Classic nose correction
What is a classic nose correction?
Rhinoplasty is a surgical procedure that changes the shape of the nose. The nose can be made larger or smaller, the angle of the nose in relation to the upper lip can be changed, the tip of the nose can be changed, and bumps or indentations or other imperfections of the nose can be corrected.
Benefits
- The nose is located in the center of the face and therefore has a great influence on your appearance.
- When you look good, you feel good.
Cons
- A difficult operation with risks if you go to the wrong surgeon.
How does a nose job work?
During a nose job, Dr. van Nimmen incisions to access the bone and cartilage that support the nose. The incisions are made inside the nose so that they are invisible after the operation. In most cases he will also make a small incision in the columella (skin between the 2 nostrils) so that he can better see what he is doing. Once this incision has healed completely it will no longer be visible from a normal distance between people and usually not at all. Depending on the desired result, some bone and cartilage can be removed or tissue can be added (from the septum of the nose or from the ears or synthetic material). After Dr. van Nimmen has adjusted the bone and cartilage, the skin and tissue is repositioned over the structure of the nose. A splint is placed on the outside of the nose to support the new nose shape during healing. The splint must be worn continuously for six days and then for another 2 weeks at night to ensure that the nasal bones do not move.
Dr. van Nimmen almost always uses general anesthesia. He can only perform minor corrections to the tip of the nose under local anesthesia. He prefers that the patient stays in the clinic for one night, but day surgery is also possible.
Who is a nose job suitable for?
- A nose job may be suitable for you if you are unhappy with your nose. This may be due to its innate shape or the way your nose ages.
- Expectations are an important factor in determining suitability. The best candidates for nose surgery simply want to improve the appearance of their nose, but are not looking for perfection. The ideal candidates are otherwise happy with their lives and do not expect a nose job to change them.
Minimum age for a nose job
We prefer to wait until the patient is 18 years old and can better understand the consequences of a nose correction. The nose continues to grow. If you do have a correction, the growth plates can be damaged, which can change the shape as it continues to grow.
Who is not suitable for a nose job?
In addition to the above conditions, good health is an absolute requirement. If you have major health problems, they should be treated first.
How do you prepare for a nose job?
There is no special preparation. Of course, your stomach must be empty at the time of the operation, which means that you must not eat or drink for six hours before the operation.
How is an open rhinoplasty performed?
The open or external rhinoplasty uses a small bridging incision, called a trans-columellar incision, to connect the incisions in the right and left nostrils.
Most rhinoplasty specialists prefer open rhinoplasty when the anatomy of the nose is "difficult." In addition, many of the most effective and modern rhinoplasty techniques can only be performed using the open method.
If performed correctly, the healed trans-columellar incision is often invisible and almost never results in an objectionable scar.
Order of procedures
If necessary, Dr. van Nimmen can begin the operation by removing some cartilage from the ear, but this is rarely necessary because there is usually still cartilage in the nasal septum that can be transplanted.
- Injection of local anesthesia.
- Correction of the nasal septum (correction of deviation, lengthening, shortening) and removal of a transplant to support the tip of the nose.
- Preparatory reduction of the hump/ lowering of the bridge of the nose.
- Correction of the cartilage that supports the tip of the nose (medial and lateral crura).
- Creating the nasal tip (double dome technique, lateral steal, interdomal sutures).
- Osteotomy (lateral and medial, intermediate if indicated).
- Permanent lowering of the bridge of the nose.
- Placement and suturing of spreader grafts (strips of cartilage) if necessary (to ensure that air can flow properly through the nose).
- Closure by placing sutures.
- Basal excisions (reducing the nostrils and possibly the nostrils).
What can you expect and what should you do during the recovery period after a nose job?
The day of the procedure
- Ache —Oddly enough, pain after rhinoplasty is not really a problem.
- Blockage — The most obvious and somewhat annoying symptom after a rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion for the first few weeks after the procedure until the swelling gradually subsides. This is usually worst in the first few days after surgery. After 2-3 weeks, breathing should return to normal.
- Swelling and bruising — Swelling and bruising on the outside of your nose and cheeks is also common after surgery. This can range from mild to almost none, but most often it is somewhere in between. Even in the worst cases, bruising usually goes away within 7-14 days after surgery.
The first week
- Most patients stop working and other important activities for a week.
- You will have an aluminum splint on your nose and a few stitches that will need to be removed. This will be done six days after the surgery. Once the splint is removed, you will look presentable again within one to two weeks after the surgery. We do not recommend planning your wedding during that week, but your friends and coworkers should not notice any bruising or swelling. You can wash your face gently and apply a little opaque makeup or foundation after a week.
