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Surgeries

Nose correction (Rhinoplasty)

Video zur Nasenkorrektur in Zürich | Pevention Center Video zur Nasenkorrektur in Zürich | Pevention Center

In most cases this procedure involves reducing the size of the nose. The second most common request is for nose straightening. For nose operations, the experience of the surgeon is enormously important. Because of its prominent position in the middle of the face, only first-class results are acceptable.

The Rhinoplasty

Nose correction or rhinoplasty is an operation in which the external shape of the entire nose, or just the tip, is corrected through an operative procedure. If the nose is misaligned, there is often an additional deformation in the nasal septum, resulting in a breathing restriction. This can also be corrected during an operation on the external shape.

As part of the surgery, the size and shape of the tip of the nose can be altered, as can a bump on the bridge of the nose or misalignment of the entire nose. These undesirable features are often the result of an accident, or they can be congenital.

Nose surgerys are usually performed under general anaesthesia so that you remain asleep for the entire operation. A correction of the tip of the nose can also be performed under local anaesthetic.

Indications

A nose operation can be recommended for a variety of reasons: an undesirable bump on the bridge of the nose, a misalignment of the entire nasal skeleton, a fat nasal tip, or a very wide nasal bridge. Patients with a misaligned nose often also suffer from breathing restrictions, which are mostly caused by a crooked nasal septum. During the operation, the nasal septum is simultaneously straightened and moved to a central position. Nose jobs are useful when the size of the nose is out of proportion with the face. In terms of its size and shape, the nose should blend harmoniously with, or be in keeping with, the rest of the face.

Contraindications

The results of a nose correction are dependent on factors including local anatomical prerequisites. For example, if the skin on the nasal tip is very thick and has large pores, there is a limit to the subtlety of the result because of the coarser overlying skin, no matter how fine the shaping of the cartilage in the nasal tip may be. Realistic planning and proper explanation are therefore decisive in achieving the desired results. Widespread scarring from previous operations can also limit the operation results.

The surgical procedure

A nose correction usually takes 1 to 3 hours, depending on the extent of the procedure. The individual extent of your nose correction depends on your anatomical prerequisites, your personal wishes, and the recommendations of your surgeon. In principle the operation proceeds as follows:

For a closed rhinoplasty, incisions are confined to the inside of the nostrils and the nasal septum. None of these incisions are externally visible. An open rhinoplasty is carried out via an angled incision in the nasal septum. Open rhinoplasty is performed in approximately 90% of cases. The access point on the nasal septum becomes an externally visible scar. Due to very quick wound healing and very subtle scar formation in this area, only a very slight comma-shaped scar is usually visible, as early as a few weeks after the operation. Further incisions are made internally in the nostrils. This provides a precise overview of the cartilage and bone of the nasal skeleton, and of the initial anatomical situation of the nasal tip. As part of the operation, complex corrections of the nasal bone skeleton, the cartilage structure and the mucous membranes are performed. The operational procedure differs according to the preoperative planning. The process may only involve creating a new shape for the nasal tip, e.g. by refining a broad nasal tip and reducing its dimensions.

For noses that are too large or hooked, the operational procedure is more complex, and usually requires complete reshaping of the support framework of the nose, along with new cartilage definition. This includes reduction of a hooked nose, straightening of a crooked nose, and straightening of a crooked nasal septum when it is causing functional impairment (restricted breathing). This is often the cause of a trauma.

By transplanting structures taken from the nasal bone skeleton, it is possible to perform an extension of the nose and also to raise the bridge of the nose if this is deemed necessary.

After the newly formed bone structures have been fixed, the incision is sewn up, usually with dissolvable sutures.

For corrections made in the nasal septum area, a kind of internal splint is applied. It is made up of narrow silicone pieces that are to be worn temporarily.

In order to counteract excessive swelling of the mucous membranes, foam packing is then placed in the nostrils. For subsequent stabilisation, a multilayer dressing and plaster cast is applied and fixed in place with a head bandage.

Follow-up treatment: you are discharged after one overnight stay in the clinic. Small corrections, e.g. to the nasal tip, can also be carried out on an outpatient basis.

Results

With a correct indication for surgery and realistic expectations, most patients are very content and happy with the achieved result. The improvement in external appearance means the start of a new phase of life for most patients, with raised self-confidence and increased self-esteem.

In principle, nose job can be repeated. Regular checkups with your plastic surgeon can help to recognise and treat any complications that may arise.

Nose jobs are very complex and require a variety of operation techniques. Many variations and alterations are possible as part of a procedure to correct the shape of the nose. In order to clarify the exact changes to the face, we recommend creating an optical simulation in conjunction with our clinic in order to define a realistic objective for the operation.

