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Rhinoplasty (Nose job) – Rhinoplastica

Nose surgery – rhynoplastica – is one of the most demanding and most sophisticated surgeries in practice of esthetic surgery. A nose represents a centre of face; with its size and shape it gives the face an identity and expression. Beautiful form of the nose is reflected in its size – proportion, regular upper line, optimum width, finely shaped nostrils. Also, our airway begins with a nose. Some people have naturally big, cumbersome, deformed nose; some deformity is obtained as a result of injury. Often the external nose deformity is accompanied by the deformity of inner structures, which causes difficulty in breathing, especially while straining. Esthetic procedure done on a nose – rhinoplasty – corrects uneven cartilage/bone, a line, shape and length of a nose are corrected, the top is narrowed and defined with regard to the rest of the nose. Nose surgery is performed on nasal wings as well, as a way of adapting the nostrils. Functional procedure of a nose surgery is done for the sake of correction of a deviated septum and reduction of the enlarged nasal shell, which cause obstruction to the airway, and even sleep apnea. The level of nose correction mostly depends on the clients’ demands and wishes, which are expressed during the individual consultation with Dr. Aleksandar Milenović, PhD.

Description of the procedure

There are two main approaches to nose surgery: closed approach and open approach.
Closed approach implies that correction is done through incisions placed inside the nostrils; there are no visible cuts on the outside of the nose after the surgery.
Extranasal or decorticational approach implies a miniature incision on the outside of the nose, more precisely, on collumela, which heals quickly and with minimum scarring. Typical for this approach is that the skin at the tip of the nose is risen from the underlying cartilage, facilitating the approach to the tip of the nose.
Both methods of nose surgery are accepted as a world standard in esthetic surgery; likewise, they can be combined with a series of other procedures in order to achieve the desired effect.
What should always be kept in mind is that nose is already partially determined by its natural shape and dimensions. Nasal structure reduction that is too radical is not recommended because it can weaken the backbone of the nose. Firmness and thickness of the skin have an important effect on the result of the surgery, as well as soft tissue cover, which also limits to what extent the nose can be changed. Although the skin cover does not change, after surgery the skin must cover pre-formed cartilage, because excessive reduction of cartilage and bone can result in inadequate adaptation of the skin.

Candidates

It is very important to have realistic expectations. With regard to that, the goal of cosmetic nose surgery is not getting a “new face”, but reshaping the nose so that it fits into normal relations with the rest of the face.
The consultation examination includes the analysis of physical, i.e. anatomic conditions and possibilities of the procedures, as well as personal motivation and clients’ wishes. A good candidate
  • 1. is displeased with the size or shape of the nose
  • 2. wants to improve appearance
  • 3. has issues with breathing through the nose and snoring
  • 4. has experienced injury of nasal structures
  • 5. has an inherent malformation or deformity

Preparation

The patient will – during the consultations – get all necessary instructions for the surgery and postoperative period. Before the surgery, it is necessary to perform laboratory testing, make an EKG, prepare relevant medical documentation in case of some pre-existing diseases and disorders – results are to be brought for preoperative anesthesiological examination to Dr. Čandrlić. It is also necessary to fill in preoperative anesthesiological form, which you will be provided during the first examination.

During the anesthesiologic examination, the patient is provided with information on the type of anesthesia, regime of pre- and postoperative behavior – diet, hydration, activity, taking medication, etc. It is important to memorize that 6 hour prior to the procedure you are not allowed to eat anything; it is only allowed to drink water.

Three days prior to the procedure you should stop using painkillers and blood thinners from the group of nonsteroidal antirheumatics – acetylsalicylic acid (Aspirin, Andol,…). In that way, we prevent possible unwanted bleeding and hematoma (blood bruising) during and after the surgery, which aids and accelerates recovery and improves the result of surgery. You must also warn your anesthesiologist about the possible anticoagulant therapy.

For the sake of safety, everything that is necessary concerning the preoperative preparation, surgical procedure, and postoperative course will be consolidated during the final arrangement for the surgical procedure – personally or over the telephone.

Immediately before the surgery, in his suite, the patient changes into our one-time use clothing; takes premedication – for the sake of relaxation and against anxiety.

Course of the procedure

Surgery is done under general anesthesia, which means that you are asleep during the procedure. You can find out more about the anesthesiological examination in our Polyclinic and differences between general and local anesthesia, by clicking HERE. The procedure itself usually takes 1-2 hours.

During the surgery, cartilage and bone of the nose are reduced or reshaped and placed back to get a satisfying shape, appearance and size of the nose. For the design of the nose the cartilage of the nose (usually nasal septum), ear cartilage or rib cartilages usually used if these are insufficient (previously used), or a major reconstruction is required.

Recovery

The first 24 hours the nose and face look swollen with bruises (hematomas) and a light headache might occur. The nose does not hurt after the surgery. Recovery usually takes about seven days. During that time, plastic immobilization is placed on the external side of the nose, and there are tampons inside the nose; they are the only discomfort present in postoperative course, because there is a sense of stuffy nose. Tampons are extracted 2-5 days after the procedure.
Hematoma and swelling are minimal, they disappear gradually and spontaneously within eight days, and recovery is painless. It can be accelerated by using cold compresses and keeping your head elevated during the first couple of days.
During the next month, you should avoid great physical exertion and, normally, risk of injury.
After seven to ten days, the patient is ready to return to his/her usual activities.
Definitive shape and appearance of face and nose is evident after 3 months.

Precautions and limitations

If you are searching for improving the appearance, but not perfection, you’re physically healthy, psychologically stable and realistic in anticipation of the results of operation.
It is of utmost importance that the candidate for the surgery is mentally stable, balanced person, realistic in expectations – a person who wants to improve appearance or function, but does not expect perfection.
There is no unique method for rectification of each nose. Nose surgery is one of the most challenging procedures in plastic surgery of the head and neck. Knowing the different methods and their use, due to the specific problems of each individual is the only way to achieve optimal results: good functionality of the nose, which ensures normal breathing, harmonious overall appearance of the face and the satisfaction of the patient.
Today’s approach to rhinoplasty is different than it was before, and the nose is not viewed in isolation, but rather by trying to bring it into an optimal relationship with existing structures of the face, such as the cheeks, lips, chin and forehead. With regard to that, the goal of cosmetic nose is not getting a “new face”, but reshaping the nose so that it fits into normal relations with the rest of the face.

Side effects and complications

As with other operations, there can be certain complications (infection, bleeding), on which you will be informed during consultation. If you follow the instructions received, the risk of the above is much lower. It does not exclude the possibility of minor irregularities and asymmetries in the nose during the postoperative periods, which usually disappear within one year of the surgery. If you need a smaller secondary correction, it can be made only after at least one year after the first surgery.

Package

Package includes: first consultation examination with the doctor, preoperative examination by an anesthesiologist, surgery under general anesthesia, postoperative supervision, necessary medications, reviews and bandaging during the first postoperative days, extraction of sutures and necessary control examinations one year after the surgery.
Package does not include: preoperative laboratory tests (blood tests), ECG, intern’s examination, consulting with other specialists (specialist for diabetes, asthma, high blood pressure, thyroid gland, transfusion), medications that you will take at home.
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