The first month
- About two to three weeks after surgery, about 70% of the swelling will have gone down and you will be able to appreciate the changes. You won’t be able to see the details until about six weeks after surgery, when about 80 to 85% of the swelling will have gone down. Even though you may look pretty good after two weeks, you may still feel a little self-conscious. This is because your nose (especially the tip) may feel a little (and sometimes a lot) numb after surgery, regardless of the technique used. It may take several weeks to six months or longer for the sensation to fully return. Your nose will feel like it’s not your nose for the first six weeks. Smiling and talking animatedly may feel strange.
- Many patients are afraid that they are doing something that could harm the result. It is true that a blow to your nose can cause unwanted recovery problems. However, there is not much you can do to harm the result, so don't be too careful when touching your nose. However, there are a few things you can do to speed up the recovery process and get back to looking beautiful faster. Apply cool compresses to your eyes and cheeks for the first 48 hours. Avoid bending, lifting (more than 10 kilos), exercising or other activities that raise your blood pressure for the first few weeks. This can increase swelling and cause bleeding. Get enough sleep. Go outside and take light walks. Eat well. Things won't look perfect in the first few weeks, so don't look in the mirror too much and don't focus on small changes.
- There are a few other symptoms that often occur in the months following surgery. Your nose may run more easily, especially if it is irritated. Your nose will swell a little when you exercise or do anything strenuous. The skin on your nose is more prone to breakouts and is more susceptible to sunburn. Keep in mind that after each subsequent revision surgery, the entire recovery process is a little slower. It is not unusual for a revision procedure to take two years or more before you see the changes you want.
What are the risks of rhinoplasty?
- Risks of anesthesia
- Bleeding (hematoma)
- Infection
- Poor wound healing or scarring
- Change in skin sensitivity (numbness or pain)
- A perforation (hole) in the nasal septum is rare. Additional surgical treatment may be necessary to repair the septum, but it may also be impossible to correct this complication
- Difficulty breathing
- The nose doesn't look good
- Discoloration and swelling of the skin
- Possibility of recovery surgery
How long does the result of a nose job last?
If the procedure is done correctly, the result will last forever. However, keep in mind that the natural aging process can have a small effect on the shape and size of your nose.
Rhinoplasty with rib graft
What is a rib graft rhinoplasty?
In some cases, after one or more rhinoplasties, so much of the patient's nose has been cut away that the nose must be reconstructed with cartilage taken from one of the patient's ribs.
Benefits
- Exceptionally stable results.
- Even the most severely damaged noses can be successfully treated.
- The rib graft is taken from an inconspicuous area.
- Any functional problems can be corrected at the same time.
Cons
- Duration and complexity of the operation (the operation requires time and special care).
- A rib graft needs to be removed.
- The nose will feel quite stiff.
How does a secondary rhinoplasty using a rib graft work?
A piece of cartilage about 3 cm long is taken from the patient's rib. In women, the scar is hidden by the fold under the breast. The rib graft is divided into slices of cartilage about 1 – 1,5 mm thick that can be used to build the nose.
What can a secondary rhinoplasty do for you?
This procedure can create a particularly straight, firm nose that remains stable in the long term and guarantees good breathing through the nose.
Who is a good candidate for secondary rhinoplasty using a rib graft?
Any healthy patient who has had too much of their own nasal cartilage removed, resulting in an unaesthetic nose that is often accompanied by breathing problems.
How is a secondary rhinoplasty using a rib graft performed?
A piece of cartilage is removed through a 3 cm long incision along the length of a rib in the skin fold under the breast. During the first 24 hours after the operation, a small catheter for the injection of a painkiller remains in the wound and the wound is closed in layers. The rib graft is cut into slices of 1 – 1,5 mm thick and stored in a saline solution (water with a little salt).
The open or external rhinoplasty uses a small bridging incision, called a trans-columellar incision, to connect the incisions in the right and left nostrils.
Most rhinoplasty specialists prefer open rhinoplasty when the anatomy of the nose is "difficult." In addition, many of the most effective and modern rhinoplasty techniques can only be performed using the open method.
If performed correctly, the healed trans-columellar incision is often invisible and almost never results in an objectionable scar.
Order of procedures
- Injection of local anesthetic into the nose.
- Correction of the nasal septum (correction of the deviation, lengthening, shortening).
- The reconstruction begins at the bridge of the nose. Two downward-facing pieces of cartilage are attached to the bony part of the septum.
