What is a classic nose correction?

Rhinoplasty is surgery to reshape the nose. This procedure can make the nose larger or smaller, change the angle of the nose in relation to the upper lip, alter the tip of the nose or correct bumps, indentations or other defects of the nose.

Advantages

  • The nose is positioned in the centre of the face and therefore has a big impact on the way you look.
  • If you look good, you will feel good.

Disadvantages

  • Difficult surgery and therefore risky if you go to the wrong surgeon.

How does a rhinoplasty work?

During a rhinoplasty, Dr van de Ven makes incisions to access the bones and cartilages that support the nose. The incisions are made inside the nose, so these are invisible after the surgery. In most cases, he will also make a small incision over the columella (the skin in between the nostrils) in order to have a much better view on what he is doing. After this incision has healed completely, it will not be visible for other people at a normal distance. Depending on the desired result, some bone and cartilage may be removed, or some tissue may be added (either from the septum of the nose or from one of the ears or a synthetic material). After Dr van de Ven has rearranged and reshaped the bone and cartilage, the skin and tissue are redraped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose as it heals. This splint should be worn for six days uninterruptedly and then another two weeks during the night to make sure the nasal bones do not move.

Dr van de Ven almost always administers general anaesthesia for this procedure. Only in case of small corrections to the tip, he might do it under local anaesthesia. He prefers that the patient stays one night in the clinic, but you can also undergo a rhinoplasty as an outpatient procedure.

Who is a good candidate for a rhinoplasty?

  • You may be a good candidate for rhinoplasty if the nose you were born with makes you unhappy or if you dislike the way your nose has aged.
  • Expectations are an important criterium in what makes a good candidate. The best nose surgery candidates simply want to improve their nose appearance, but do not seek perfection. The ideal candidates are well-adjusted and otherwise happy with their lives and do not expect that the rhinoplasty will transform them into someone else.

Minimum Age for Rhinoplasty

As long as the growth centres that are located in the posterior part of the septum of the nose are not damaged during surgery a rhinoplasty is possible at all ages. We prefer, however, to wait until the patient has reached the age of 16 years so he or she will be able to better overview the consequences of having a rhinoplasty.

Who is not a good candidate for a rhinoplasty?

Apart from the conditions mentioned above, a good health is an absolute requirement. If you have major health issues, these should be dealt with first.

How to prepare for a rhinoplasty?

There are no special preparations. Of course, your stomach needs to be empty at the time of surgery which means no eating or drinking as of six hours before the surgery.

How is an open rhinoplasty performed?

The open or external rhinoplasty approach makes use of a small bridging incision, called a trans-columellar incision, to connect the right and left nostril incisions.

In fact, most rhinoplasty experts regard open rhinoplasty as the procedure of choice for noses with a difficult anatomy of any type, and many of the most effective techniques of contemporary rhinoplasty can only be performed through the open approach. When performed correctly, the healed trans-columellar incision is often invisible and seldom results in an objectionable scar.

Sequence of procedures

If needed, Dr van de Ven starts the surgery by taking some ear cartilage, but this is rarely necessary as most of the time there still is cartilage available for grafting in the septum.

  1. Injection of local anaesthesia.
  2. Correction of septum (correction of deviation, lengthening, shortening) and graft taking for a strut to support the tip.
  3. Preliminary reduction of the hump/ lowering of the dorsum of the nose.
  4. Correction of the cartilages that support the tip (medial and lateral crura).
  5. Creation of the tip (double dome technique, lateral steal, interdomal sutures).
  6. Osteotomies (lateral and medial, intermediate on indication).
  7. Final lowering of the dorsum.
  8. Insertion of spreader grafts if necessary (to ensure a good air passage through the nose).
  9. Closure by suturing.
  10. Basal excisions (nostril size reduction, alar flaring reduction).

What to expect and do during the recovery period after a rhinoplasty?

The day of the procedure

  • Pain—Strange enough, pain is not really an issue after a rhinoplasty.
  • Congestion—The most obvious and slightly annoying symptom after a rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion in the first few weeks afterwards, until the swelling slowly subsides. This is usually at its worst in the first few days after the surgery. After two to three weeks, your breathing should have normalized.
  • Swelling and bruising—Swelling and bruising on the outside of your nose and cheeks is seen after surgery as well. This can sometimes be moderate and sometimes almost non-existent, but usually it falls somewhere in the middle of this continuum. Even in the worst cases, bruising is usually mostly gone within seven to fourteen days after the surgery.

The first week

  • Most patients plan to take about a week from work and other major activities.
  • You will have a cast on your nose and some stitches that need to be removed. This is all done six days after the surgery. Once the cast is removed, you will look presentable within one to two weeks after the surgery. You should not plan to have your wedding the week after, but your friends and colleagues should not be aware of anything. You can wash your face gently and put on a little cover-up makeup or foundation after one week.

The first month

  • Two to three weeks after the surgery, about 70% of the swelling is gone, so you should be starting to appreciate some changes. You will not really see the details yet though until about six weeks after surgery when about 80 to 85% of the swelling has gone down. While you will be looking pretty good after two weeks, you might still feel a little self-conscious. That is because your nose (especially your tip) will feel a little (or sometimes a lot) numb after surgery, no matter what technique was used. It can take anywhere from several weeks to six months or more for the feeling to return completely. During the first six weeks or so, your nose just will not feel like your own. Things like smiling and talking animatedly will feel strange.
  • Many patients are very afraid that they will do something to harm their result. While it is true that a major bump in the nose can cause unwanted healing problems, there are not too many things you can do to really harm the result, so there is no use in avoiding touching your nose. There are some things you can do, however, to speed up the healing process and get you back into camera-ready shape more quickly. Keep your head up after surgery. Keep some cool compresses over your eyes and cheeks in the first 48 hours. For a few weeks, avoid bending, lifting anything over a few pounds, exercising or anything that gets your blood pressure up. This may increase swelling and cause bleeding. Get a lot of sleep. Go outside and take some light walks. Eat well. In the first weeks, things will not look perfect so try to avoid staring in the mirror or over-analysing small changes.
  • Some other symptoms are also common in the months after surgery. Your nose may run more easily, especially when irritated. Your nose will tend to swell up a little when you exercise or do anything exceptional. The skin over your nose can break out more easily and can be more sensitive to sunburn. It is important to remember that with each subsequent revision surgery, this entire process of recovery is slowed down a bit. As a result, it is not uncommon that it takes up to two years or more to see some of the changes you seek if you have already had a revision procedure.

What are the risks of a rhinoplasty?

  • Anaesthesia risks
  • Bleeding (hematoma)
  • Infection
  • Poor wound healing or scarring
  • Change in skin sensation (numbness or pain)
  • Nasal septal perforation (a hole in the nasal septum) is rare.
    Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication.
  • Difficulty to breathe
  • Unsatisfactory nasal appearance
  • Skin discoloration and swelling
  • Possibility of revision surgery

How long can I expect the results of a rhinoplasty to last?

The results of a well-performed rhinoplasty last forever. Nevertheless, keep in mind that the natural aging process may mildly affect the shape and size of the nose.

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