1. Does rhinoplasty leave scars?
Rhinoplasty produces virtually imperceptible scars. Certain noses allow scars to be hidden within the nasal cavity, leaving traces not apparent. In other cases, there are external scars that over time become imperceptible, either at the junction between the nose and the upper lip region (called the columella) or at the junction between the wings of the nose and the face. Such scars, when indicated, are intended to better harmonize the nose and treat its structures with greater detail.
Each patient behaves in a way in relation to the evolution of the scars and in the specific case of the nose, they usually become imperceptible. However, certain patients may be prone to unsightly healing (hypertrophic or keloid). This fact, as well as its family characteristics, should be discussed at the initial consultation. Light-skinned people tend to develop this type of healing less. However, this type of alteration in rhinoplasty is very rare.
2. What will my breathing look like after rhinoplasty?
Currently, rhinoplasty allows the correction of the aesthetic part and the functional part (respiratory) in the same surgery. Thus, if the patient has poor respiratory conditions before surgery due to some nasal anatomical alteration (deviated septum, for example), it may be corrected. In situations where, in addition to the aesthetic correction of the nose, some alteration in the nasal septum occurs, the surgery is called rhinoseptoplasty.
It is important to know that in the immediate postoperative period, up to about two weeks after surgery, there may be some difficulty breathing due to swelling (edema) that occurs in the inner region of the nose (mucosa) and the change in elasticity that occurs in the wings. nasal After this period, breathing tends to normalize. If the patient has allergic changes prior to surgery, such as rhinitis, they will not change, requiring clinical treatment for its improvement.
3. In rhinoplasty, can I choose any shape I want in my future nose?
No. In medical consultation there must be a consensus between the patient's desire and what rhinoplasty can provide. The possibilities of treatment in a rhinoplasty are numerous: to increase or decrease the nose, to thin the tip, to increase the projection (to burst) of the nose, to narrow the nasal wings, to narrow the superior region (bone) and to remove the excess of bone and cartilage. in this region. However, there is an aesthetic balance between the nose and the various facial structures that must be observed and maintained by the plastic surgeon after surgery. There are numerous measurements and proportions between the nose and the other structures of the face and each case must be thoroughly analyzed through physical examination, photographs and sometimes through imaging (such as X-ray and tomography) in order to provide the patient with best possible shape for your nose.
In addition to the limitations of the face, there are limitations that the nose wrap tissue has. Thus, people with thick nose skin can never have a thin and delicate nose like people with thin skin. As a result, each patient has a type of outcome that can be obtained. A rhinoplasty on a thin-nosed woman, such as Giselle Bundchen, for example, will have been very different from a nose job with thick skin and stronger facial features, such as Mike Tyson, for example. We can conclude by saying that the current trend of rhinoplasty is more natural results, removing the stigma of rhinoplasty with very small noses and totally incompatible with the face, as it once existed.
4. At what age can I perform rhinoplasty?
Currently, there is a growing demand for adolescents for plastic surgery. Younger and younger people are looking for cosmetic treatments such as rhinoplasty, liposuction or breast implants. However, greater caution is required when indicating rhinoplasty in these patients. Surgery may be indicated when the patient's facial development is completed, which usually occurs around 16 years. Thus, if the adolescent has a normal development for his age, surgery can be performed from this age without problems.
Because adolescence is a period of great changes, both physical and psychological, the consultation should be even more attentive, seeking to listen carefully to all patient complaints and answer their questions. Just as important as listening to the patient is listening to their caregiver, explaining both possible outcomes with rhinoplasty, as well as its postoperative evolution. With all the care taken, teenage rhinoplasty is certainly an extremely rewarding procedure, often improving the social life of formerly shy and withdrawn youngsters for more confident and self-confident personalities.
5. What preoperative exams should I perform before rhinoplasty?
Usually, preoperative examinations required before rhinoplasty are the usual for any plastic surgery: blood tests, chest X-ray and electrocardiogram. In the vast majority of cases, some imaging exam, such as computed tomography, is required to study the nasal structures in greater detail and better plan the surgery. If there is a deviated septum, an examination called rhinoscopy is also requested, in which, through a small camera, it is possible to visualize the internal structures of the nose, detecting the exact point and magnitude of the deviated nasal septum, as well as other existing alterations. inside the nasal cavity.
