Rhinoplasty: what is this nose surgery?

These last years, plastic surgeons have seen a flood of people suffering from a physical complex born from an overuse of selfies. “Beyond the fact of reinforcing the culture of the ego, especially among teenagers who do not yet have sufficient maturity to take a step back, smartphones reflect a distorted view of reality. If you add to a wide-angle lens that distorts a shot at arm’s length, less than a meter away, you get a nose whose proportions are not at all what they actually are. As a result, people see themselves through their screen and they don’t like the image it sends back. Except that this image is distorted, it does not correspond to reality” emphasizes from the outset Dr. Michel Rouif, plastic surgeon. Rhinoplasty is an act of plastic surgery which aims to change the shape and/or size of the nose. It can be aesthetic or restorative. After how long do we see the final results? What are the risks ? What is the price of a rhinoplasty and how choose your surgeon? What to do in case of failed surgery?

Definition: what is rhinoplasty?

Rhinoplasty is a plastic surgery who aims to modify the morphology of the nose for aesthetic and/or functional reasons. These disgraces can be congenital, due to trauma or related to aging. Rhinoplasty, a fairly frequent operation, thus allows the patient to obtain a nose that he likes more.

What are the types of rhinoplasty?

► Reduction rhinoplasty correct:

• long noses,
• noses that are too wide or flat,
• bumps that distort the bridge of the nose,
• tips that are too thick or drooping,
• dilated nostrils…

Note that the removal of the bump is a frequent request for reduction rhinoplasty. The surgeon is often required to perform another gesture, on the tip for example, in order to ensure a natural harmony to the whole face.

► Augmentation rhinoplasty correct:

• noses too short,
• noses that lack projection,
• the marked saddles….
• volume deficiencies whether related to trauma or heredity. A cartilage graft (taken from the nasal septum or from the cartilage of the ear) is then performed. When there is not enough cartilage available, costal cartilage can be harvested.

Who can do rhinoplasty?

Rhinoplasty can be performed on anyone who needs it. Nevertheless, it is not recommended for children or adolescents : “the nose of the teenager is not mature before 15/16 years, classically later in boys. In general, it is preferable to wait for the majority. You don’t have to rush. On the one hand because the young person must have matured his decision and on the other hand, because there is a risk of late growth. There is a risk of operating on noses that are not yet fully developed” indicates the Dr. Michel Rouif.

“You should not expect an immediate definitive result”

The intervention is performed “almost all the time under general anesthesia with hospitalization. It is possible that this will be done on an outpatient basis under certain conditions: do not drive when leaving the hospital, do not stay too far away…“Otherwise, one night of hospitalization is enough. Each surgeon has his or her operating habits, but there are nevertheless fundamentals.”In France, we did for a very long time closed laness, whereas in the United States surgeons overwhelmingly did open ways. And gradually we got down to it, explains Dr. Rouif.

► By closed way, the surgeon works through incisions internally, in the nose. These incisions are hidden, usually in the nostrils, and more rarely under the upper lip. No scar is visible externally.

► By open way (open rhinoplasty), the surgeon operates through a small incision in the columella (part located between the two nostrils, under the nose). Open rhinoplasty is becoming more common.

► Advantages: “You can see what you are doing better. This technique also makes it possible to work on complicated noses better, to better reshape the tip of the nose, for example. On noses that have already been operated on or traumatized, open rhinoplasty will make it possible to do things more precise, more sophisticated.”

► Disadvantage: healing time:it’s true that we take off more fabrics, that we do more things, the suites are therefore a little longer.“The final results will also be later, after about 2 years for a work by closed way against about 3 years for an operation by open way.

After how long do you see the results of a rhinoplasty?

“You should not expect an immediate definitive result, warns Dr. Rouif. Of course, if you remove a big bump, when you remove the bandage you will see the change. But there may be swelling that will not resolve immediately or evenly. You get a lot of the results very quickly, but for the final result, you have to be patient. If the tip of the nose has been opened – in an open way with tissue detachment – the consequences will be longer.” He it takes an average of 3 months for the operated area to completely deflate and the skin adapts to the new bone and cartilage structure. It is only beyond 12 months that the final result can be really appreciated. During this period, there are follow-up by the surgeon and if any defect appears over time, secondary rhinoplasty or retouching are entirely possible.

