Open rhinoplasty
Rhinoplasty is the operation to reduce or refine the nose, and it is one of the most frequent facial surgery requests. The reason may be simply that the person is self-conscious of a large hump or a prominent tip or it may just be that this is the subject of irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities or deviations with or without associated breathing difficulties. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. For men, it can mean that the nose disturbingly dominates the face. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.
Am I suitable for this facial cosmetic surgery?
Only a consultation can establish this. A consultation will determine a few things. You will be asked about your general medical history, which will include questions about any previous nasal surgery or injury. If you require corrective surgery to the nose as a result of a previous rhinoplasty it is important to wait at least 1 year before any further facial cosmetic surgery is attempted. Enquiries will also be made as to your breathing patterns and whether you suffer with any nasal obstruction. Many times this can also be addressed at the same time as a rhinoplasty. Mr. Solomos will then want to know why you are unhappy with the shape of your nose. The most common request is to reduce the size and alter the shape of a large nose, but occasionally an increase in profile or projection is requested. During any cosmetic surgery, the greatest risk is that the surgeon will not give you what you want. This problem can be greatly alleviated by ensuring that Mr. Solomos knows exactly what it is you want. If you don’t have a thought or a picture in your mind about how you would like the nose to be, then at the very least, try to let him know what it is that you don’t like about your nose. This way he can try to explain to you what can or cannot be done. Remember Mr. Solomos will always give a nose that he feels is attractive and proportional in size and shape to the rest of your face. However your input is of vital importance also. Many people like to bring in photographs, at the time of consultation, of a nose which they would like to have. This can give the cosmetic surgeon a feel for the type of nose you may like to acquire. It is important to realise however, that every individuals nose is different and so one cannot expect to have a very small, delicate nose made from, for example, one that has a large amount of thickened skin. If this is the case, Mr. Solomos will always try to make this clear to you.
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What does the Operation involve?
The operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required. If alar base reductions have been performed then the scars will be found tucked into the base of the nostrils within the natural skin fold. These are also generally well hidden by the natural shadow cast by the position of the nose. In complex tip cosmetic surgery, you may require an external incision (open rhinoplasty) carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately. Any bump on the bridge is removed with a delicate chisel to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) can be altered accordingly. Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. Sometimes this is done with internal stitches, other times a small segment of your own cartilage is used. When the surgery is complete, small dissolvable stitches are used inside the nostrils and then foamy nasal packs are inserted. These packs are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. Indeed it is exceedingly rare for significant bleeding to occur following a Rhinoplasty. Finally a plaster cast is placed on the bridge and held in place by tape on the forehead and cheeks.
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What type of anaesthetic is used in this facial reconstruction surgery?
A rhinoplasty is usually performed using a general anaesthetic, and frequently requires an overnight stay in hospital. Occasionally a local anaesthetic can be used for more minor work such as narrowing of the nostrils. In the latter instance then this can be performed as a day case.
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How long does the cosmetic surgery take?
A rhinoplasty takes approximately 1 hour to perform.
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What happens after the cosmetic surgery?
After the cosmetic surgery you will notice that you will be propped up in bed with a couple of pillows in order to elevate your head and thus reduce the swelling around your nose. You will also notice that it will be difficult to breath through your nose. This will be because you will have packs placed inside each nostril.In this case you will automatically breathe through your mouth, so please do not panic! Understandably, most patients report that the packs are the most unpleasant part of the whole operation. This is not because these are painful, but because you are forced to breathe through your mouth until these are removed, the following morning. However even after these are removed, your nasal passages will still feel somewhat blocked for the first couple of weeks due to normal post-operative swelling and congestion. The bridge of the nose is usually protected after the operation by a plaster cast, held in place with tapes across your cheeks and forehead, and which is worn usually for about 7-10 days. During this time you should avoid blowing your nose, stooping, and any vigorous activity for next three weeks. After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure (see postoperative instructions). However, rarely it is necessary for medical intervention to stop difficult bleeding.
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What kind of after effects of the cosmetic surgery should I expect?