A nose surgery can achieve an extremely high level of aesthetic improvement, often attaining aesthetic emphasis of the rest of the face. For example, an extremely large hooked nose distracts from beautiful cheekbones or beautifully shaped eyes. After the operation, the nose should not distract from other facial aesthetics in its size and shape, but should compliment them.

After the Rhinoplasty

In the first few days after a nose job you will feel pain in the wound area. This will limit your usual mobility. Pain relief medication will be provided.

The nasal packing inserted during the operation will usually be removed on the first day after the operation. The dressing will be removed within the next few days. In the first few days after the operation, you should allow yourself to rest as much as possible in order to minimise swelling.

Any swelling, haematoma and possible numbness of the skin should usually subside within a few weeks of the operation.

The sutures are removed eight to ten days after the operation, if required. At first the scar is red and firm. Over the course of several months the scar will become paler and will blend with the surrounding area. You may begin to treat the scar with suitable ointments and creams from the third week after the operation. For an incision inside the nose there is usually no need to remove the sutures, and the scar is not visible.

You can resume your normal daily life again after a few days, depending on the level of physical effort required.

However, you should plan to rest for the first week after the operation. Sport can be resumed after 6-8 weeks in consultation with your doctor. You should reduce your nicotine and alcohol consumption to a minimum after the operation, and avoid saunas and steam rooms for a few months.

It is possible to shower with the adhesive dressing in place. You should ensure that the dressing does not get wet.

Other:

  • Please contact your doctor if your wound dressing begins to slip, or if your condition worsens.
  • Discuss removal of the sutures with your doctor. Do not worry if you notice swelling, discolouration through haematoma, or a feeling of tightness. These are normal as long as they subside within the first few weeks. A feeling of tightness and loss of sensation in the area around the scars sometimes take months to subside.
  • The adhesive dressing is changed after approximately 1 week.
  • Light physical activity can be resumed after just a few days. Major physical activity such as sport should be avoided for at least 6 weeks. This helps with scar healing.
  • In the first few months, some clients report sudden shooting pains in the scar area (like pinpricks) for a short time. This pain is usually caused by reinnervation, which means that the skin nerves are starting to grow again, and the feeling improves with time.
  • The scars will appear red for a few weeks, but they become paler after a few months.

Risks & side effects

  • Post-operative infection, secondary bleeding with haematoma formation, loss of sensation in the skin.
  • Loss of sensation in the scar area. This usually improves within a few weeks/months, but can last longer (in rare cases).
  • Formation of skin folds in the area of the lateral incisions.
  • Swelling and discolouration from haematoma. This usually subsides of its own accord. Keeping the area cool can assist with this.
  • Secondary bleeding and haematoma may occur, even several days after the operation. For the most part, this requires no further treatment. An operation to stop the bleeding is only required in extreme cases.
  • The edges of the wound may come apart under mechanical stress, e.g. when combing hair. This can have an undesirable effect on scar formation and in very rare cases can even require a scar correction procedure.
  • In very rare cases, local anaesthetic or the additional injection of haemostatic medication during anaesthesia can cause undesirable side effects such as allergic reactions, or reactions to the anaesthetic (swelling, itching, severe circulatory reactions and shock), additional side effects in the central nervous system (restlessness, cramp, respiratory disorders), raised or lowered blood pressure, cardiac arrhythmia and slowing of heartbeat.
  • Rare inflammatory reaction of the wounds, especially with embedded sutures. This can extend treatment duration.
  • Scars: the operation cannot be performed without leaving scars. However, they are positioned in skin folds to ensure that they are as inconspicuous as possible and can be easily concealed. The natural redness of fresh sutures disappears after 2-3 weeks, but in rare cases it can last for several months. Small skin cysts may form in the scar area, but these can be treated quickly and easily.
  • Disruptions to scar formation: depending on the constitution of the patient, bulging, painful scars that itch may occur (excess scarring, keloid scarring). Keloid scarring usually subsides through conservative treatment without the need for further operations.
  • Excessive scarring of the skin and musculature really only occurs after years of nicotine misuse, or if there is severe internal bleeding with no inflammation. Scar deformations following complications such as these must often be improved with a follow-up procedure.
  • In some cases the cosmetic result may be unsatisfactory. This can be corrected with a further operation if necessary.
  • Straining can lead to the tearing of the sutures within the muscle or skin, which can require a follow-up operation.

Before & After Pictures

nose correction before nose correction after
nose correction after nose correction before
nose correction before nose correction after