Rhinoplasty and Naturalness

Rhinoplasty is a sophisticated surgery that requires technical skills and expertise. There is no such thing as routine rhinoplasty. Excellent surgical skills and experience are often required to achieve the perfect combination of nasal anatomy. Nowadays, refined aesthetic judgments are now put aside. On the other hand, using structural grafts to provide aesthetic and functional balance is essential.

Surgery should be planned by considering healthy breathing and aesthetic beauty together. Both the science and technical skills should be definitely at the forefront in the rhinoplasty. Of course, there is the artistic aspect of this job, but I think we, physicians, exaggerate this a little. Being a great sculptor doesn’t mean that you will perform this surgery perfect, or maybe, you can’t even do a charcoal drawing, but you can perform a perfect rhinoplasty operation. The essence of the job is catching the naturalness. The closer the result to naturalness, the more successful the artistic aspect of the surgery. This is not good news if someone who knows you realizes that you had plastic surgery.

When it came to rhinoplasty 30 years ago, small, upturned and slim noses came to mind. In other words, the same nose was seen as acceptable for each face. The same noses were easily understood that they were subject to plastic surgery. Unfortunately, breathing problems occurred after a while because the middle nasal vault was narrowed too much in these types of noses. This approach is desirable today. The basic philosophy of modern rhinoplasty is to make separate plans for each face, to create a balanced nose, and to catch the harmony with the other areas of the face. More frequent use of structural grafts also positively affects breathing in the long-term period.

There are two different techniques in rhinoplasty: open and closed technique. Years ago, the only method used in rhinoplasty both in Turkey and in the world was closed technique. In other words, the operation was performed by making all necessary incisions within the nostrils. However, it has been seen over the years that the results obtained with the open technique are much more successful and functional than the closed technique. Today, rhinoplasty surgeons, who have a say in rhinoplasty both in the USA and Europe, use closed technique when necessary, but they generally prefer open technique in their cases. In the open technique, a small incision is made on the columella that is not seen when looked at from the front and the anatomy of the nose can be fully controlled. In this way, it is possible to make more detailed fine interventions and naturally more successful results are obtained. Furthermore, bleeding is minimal as small vessels that may bleed during surgery can be intervened immediately and accordingly, the recovery is more rapid. The incision made on the columella almost disappears within 6 weeks at the latest.

Nowadays, rhinoplasty has become more challenging for surgeons due to its increasing specifics and details, however, with the advancing technique, it has become more comfortable and painless for patients. No tampon is inserted into the nose and swelling and bruises disappear within 5-6 days. Plaster or plastic mold is usually removed on day 7, and thin patches placed can be removed even by the patient himself/herself. The average period of return to work and social life is one week.

Many problems arise after a failed rhinoplasty including insufficient bone removal, lower nasal tip, excessive reduction of the nose, and continuation of the deviation or asymmetry in the nose. Of course, these functional and cosmetic defects can be corrected by correction surgeries called revision. However, the chance of success is always lower than the first surgery. Therefore, the surgical skills and experience of the physician are more important in revision surgery. After all, it is easy to operate the patient who will be operated for the first time, but revision surgery is not a procedure that can be performed by every rhinoplasty surgeon. Patients should be, therefore, very careful and selective when choosing a surgeon.

I see many patients who want to get a rhinoplasty but postpone it because of the season. However, this is a false belief. There is no recommended season or period for this surgery; it can be performed in four seasons for twelve months. Hot or cold weather does not affect the healing process. Anyone over 18 years of age can have this surgery.

In recent years, the number of male patients that have begun to get rhinoplasty has increased in Turkey. I have many male patients, especially from Southeastern Anatolia and Eastern Anatolia. Ethnic, geographical and cultural characteristics should be taken into consideration when performing rhinoplasty for men. Excessive reduction and narrowing of the nose and lifting the nose tip more than 100 degrees may cause a feminine looking.

In women, a droopy nasal tip causes a masculine looking. While arched nose creates a stern expression, small, thin and slightly upturned nose beautifies the expression in women. Throughout history, small nose has been seen as an expression of innocence.

There is also nasal congestion in most of the patients who want to get rhinoplasty in Turkey. Problems such as deviation, turbinates, and sinusitis must be resolved at the same time to ensure healthy breathing.