- Another piece of cartilage is attached to one side of the spina nasalis anterior (at the transition between the upper lip and the nose) and to the two pieces of cartilage mentioned under point 3. In this way, the basic frame is built that will support all the other pieces of cartilage for the reconstruction of the nose.
- Thin pieces of costal cartilage are used to reconstruct the lower lateral cartilage that supports the nostrils so that the nose does not collapse during forced inspiration.
- Osteotomy of the bony part of the bridge of the nose (lateral and medial, intermediate if indicated). Sometimes the bone can be manipulated by osteoplasty instead of or in addition to osteotomy. Such bone manipulations are nowadays performed with electric or piezoelectric instruments (small and precise grinding stones and saws)
- If indicated, peripheral grafts or small onlay grafts can be used to further shape the nose into the desired shape.
- Insertion of a piece of temporalis fascia (strong fibrous layer around the muscle in the area of the temples) that can be wrapped around small blocks of cartilage on top of the bridge of the nose and sometimes on the tip of the nose. This is to make the whole thing extra smooth and prevent irregularities.
- Close with sutures.
- Basal excisions if necessary (reduction of the nostrils, reduction of bulging of the nostrils)
- Internal and external splinting of the nose. The splints are removed after a week.
What can you expect and do during the recovery period after a rhinoplasty using a rib graft?
The day of the procedure
- Ache—Oddly enough, pain after a nose job is never really a problem.
- Stuffy nose—The most obvious and bothersome symptom after a rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion for the first few weeks afterward until the swelling gradually subsides. This is usually worst in the first few days after surgery. Breathing should return to normal after 2-3 weeks.
- Swelling and bruising— Swelling and bruising on the outside of your nose and cheeks is also common after surgery. This can range from mild to almost none, but most of the time it’s somewhere in between. Even in the worst cases, most of the bruising will have disappeared within 7-14 days after surgery.
The first week
Most patients take a week off from work and other important activities.
You will have a cast on your nose and some stitches that will need to be removed. This will be done six days after the surgery. Once the cast is removed, you will look presentable again within one to two weeks after the surgery. We do not recommend planning your wedding during that week, but your friends and coworkers should not notice any bruising or swelling. You can wash your face gently and apply a little opaque makeup or foundation after a week.
The first month
After about two to three weeks, 70% of the swelling will have gone down so you will notice some changes. You will not be able to see the details until about 6 weeks after surgery because about 80 to 85% of the swelling will have gone down. Even though you will look pretty good after 2 weeks, you may still feel a little embarrassed. This is because your nose (especially the tip) may feel a little (and sometimes very) numb after surgery, regardless of the technique used. It may take several weeks to six months or longer for the feeling to fully return. Your nose will feel like it is not your nose for the first six weeks. Smiling and talking animatedly may feel strange.
Many patients are afraid that they will do something that will harm the result. It is true that a blow to your nose can cause unwanted recovery problems. However, there is not much you can do to harm the result, so do not be too careful when touching your nose. However, there are a few things you can do to speed up the recovery process and get back to looking beautiful sooner. Keep your head up after the surgery. Apply cool compresses to your eyes and cheeks for the first 48 hours. Avoid bending, lifting (more than a kilo), exercising or other activities that raise your blood pressure for the first few weeks. This can increase swelling and cause bleeding. Get enough sleep. Go outside and take light walks. Eat well. Things will not look perfect in the first few weeks, so do not look in the mirror too much and do not focus blindly on small changes.
There are a few other symptoms that often occur in the months following surgery. Your nose may run more easily, especially if it is irritated. Your nose will swell a little when you exercise or do anything strenuous. The skin on your nose is more prone to breakouts and is more susceptible to sunburn. Keep in mind that after each subsequent revision surgery, the entire recovery process is a little slower. It is not unusual for a revision procedure to take two years or more before you see the changes you want.
What are the risks of rhinoplasty using a rib graft?
- Risks associated with anesthesia (as with all surgeries)
- Bleeding (hematoma)
- Infection
- Poor wound healing or scarring
- Change in skin sensitivity (numbness or pain)
- Perforation of the septum (a hole) is rare. Additional surgical treatment may be needed to repair the septum, but it may not be possible to correct this complication
- The nose doesn't look good
- Discoloration and swelling of the skin
- Possibility of a recovery operation
- Pneumothorax (collapsed lung, extremely rare) caused by a small hole in the lung that is closed again.
How long can I expect the results of a rhinoplasty using a rib graft to last?
If the procedure is done correctly, the result will last forever. However, keep in mind that the natural aging process can have a small effect on the shape and size of your nose.