RHINOPLASTY, COSMETIC SURGERY OF THE NOSE

Rhinoplasty corresponds to the cosmetic surgery of the nose. The procedure consists in the improvement of the nose aesthetic appearance.

Rhinoplasty can be performed alone or in combination with a cosmetic chin surgery also called genioplasty. The combination of these two simultaneous surgical procedures will modify the facial profile of the patient.

The aim of the procedure is to obtain a nose with a natural look in harmony with the rest of the face and not a “rebuilt” and artificial aspect.

Principle of the procedure: the scars are hidden inside the nose, the architecture of the nose consists of cartilage and bone that will be modified to correct the defects. The skin covering this architecture will comply with these changes, hence the fundamental role of the skin quality regarding the final appearance of the nose.

If there is difficulty breathing due to nasal obstruction, surgery of the nasal septum (septoplasty) may be performed simultaneously. In this case, the cosmetic surgeon will perform a rhino-septoplasty.

Preoperative consultation is fundamental before a rhinoplasty. Consultations take place at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by car).

A thorough interview with the surgeon is essential to know the discomfort and the wishes of the patient. Dr. Jean-Charles BAYOL always begins his examination with a complete analysis of the face. The nose can be studied only in the overall facial context; the nasal septum will also be examined.

Photos taken after the clinical examination will enable to simulate, on a picture of the patient’s profile, the appearance of the nose after the rhinoplasty. This simulation will correspond to the points that have been discussed with the cosmetic surgeon. The final result of the rhinoplasty will not necessarily be superimposable with the preoperative simulation.

As with any surgical procedure, refrain from smoking is strongly recommended before surgery.

Rhinoplasty is usually performed under general anesthesia, sometimes under a conscious anesthesia (neuroleptic sedation) and exceptionally under local anesthesia.

Rhinoplasty can be performed as an outpatient surgery (check-in and check-out the same day of the procedure) at Laclinic in Montreux. For greater security, Dr. Jean-Charles BAYOL advises a one-night hospitalization with a check-out from the hospital the next morning.

Each nose is unique and each face is unique, Dr. Jean-Charles BAYOL adapts his technique to each patient to accurately correct the defect and get the best result. The different stages of the rhinoplasty are:

• The scars (Figure 1):

Figure 1: different incisions of the rhinoplasty

Most often incisions are hidden in the nostrils and will therefore be invisible.

In some cases, scars may be visible in the middle of the columella (external septum separating the nostrils), when the patient wants a modification of the tip of his/her nose or if the patient has already had a rhinoplasty. If the nostrils are too wide, they will be reduced by an incision at the root of the wings of the nose.

• Dissection:

Through the scars, the osteo-cartilaginous architecture of the nose will be dissected, both on the surface (detachment of the skin) and in depth (detachment of the mucosa).

• Correction:

The osteo-cartilaginous architecture will be modified to correct the defect:

-To remove a bump on the edge of the nose (Figure 2)

Figure 2: Ablation of the bump on the back of the nose

-To correct a nose tip (Figure 3).

Figure 3: Correction of the nose tip

Modern rhinoplasty techniques frequently involve re-inclusions of fragments of cartilage and / or bone that have just been removed.

• The closing :

The incisions are closed with dissolving stitches inside the nose and non-dissolving sutures at the level of the columella or the wings of the nose.

• Strings and wicks:

Each nasal cavity is packed with wadding for 24 hours if there is no deviation from the nasal septum. If the septum is deflected, rigid splints will be placed in the nasal cavity and will be kept for 7 to 10 days. The new shape of the nose will be maintained and protected on the surface by Sterile strips and a splint made of plaster or customized thermally formable plastic. This plaster splinter will be kept for 10 days.

Depending on the type of scar and the corrections to be made, the procedure can last from one to two and a half hour.

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Cosmetic nose surgery generally causes little pain, but the patient will have difficulty to breathe through the nose. In order to prevent nasopharyngeal infection, antibiotic treatment and local care will be prescribed.