6. Will I need to fracture my nose? When is this need for surgery?
In many cases, fracture of the nasal bones is not necessary at surgery. The fracture is usually made after scraping off excess bone in the upper part of the nose, which many patients call “callus on the nose”. After this scraping, as the nasal bones are very thin, there is a lack of bone in the region where it was performed. The nasal fracture approximates the bones towards the middle, correcting such a failure. In addition, fracture is indicated in situations where patients have deviated upper nose (called nasal pyramid), which may be due, for example, to previous nose accidents or trauma, requiring fracture to center the nose and correct the deviation. The fracture may also be indicated in cases where patients have a very wide nasal pyramid (black people, for example), and there may be a thinning of this region of the nose with the fracture. In patients who have aesthetic changes only in the lower nose (called the nasal tip) and small prominences of the nasal dorsum (pyramid), a fracture is usually not required.
7. How long does the surgery take?
Much depends on the nose to be operated. In general, rhinoplasty lasts from 90 to 120 minutes, but surgery may take a little longer if there is deviated septum. In addition, noses that have already been operated on also require longer surgery, as existing fibrosis from previous surgery causes greater technical difficulty and greater caution during rhinoplasty.
8. What type of anesthesia is used?
In situations where septoplasty and nasal fractures are predicted, general anesthesia is usually used. If such situations are not programmed, local anesthesia with sedation may be used.
9. What is the length of hospital stay?
Usually 12 hours if local anesthesia with sedation is used and 24 hours if general anesthesia is applied.
10. Is the result of the new nose shape immediate after surgery?
No. As with any plastic surgery, there is a period for the definitive result to be achieved. The removal of the nasal bandage (a stiff, plaster-like plastic) is after the 7th day of surgery, so a swelling (edema) will remain in the nose that will gradually disappear. In addition to this edema, bruises will be noticed around the nose, spontaneously regressing until the 10th day of surgery. By the 2nd month, almost all of the edema will have regressed and by the 6th month it can be stated that the nose is no longer swollen.
In addition to edema, the nasal tip remains more hardened in the first months as a result of internal healing in the nose. This aspect also undergoes gradual improvement, and around the 6th month the tip tissues will have a consistency closer to what they had prior to surgery. Some variations in these periods may occur, depending on the greater manipulation of nasal structures during surgery, however, the permanence of edema for a longer period does not interfere with the final result of rhinoplasty.
11. For how long does the result of rhinoplasty persists?
If the patient does not suffer any trauma to the nasal region that changes its structure, we can say that the result of rhinoplasty is practically definitive. However, after age 50, the nose will show normal changes to facial aging, such as changes in the thickness of your skin and the consistency of your cartilage, which may cause minor changes in the shape obtained with surgery.
12. Will I feel postoperative pain after rhinoplasty?
Postoperative rhinoplasty pain is usually mild and perfectly controlled with common painkillers and anti-inflammatory drugs. Even if this mild pain occurs, it usually does not exceed the first five days postoperatively.
13. When can I sunbathe?
Strict sun protection is recommended for the first two months after surgery, especially if there are small external scars on the nasal wings and at the junction between the nose and upper lip (called the columella). After the 2nd month, it is recommended to use sunscreen during sun exposure to keep the scars clear and of good quality.
14. Will nose bandages be used? What and for how long?
At the end of surgery, the nose will be immobilized with a bandage made of a stiffened plastic (called aquaplast), whose function will be similar to that of the plaster, fixing the nasal bones until healing is established. This dressing will be removed in the office between the 7th and 10th postoperative day. Buffering with gauze inside the nostrils may be used, but will be removed within 24 hours prior to hospital discharge. After removal of aquaplast, a bandage (micropore) will be maintained over the nose to accelerate the absorption of the swelling and aid in the accommodation of the nose skin over the nasal tissues. Usually after the 2nd week of surgery there will be no more dressings occluding the nose.
