
b.To make surgical operation in the optimal time of age, when are tissues healed the best and skin cover, especially with reduction rhinoplasty, that are decreasing the nose's proportions, are well adapted thanks to natural elastic and contractility of skin. This ability is decreasing with the adding age.
c. Psychological reasons. Patient is thinking after surgery about - how his new look will accept his closest surrounding. Only his positive reactions are bringing him satisfaction and mental peace. We don't have to forget that, majority of people around thirty years is already formed person, has his family, friends, workmates at job. All had accustomed to his physiognomy. Too radical change, especially with mentally unstable patients, could elicit problems, because with adding age is decreasing the adaptability to new inputs.
2. local surgery assessment
It concerns particularly the tissues evaluation, where will the surgery take place. It is mainly the skeleton of nose, that consist of firm skeleton and soft lower third of nose, created by cartilages and soft tissues. This part, especially the head of nose and above head land, is substantially more risky in the healing phase. There are no external scars, because the surgery is made usually with cuttings inside of nasal inlets. Scars are so in the course of healing created inside, between the skin and by surgeon adjusted skeleton of nose. More strong scars may in the progress of postoperative healing negatively influence originaly nice shape of the nose, achieved by surgery. The head of the nose could enlarge and above head land could arch. Strong oily skin with distinct pores, shot with artery picture is less appropriate, or even not suitable for surgery, because it has tendency to heal with stronger scar. With this understandably moves up the risk of unfavorable postoperation result. It plays a role the individual disposal (for example the type of hypertrophied scar after vaccination). This fact couldn't be influenced by surgeon, that's why the patient have to think over very good in the case of risk factors, if his problem with nose is so significant, that he will overcome even the fear from possible complications and he will manage their consequences. In the firm part of the nose we evaluate the strength of bones, back of the nose, alternatively the bump, swerved from axis and similar. At this place is also appropriate to mentiond the problems of so called profiloplastic. In most cases is the shape of nose determined by the anatomy of whole face, that is in this case evaluated from profile. The shape deviations are often accompanied with deviations of chin shape. For example noticable nose is frequently accompanied with recessive chin and it depends on the good quality evaluation of anatomical profile by surgeon, if he more noticeably reduce the whole nose, or if he joins to nose surgery also the modification of lower jaw. Reducing or increasing surgery of chin is the object of another instruction, although it's closely related to the nose surgery.
Preoperative instructions
These instructions are for patients mandatory, with their breaking you are exposed to risk, that you will not be able to undergo the nose surgery!
After final examination by plastic surgeon and after his decision for surgery do patient go through preoperation internal examination. If all is allright, he will get contractual surgery operation date. Pay of the cash advance is patient's confirmation of his motivation and covers the expenses for the surgery preparation in the case he will let expire the deadline date. Every workplace does handle this situation in a contractual way.
At least one month before surgery is prohibited to use following medicaments: Acylcoffin, Acylpyrin, Anopyrin, Alnagon, Aspro, Defebrin, Harburettas, Mironal, alternatively others, containing the acetylosalicyl acid, that is lowering the blood sedimentation rate!
Patient has to count that he will need vacation for the surgery.
Before the surgery is accomplished whole body cleaning at home.
Patient will come in arranged time after the whole body hygiene, with washed hair, women without makeup. On an empty stomach. Don't eat from the midnight, don't drink and don't smoke.
All jewels including earring leave at home.
He will take the clothing, don't pull it over the head.
At the surgery day before the operation will anesthesiologist verify health condition of patient in the case of surgery in the full anaesthesia.
At patients living in the more distance from workplace is in their interest, to have in the first 5-7 days after the surgery secured the stay at the nearness of the workplace.
The travel shouldn't take more long than half an hour, that's because, to be able to get patient present to the inspection anytime when some complications or subjective problems appear. The doctor will determine the inspection regime before leaving.
During the release to home treatment is in the patient's interest to have provided escort. The workplace couldn't guarantee the complications, that could happen by the negligent transport.
Surgical operation
Surgeon will inspect the patient once more, he will go through the whole problems again, he will verify the identity of patient's opinions with previous conference just before the operation. The most of plastic surgeons do photograph surgical parts for the possibility of comparing with postoperational result. The type of choosen surgery is strictly individual, to get the result in harmony not only with face, but also with whole personality. It concerns the rhinoplasty corrective, reduction, transplantation, or autoimplantation (where is needed to compensate the bumpiness or to replenish the missing tissues, for example with gabled nose). Often is needed to come to combined surgery, needing not only the big experiences of surgeon, but also big aesthetical feeling. Rhinoplastic surgery belongs to the most demanding operations in the field of aesthetic surgery. Operation is performed in local or full anaesthesia. Soreness of surgery in local numbness is connected only to the first minutes of application. Then the patient only feels the move of surgeon's hands, pressures, tapping during on bone parts during the work, that could be feeled more or less as unpleasant, but not at all as a pain. The type of anaesthesia is dependant on surgeon and on his surgical procedure. Also the postoperational time stand the patients very well. The length of surgery does depend on complicity of the case. To the first-rate surgeon takes the operation about one hour. The surgery is ended with inner tamponade and external plaster shaping, or plastic splint.
Postoperation period
The first night sleeps patient under the control of personnel at the bed section. The stay can be in dependancy on whole health condition also a little longer. For the whole time he keeps inactivity at bed. He is breathing with mouth, because the nose is tamponed, and he is putting cold compresses at his eyes. Third or fourth day after the surgery he turn up for new bandage and after removal of tamponade he can breath by nose already. He cleans his nose with damp woolly bristles so often, to not leave in nostrils no drying secretion, so called drivel is not suitable. The term of another re-bandage will specify doctor. If there's accomplished so type of surgery, when are used non-adsorbable sutures, then they are removed seventh to eight day after the surgery. Controls of splint depends on surgeon. Optimal is, to get patient dwell for the whole time at the close of workplace, where he was operated and not be moving. Splint at the nose is being leaved approximately next ten other days, but this time is dependant on the procedure and progress of surgery and on the approach of surgeon and his experiences. After removing of splint during the inspection is optimal to put this splint in future at night for the time of one month. After lapse of one month will patient undergo another examination, where he is explained pressure massages, that he should perform according to instructions every two hours. Another patient's inspection is done two months after operation. Only this time is possible to evaluate the direct result of the surgical operation. For the whole two months we do suggest no sport or other activities, where could man arrive to injure or congestion of nose. But after two month is convalescence not yet ended. Nose as a dominant of face, has to slowly adapt to heat at summer seasons and to cold at winter. We don't suggest taking sunbath at summer (nos does swell up and it could stay pigmented). We generaly suggesting sunbathing not earlier than 3 month from any operation. In the winter is needed to protect the nose from cold, because it impends bigger danger of getting frostbitten. Nose could also get more redden. Only after passing the all year seasons we could say, that the shape of nose is stabilized. All these informations come from usuall postoperation progress. Recuperation js ofcourse individual and it depends in a big measure not only on given possibilities of healing to every patient and complete postoperation development, but it's also the reflection of studiousness of every patient.
I have no frostbitten nose pictures at my site at this moment. I am working on putting picture gallery of frostbitten pics here soon.