What is rhinoplasty?

Rhinoplasty (nose job), is a surgical procedure performed in order both to create an improved aesthetic balance among facial features  as well as restoring breathing (functional rhinoplasty).

Which other problems can be corrected with rhinoplasty?

In particular, nose job improves the following:

• Increases or decreases the general size of the nose in order to enhance overall symmetry and aesthetic balance of the face
• Gives the nostrils a smaller or wider appearance
• Removes “humps or bumps” in the bridge of nose or improves nasal profile
• Modifies the projection/angle of the nose tip
• Gives nostrils a smaller or wider appearance
• Enhances overall symmetry

The most common causes of breathing difficulties are the following:

• Deviated nasal septum
• Hypertrophy of inferior nasal concha (turbinates)
• External nasal valve issues
• Internal nasal valve issues

A surgical procedure on the nose is performed first of all to improve breathing and, at the same time to identify and correct any nasal issues. Moreover, the goal is to enhance overall symmetry and aesthetic balance on the face in order to have the best result.

Dr Karmiris will explain you, in detail, the whole surgical procedure and will answer any questions related to that.

Functional VS aesthetic nose job

Aesthetic rhinoplasty, is the surgical procedure according to which we modify the shape and size of the nose, in order to deliver natural looking results that create an improved aesthetic balance among facial features to patients who do not have breathing difficulties. Functional rhinoplasty, is the surgical procedure according to which patient’s breathing is restored, without affecting nose appearance.

While purely aesthetic rhinoplasty or purely functional rhinoplasty are operations that can be performed separately, the most common scenario is a patient who would like not only functional, but also aesthetic improvement. In general, a deformed nose is often associated with corresponding functional abnormalities.

Who is a good candidate for a rhinoplasty?

Candidates for a rhinoplasty are the following:

• people whose concern is their nose appearance or have breathing or congestion issues
• an adult or someone with a fully developed face
• people without medical conditions that may delay recovery
• people with realistic expectations

What to expect at your first appointment:

At your first appointment, you will discuss:

• what exactly is your concern in the appearance of the nose and if rhinoplasty is the appropriate operation for you
• your past medical history, if you are on any medication, vitamins or other herbal supplements, if you have any allergies or any other operations in the past.
• if there is coexisting breathing or congestion issue, if you have precedent broken nose or previous surgical procedure on the area.
• if you smoke (if the answer is yes, how many cigarettes per day).

Afterwards, Dr Karmiris:

• will evaluate your general health condition and any other risk factors
• will examine you, he will take detailed measurements and he will evaluate aesthetic balance among facial features
• will examine your septum and your breathing
• will take preoperative photographs
• will discuss with you all the possible surgical options,depending on your case
• will discuss with you all the possible results of the surgical procedure and any risks or potential complications,as described in the international literature and finally
• will discuss with you about the anaesthetic plan.

Preoperative check

Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.

Also, it will be necessary to stop smoking preoperatively, and immediately post-operatively as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.

Rhinoplasty techniques

Rhinoplasty is performed under general anaesthesia. There are 2 main techniques of rhinoplasty:

• closed, where incisions are performed inside the nose
• open, which requires an external incision to be made along the columella (the strip of tissue just under the nostrils) allowing an accurate adjustment to the structure and shape of the nose.

Which are the advantages of the open technique?

The incision after 6 months is virtually undetectable, while the surgical procedure is performed with greater accuracy, especially if major interventions are necessary or there is a need for revision.

Through this incision, the skin covering nasal bones and nose cartilage is lifted carefully, allowing for better access and remodelling nose structure.

Specialized cases and treatment

An extremely large nose with dorsal hump, can be corrected by reducing nasal bones and cartilage, in order to achieve the best result.

If the problem is located at the tip of the nose, the correction is made either by using sutures or with the use of cartilage grafts in order to produce natural and beautiful results.

If the septum is deviated, it can be corrected in order to improve patient’s breathing.

During rhinoplasty, several times is required the use of cartilage graft for aesthetic, as well as functional corrections. This is achieved by using graft from the septum or in rare cases from other areas, such as the ear or the rib.

At the end of the surgical procedure, a single incision of 1cm will be detectable, along the columella.

Dr Karmiris will explain you the whole process in detail, and will discuss with you the appropriate technique, depending on your case, in order to have the best result.

Closed rhinoplasty

Closed rhinoplasty is performed as an alternative to the open technique. Instead of exposing the nasal structure, incisions are made in the nasal mucosa at various locations, in order to have access to different parts of the nasal cavity.

