Rhinoplasty: The post-operative
Rhinoplasty is the most common cosmetic surgery. It can reduce or increase the size of the nose, change the shape of the back and tip, narrow the nostrils, change the nasolabial angle or the nasolabial angle. The ideal candidates for rhinoplasty are those who seek improvement rather than perfection in their physical appearance.
Rhinoplasty is also performed to improve nasal respiratory function.
It is preferred to perform this surgery after the complete growth of the bony structures of the face, that is, after the age of 16.
If rhinoplasty is performed by an experienced plastic surgeon, complications are rare and usually minor. In about 10% of cases, reoperation may be necessary, even if it is a minor one. The biological healing process in rhinoplasty is absolutely unpredictable and even an experienced surgeon can be faced with small irregularities that must be corrected with a second small operation.
The scars are always hidden inside the nostrils, except in the “open” technique which involves a small incision on the columella. An external incision is also necessary for the correction of the nostrils; in this case the scar is very small and heals well.
Preparation for the intervention
Do not take acetylsalicylic acid (aspirin and the like) from the week before the surgery.
Do not smoke or otherwise drastically reduce smoking in the two weeks before and in the two weeks following the surgery.
Postpone surgery to another date if you are recovering from an infection or other disease.
To prepare the patient for surgery, the final result can be prefigured through a computer simulation or in any case using photos of the patient himself. In no case, however, the correct images obtained can be considered a promise of results, as the computer simulation or the correct photo does not take into account the biological healing processes that come into play in a rhinoplasty.
The surgical intervention
The surgical procedure takes approximately one hour. The incisions are hidden inside the nose and the technique involves reshaping the osteocartilaginous skeleton according to preoperative planning after the latter has been separated from the skin. The skin is then redistributed, also thanks to the application of steri-strip patches, on the new scaffold. Sometimes an external incision can be made transversely to the columella to perform what is called “open” or “open” rhinoplasty (to be used above all for reoperations or for congenital malformations of the nose). In any case, at the end of the operation, tampons are placed in the nasal cavities and a plaster or a rigid plate is applied to protect the nasal pyramid.
In certain cases, the functional intervention of septoplasty and / or reduction of turbinates (diathermocoagulation, turbinotomy, turbinectomy) can be associated with the aesthetic rhinoplasty if the patient needs to improve nasal respiratory function. The two interventions can be conveniently combined so that with a single anesthesia and a single convalescence the patient will benefit from a functional as well as aesthetic improvement.
Rhinoplasty surgery is usually performed under general anesthesia, which is essential if functional intervention is to be associated with the aesthetic intervention; However, it can also be performed under local anesthesia with sedation only for the aesthetic component.
This type of surgery can be performed in the day hospital or with one day of hospitalization.
After the rhinoplasty surgery, the edema affects the oculo-eyelid region, where bruising can also occur as early as the first hours after the surgery. Typically this swelling tends to increase in the first 48 hours to begin to reduce from the third day onwards. The pain is practically absent and the discomfort deriving also from the nasal tamponade is well controlled by medical therapy. The swabs are removed on the second-third day (fourth-fifth day if a septoplasty and an operation on the turbinates has been performed); the external chalk is removed after 7-10 days.
Resumption of activity
Most bruising and swelling tend to go away within 10-15 days. Swelling of the nose is reduced over a much longer time; especially the tip is the one that takes the longest to return to normal. The average time for the disappearance of edema is 6 months, but it is not uncommon to have to wait even a year.
As for the resumption of activity, once the tampons have been removed, the patient can return to a normal life, always avoiding physical exertion for at least 15 days.
If the patient is a wearer of contact lenses, it is best to avoid them for the first 4-5 days after surgery; as for the glasses, once the plaster has been removed they can be placed on the bridge of the nose without this interfering with healing.
The new appearance
Rhinoplasty requires time and patience on the part of those who undergo the surgery because the complete recovery times are long. It is common experience of patients who undergo rhinoplasty surgery that the people closest to them do not notice a big change in the nose. This consideration should be interpreted as a synonym of successful intervention and not as a failure, as the physiognomy of the face has improved but not radically changed.
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