There are frequent bruises and swelling around the eyes (edema) that can be impressive for the patient and his entourage. They usually regress between 10 and 20 days.

To reduce the importance of the postoperative follow-ups, you will be systematically taken care of by the department of physiotherapy, for a postoperative care. The check-out will happen on the same day, in the case of an outpatient hospitalization, or the next day, if you stay in hospital overnight. Gentle massages of the operated areas and LED care will ensure the lymphatic drainage and will promote the healing process. Several weeks after the procedure, an LPG treatment can be undertaken on the areas where the fat tissue has been collected.

The packed wadding in the nasal cavity will be removed the day after the surgery, the splint on the back of the nose will usually be removed around the 10^th day. In case of an associated septoplasty, rigid splints inside the nasal cavity will also be removed on the 10^th day.

The practice of combat sports can be resumed at least three months after surgery, other sports can be resumed after 4 to 6 weeks.

It takes around 3 to 4 months for the edema to regress completely and to get a glimpse of the result. This result will be considered final after a year. It corresponds to the patient’s wish and is mostly similar to the simulations carried out before the procedure.

The benefit for the patient is not only aesthetic but also psychological.

They may be caused by unexpected healing reactions, poor skin draping (when the skin is thick) or scar fibrosis:

• Contour irregularities.
• Persistent nasal asymmetry, especially when it existed before. It should be noted that there is always a certain degree of asymmetry between the two sides of the face.
• Progressive deformations of the tip of the nose, linked to scar fibrosis and / or to a bad retraction of the skin, especially in case of a thick skin.
• Subjectivity: Because the intervention is motivated by aesthetic reasons, the results can only be assessed subjectively. It is therefore important to recognize that the obtained results may not correspond exactly to the expected results.

It may also be a deficiency in the surgical correction (small persistent bump) which can easily be corrected under local anesthesia. An excess of correction will be more difficult to correct.

As for any cosmetic surgical procedure in general, one must remember that the modifications must always be reasonable and natural. Since excessive correction is more complex to rectify, the situation can lead to real discontent.

The risk of surgical retouching is therefore not negligible regarding a rhinoplasty. If necessary, this can be done under local or general anesthesia. It should not be done less than one year after the initial procedure. It is indeed necessary to wait for the complete disappearance of the scarring phenomena to operate under good conditions.

A rhinoplasty is a cosmetic surgical procedure, but like any surgical act, it carries risks even if they are rare:

• The complications related to anesthesia:

They remain exceptional. The anesthesiologist will inform the patient of the risks associated with anesthesia during the preoperative consultation.

• The complications related to surgery:

As for rhinoplasty, more than for any other cosmetic surgery, the experience and the skills of the cosmetic surgeon are fundamental. The choice of the cosmetic surgeon is important when one desires a cosmetic nose surgery because a qualified surgeon will reduce the risk of rare complications:

• Bleeding (epistaxis): frequent during the first 24 to 48 hours, they are moderate.
• Hematomas: rare, if they are important, they must be drained.
• Infection: infections are rare because the nose naturally contains bacteria.

Dr. Jean-Charles BAYOL will prescribe antibiotics to avoid any superinfection of the sinuses due to the congestion of the nasal cavities.

• Abnormal scarring: These are scars at the level of the columella or at the base of the wings of the nose. If necessary, surgical retouching under local anesthesia may be performed.
• Sore skin
• Persistent edema of the tip of the nose in the case of a columellar scar (open path).
• Functional ventilatory troubles with inspiratory discomfort.
• Modification of the sense of smell
• Imperfections of result: (see above)

Rhinoplasty is a cosmetic surgical procedure that gives great satisfaction to the patient. The experience of the cosmetic surgeon is very important to limit the risk of complications and imperfections of results that may exist.

During his training, Dr. Jean-Charles BAYOL specialized in cosmetic surgery of the nose, frequently performs this procedure at Laclinic in Montreux near Lausanne, where the whole team will listen to you and will take care of you to make this procedure a real success.