Closed rhinoplasty offers the patient reduced recovery time and undetectable scars.

However, as the nasal skeleton is not exposed, there is reduced access to specific parts as it is the tip of the nose. Endoscope can be used during closed rhinoplasty, in order to increase visibility. At the end of the surgical procedure, incisions will be stitched with sutures and silicone strips will be placed in the nose.

The goal of closed rhinoplasty is to enhance the symmetry of the face by changing the shape, size or angle of the nose. Closed rhinoplasty can be also used in order to correct breathing issues caused by abnormalities inside the nose.

Open rhinoplasty

An open rhinoplasty allows better access to nasal structures during the operation.

Open rhinoplasty, requires an external incision to be made along the columella (the strip of tissue just under the nostrils) allowing an accurate adjustment to the structure and shape of the nose.

The incision after 6 months is virtually undetectable, while the surgical procedure is performed with greater accuracy, especially if major interventions are necessary or there is a need for revision.

Through these incisions, the skin of the nose is lifted carefully, allowing better access and remodeling of the nose structure.

An extremely large nose with a prominent hump can be corrected by reducing partly nasal bones and cartilage, in order to achieve the best result.

In case the problem is located at the tip of the nose, the correction is made either by using sutures or with the use of cartilage grafts in order to produce natural and beautiful results.

Several times, if the septum is deviated, can be corrected in order to improve patient’s breathing.

During rhinoplasty, several times is required the use of cartilage graft for aesthetic, as well as functional corrections. This is achieved by using graft from the septum or in rare cases from other areas, such as the ear or the rib.

Less invasive techniques, such as closed or endoscopic rhinoplasty, may provide patients a reduced recovery time and sometimes a more cost effective option, however, the technique of open rhinoplasty is still widely used and remains the “gold standard” for nose restoration.

It is also important to emphasize once again that in open rhinoplasty, at the end of the surgical procedure, only a single incision of 1cm will be detectable along the columella.

The surgical procedure

The surgical procedure involves the following stages:

1^st stage – Anaesthetic plan

Options include intravenous sedation or general anaesthesia. Your doctor will suggest you the best option.

2^nd stage – The incision

Rhinoplasty is performed either by closed technique, where incisions are performed inside the nose, or by an open technique, where an incision is made along the strip of tissue just under the nostrils (columella).

Through these incisions, the skin covering nasal bones and nose cartilage is lifted carefully, allowing for better access and remodeling of the nose structure.

3^rd stage – Remodeling of nose structure

An extremely large nose can be reduced by removing bones or cartilage. Several times, nose surgical procedure may require nasal graft.

Usually, septum, that is the cartilage in the middle of the nose, is used for this purpose. Occasionally, ear cartilage can be used or rarely a part of the rib.

4^th stage – Correction of deviated septum

If the septum is deviated, it can be straightened and the projection on the nasal tip can be corrected, in order to improve breathing.

5^th stage – Incision Closure

Once the underlying nose structure is sculpted into the desired shape, nasal skin and tissue are reshaped and incisions are closed. More incisions can be placed on nasal creases, in order to change their size.

Recovery from rhinoplasty

Immediately after the surgical procedure, you will have gauzes into your nose, usually for 48 hours, as well as a splint for 5-7 days, in case of osteotomies. Swelling and bruising are healed in 7-10 days.

In general, the result is obvious immediately after the procedure, however the first month, you will have a significant improvement as swelling goes down.

In most cases, patients are discharged the same day. Dr Karmiris will give you particular instructions on how to take care of your wound immediately post-op, what medication you should take and when you will be seen for a follow up.

Risks and safety information

In general, rhinoplasty, is a safe surgical procedure if it is performed by an experienced Consultant Plastic Surgeon. Of course, like any other surgical procedure, rhinoplasty has some risks, as well as potential complications that every patient should be aware of and should fully understand, before entering operating room.

The most important potential issues are the following:

• Bleeding or haematoma
• Wound infection
• Poor healing
• Hypoaesthesia at the incision line
• Breathing difficulties
• Nasal septum perforation and need for revision
• Unnatural looking result
• General risks from anaesthesia such as deep vein thrombosis, cardiac or pulmonary complications.

Dr Karmiris will explain you, in detail, the whole surgical procedure and will answer any questions related to that.

For more information on rhinoplasty prices and cost, depending on the type of the surgery, book your appointment today with Dr Nikos Karmiris.