After the cosmetic surgery, as the nasal bones are usually broken and reset, you should expect to have “black eyes” and some swelling of the face. This usually settles by 2-3 weeks although as soon as the plaster cast is removed you may, in fact, apply light make up to mask this if you like. It is very important to realise that even once the plaster cast is removed from the bridge of the nose there will almost certainly be a significant degree of swelling still present. Therefore the shape of the nose at this stage is not the final one. Moreover, many times the nasal bridge looks quite narrow and slim immediately once the plaster is removed, but then subsequently swells up again due to normal healing process. This obvious swelling will however rapidly decrease in the ensuing 3-4 weeks. However, it is important to remember that even after this time, the shape of the nose is still not the final one. This is partly because of scar tissue which will form underneath the skin of the nose, as a result of the surgery, and which will have a subtle volume effect on the final shape giving rise to some fullness and width to the nose. These internal scars gradually change their shape (called scar maturation) and resolve in time. It is important that the tip of the nose in particular is regularly massaged in order to prevent the internal structures from becoming fixed by this scar development, in an undesirable position. You will be instructed in this. The process of scar maturation will take up to one year, sometimes longer, to complete and therefore only after this time is the final ultimate shape of your new nose apparent. As a simple guide in assessing the progress of your nose, you should gently squeeze the tip of a normal unoperated nose, and then your own to compare the firmness. The firmer it is, the more time is required for it to settle. Bear in mind of course, that it is possible for an unacceptable result to occur because of the sometimes-unknown effects of healing and settling. During the initial weeks, and sometimes months, the nose tip usually feels numb. This invariably recovers as the nerve supply to the skin regenerate
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Is the cosmetic surgery painful?
Remarkably enough, pain after this operation is not usually a problem and is easily relieved by an injection in the first few hours and a mild painkiller such as paracetamol as necessary afterwards.
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What are the Scars like?
In most instances, all the incisions for a rhinoplasty, are placed well within the nostrils and therefore cannot be seen. However as mentioned already (see Operation), in some instances external scars may be needed to reduce the nostril size or to perform more complex nasal tip work. Although these scars are usually red and lumpy for the first few weeks, they do tend to settle in time. However, you must bear in mind that it is impossible to predict the final appearance of any scar.
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What could go wrong in the cosmetic surgery?
All plastic or cosmetic surgery carries some uncertainty and risk. When a rhinoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Infection, as in any operation can occur but is thankfully quiet uncommon. Occasionally though, a “Blind boil” type infection may occur on the skin of the nose. These can be quite uncomfortable and may take a week or so before they finally settle. After your discharge from the hospital it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following delicate application of pressure (see postoperative instructions). However, rarely it is necessary for medical intervention to stop difficult bleeding. Irregularities of skin, bone or cartilage may occasionally appear following surgery. These may show up on the surface as slight depressions, dips of bumps. Although through conservative measures and time, most of these situations improve, additional surgery may occasionally be required for correction (2% incidence). Very rarely a perforation in the nasal septum may ensue from this plastic surgery. If this occurs corrective surgery may be needed. Occasionally however it may not be possible to correct this complication. Some degree of nasal obstruction may also ensue after the surgery. Usually this is short-lived and is a result of a mild pre-existing nasal obstruction which may not have been noticed prior to the surgery, but became somewhat exacerbated following the surgery. In this situation, revision surgery to improve the situation is sometimes warranted. Following a Rhinoplasty it is possible, but again quite rare, for a series of thread or spider type veins to occur. These are permanent. However, they can be treated effectively by laser. It is also quite possible that surgery on a badly deviated or bent nose may not result in a perfectly straight, well-aligned nose. Many reasons may be responsible for this but it is conceivable, in particularly difficult situations, that two or more procedures may be required to remedy these noses. You will be advised at the consultation for the cosmetic surgery what the likelihood of this occurrence will be with you. Overall however, there is a definite incidence of about 2% of patients who, along with their cosmetic surgeon, feel that the shape of the nose at the end of 9-12 months is not quite what was intended. This happens more frequently in noses that have been the subject of severe nasal injury or previous nasal surgery. In these situations further procedures may be necessary to achieve correction. When secondary (from a previous operation) or revision surgery is carried out however, a higher incidence of complications and a higher degree of uncertainty with respect to the final results can be expected.
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How long before I'm back to normal after cosmetic surgery?
In most instances, all the incisions for a rhinoplasty, are placed well within the nostrils and therefore cannot be seen. However as mentioned already (see Operation), in some instances external scars may be needed to reduce the nostril size or to perform more complex nasal tip work. Although these scars are usually red and lumpy for the first few weeks, they do tend to settle in time. However, you must bear in mind that it is impossible to predict the final appearance of any scar.
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How many Rhinoplasties does Mr. Solomos perform?
In accordance with the National Healthcare commission guidelines, and according to the last five years (2002 -2006) of annual audit figures submitted to the Hospital of Highgate and BMI Hospitals in London, Mr. Solomos performed on average 140 rhinoplasty procedures per year. In the last 10 years he has performed over 1200 rhinoplasty procedures.
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