23 July 2019 What is rhinoplasty and septorhinoplasty? The nose being a central structure of a person’s face, it is comprehensible that rhinoplasty (cosmetic nose surgery) is the most frequent surgical procedure in facial plastic surgery . In theory, in rhinoplasty there is only an aesthetic correction of the nose, but in septorhinoplasty , besides the aesthetic aspect, the surgeon also performs a functional correction , that is, the treatment of nasal septum deviation. In practice, the great majority of rhinoplasties require some level of approach of the nasal septum, being really septorhinoplasties. The shape of the nose is closely related with the nasal septum and the septal cartilage may be used for different grafts, allowing an optimal combination between the aesthetical and functional aspects of the correction. In what situations rhinoplasty may be indicated? Rhinoplasty may be indicated when it is necessary to correct the aesthetical component and, in most cases also, the functional component of the nose. Typically, this procedure can be made in late adolescence (around 17 years old). However, in more extreme cases, it can be applied in childhood , namely in result of traumatic situations, for instance, after accidents affecting the nasal area. How is the need for a rhinoplasty determined? In what concerns the aesthetical component to be corrected, it is essential a consultation with the surgeon and an honest and realistic conversation about the patient’s expectations and the expectable surgical result . In the postoperative phase, a photographic registration is made, fundamental for an individualized analysis of each case. In what concerns functional correction, the inside of the nose can be observed via nasal endoscopy (painless procedure and easily tolerated, performed in consultation). Sometimes, a computed tomography (CT scan) is needed for a more detailed evaluation of nasal and nasal sinus anatomy. Managing the patient’s expectations, namely the final aesthetic aspect, is an important issue. A very straightforward conversation between doctor and patient is fundamental. Often, what the patient considers to be a big problem is not really so. The help of software to simulate the final aspect can be an excellent tool to ease the communication between doctor and patient. It is important that the patient sees other cases already operated by the surgeon to identify himself with the results obtained. How is rhinoplasty performed? During the preoperative consultation, a pre-anesthetic assessment is done. Usually, the rhinoplasty is performed with general anesthesia, for greater convenience of the patient. However, it can also be performed with local anesthesia and sedation. The surgical procedure can take long (on average 3h30m, in accordance with the case and technique used), normally requiring one day of hospitalization. There are two types of approach to perform a rhinoplasty: Closed rhinoplasty: there are no incisions in the skin and the nasal structures are intervened through the nostrils. Open rhinoplasty: there is a small incision in the central area that separates the nostrils (columella), to expose the nasal structures. In these cases, after 15 days, the surgical scar is almost imperceptible. Complications in the immediate postoperative period are rare . However, although there is a detailed and individualized planning for each surgery, the truth is that it may be necessary to do a surgical revision procedure (rarely), typically one year after the first surgery. Postoperative phase: what happens? The surgery is almost painless and very well tolerated by the patient. In practically all rhinoplasties, there may be some degree of ecchymosis (dark patches) near the eyes, and it is normal to have edema (swelling), that will persist in the first weeks. Almost always, the greater discomfort is due to some degree of nasal obstruction and secretion, which will occur in the first week. Usually, an external protection splint is used , for one week. An intervened nose may take years to assume its final shape , but generally after one to two months after most of the edema disappears . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