15. Pode ocorrer sangramento pelas narinas nos primeiros dias após a cirurgia?
In the first 48 hours after surgery minor bleeding may occur, especially if septoplasty was performed. However, it is not usually a concern because a gauze dressing is left at the base of the nose for the first 48 hours to control these minor bleeds. This dressing can be changed at home if necessary, unlike the aquaplast bandage on the nasal pyramid, which can only be removed by the surgeon.
16. When can I perform physical exercises?
Physical exercises are released one month after surgery. However, contact physical activities such as wrestling, basketball and soccer are only released after two months, as this is the safe time for the healing of the nasal fracture that is usually performed during rhinoplasty.
17. I have deviated septum and would like to improve the aesthetic part of my nose. Can I perform both surgeries at the same time?
Yes. Even the association of nasal cosmetic surgery and septoplasty is very common, a situation in which the surgery is called rhinoseptoplasty. In these situations, the procedure may last a little longer, but hardly exceeds 3 hours of surgery. In this situation, greater rest care should be taken to prevent nosebleeds and the swelling inside the nose may be slightly higher, taking longer for the patient to have normal breathing after surgery. Even with this higher internal edema, usually after the first week of surgery breathing is practically normal, with most internal nose edema resolved.
18. In what position should I sleep in the early days?
For the first two weeks, the patient should sleep with his head slightly raised on the pillow to accelerate the regression of edema. Up to one month postoperatively, the patient should keep his head up, never laterally, so as not to touch his nose to the pillow and cause nose deviations.
19. Can rhinoplasty be associated with other plastic surgery?
Yes. It is very common to associate rhinoplasty with other procedures in the facial segment, such as eyelid surgery, cervical liposuction and face lifting. Less frequent but also possible is the association with body contouring surgeries such as breast prosthesis, abdominoplasty and liposculpture. Such associations should be discussed with the surgeon during the appointment, when at the surgery time, its confirmed the safety, postoperative comfort and feasibility of the association are expected.
20. What is the postoperative evolution of rhinoplasty?
Although the immediate result of rhinoplasty is already very good, it should not be forgotten that the result tends to improve even more along the months, providing an increasingly natural and harmonious nose to the face. Thus, in the first days after surgery, it is common to have some difficulty breathing, bruising around the nose and edema (swelling). In the first two weeks after surgery, blemishes and difficulty breathing tend to normalize, while edema takes a little longer to absorb (by the third month, about 80% of the edema is absorbed and the rest decreases gradually until the 6th month). Following the absorption of edema, the tip of the nose becomes increasingly natural due to the decrease in internal fibrosis in the first months of rhinoplasty, which makes the nose look slightly hardened. There are individual variations between patients regarding the specified time periods. If your evolution takes a little longer, do not worry, because your body will take care of dispelling the small disorders that may happen. The most important thing is to pass on any doubts to the medical team and not to listen to lay people.
Postoperative anxiety is normal and reflects the patient's desire to achieve the end result as soon as possible. It is important to control such anxiety and remember that no results in rhinoplasty should be definitively evaluated before the 6th postoperative month, and it is ideal to wait for a period of 1 year, since minor changes in edema and nasal tip shape can still occur until the end of this period.
21. Is the result of rhinoplasty worth it?
Certainly. Among the cosmetic surgeries, rhinoplasty is one that provides greater satisfaction to patients. However, it is important to remember that each patient is analyzed individually during the consultation with the plastic surgeon, at which time all the details reported here are clarified, as well as any other questions you have regarding the surgery. If the decision to perform the surgery is mutual (doctor and patient), the result pays off. Otherwise, if the expectations cannot be fulfilled or if there is something that prevents rhinoplasty, the doctor should be the first to refuse rhinoplasty.
22. Are there risks in rhinoplasty surgery?
There are rarely serious complications after rhinoplasty surgery. This is due to the fact that each patient is properly prepared for surgery, indicating the procedure correctly and explaining details during the appointment and results that can be obtained with it. However, as with any surgical procedure, there are risks such as bleeding, surgical infection, anesthetic complications, bruising, nasal obstruction and irregularities.