“Sequences can be quite simple, ensures the plastic surgeon. It is the quality of the intervention and the existence of previous traumas (surgery, accident) that determine the consequences.“Rhinoplasty is a painless operation most of the time. The locks are removed the next day (sometimes after a few days in case of complex work on the partition), the splint is left to protect the nose for about a week and the stitches inside the nose resolve on their own. Hematomas, edema, bruising can usually occur. Hematomas will evacuate spontaneously. “You can suffer from difficulty breathing, the taste may be altered for a few weeks while the edema subsides. In terms of social eviction, everything depends on the patient. If he doesn’t mind going out in the brace, he can get back to work quickly. Otherwise, he will wait a week for the splint to be removed. As it concerns the resumption of sport, we are on a deadline of 8 to 10 days, depending on the type of sport of course. Avoid contact sports with risk of shock for 3 weeks to a month.” Note, once removed, the splint reveals edema that subsides in a few weeks.

What are the risks of rhinoplasty?

If the procedure is not clear, we can advise against the operation.

Dr Rouif reassures: “rhinoplasty is not really a risky procedure in terms of complications immediate. They exist of course as for any surgical intervention, in particular in connection with anesthesia, but there is practically no risk of phlebitis or pulmonary embolism. This type of intervention does not require emergency recovery in the hours that follow. There are not many complications and infectious problems are rare“. But nose surgery is not trivial. If very often the interventions of aesthetic medicine or surgery have something of the order of the intimate, which refers to the image of oneself, it is all the more true with an attribute located right in the middle of the face. “The nose crystallizes a lot of things, sometimes a malaise. We must not minimize the family reasons – a shape of the nose specific to a parent with whom we have a difficult relationship -, ethnic – some people may find their nose too “typical”. Sometimes a word, a remark can be enough to trigger the desire to correct his nose in a person” continues the plastic surgeon. An extremely important psychological dimension which is not to be taken lightly. “Two prior consultations are almost essential, warns Dr. Rouif, plastic surgeon. They help to understand the motivations of the patient. If the approach is not clear, we can advise against the operation. Reflection time is very important. A process that also requires a perfect understanding between the doctor and the patient so that the latter is satisfied with the result obtained:The patient must be in agreement with his decision and fully understand the expected resultschallenges.“

Generally, time does its work. Edemas and hematomas resolve on their own. To speed up the process a little or at least not slow it down, it is worth “sleep with your head slightly elevated to avoid edema, advises Dr. Rouif. It is necessary to avoid too hot environments which favor the dilation of the tissues. And if necessary, local anti-inflammatory treatments can be prescribed.“

How much does a nose job cost?

“Rhinoplasty is covered by health insurance in the case of functional discomfort with breathing disorders“explains Dr. Rouif, or in the event of deformation or deviation of the nasal septum following a trauma. Nose surgery for purely aesthetic purposes is never covered by Social Security. And it is up to the surgeon to draw up an estimate detailing the overall sum of the intervention. A reflection period of at least 15 days is mandatory in all cases between the submission of this estimate and the intervention. Count between 4 000 € and 6 000 €a price that changes according to the region, the reputation of the surgeon, the structure…

The patient-surgeon relationship is essential. To find a competent practitioner, you can turn to reference sites such as the SOFCEP or the National Council of the Order of Physicians which makes available to the public a directory of qualified surgeons.

Failed rhinoplasty: what to do?

Small imperfections may appear but they will not be revealed immediately, only once the edema has been resorbed. They may be due to an insufficient correction or an unexpected evolution of the nasal structures. It is then necessary to wait until the healing is completely completed before possibly intervening again. “If it is necessary to carry out a recovery, we will wait on average at least 18 months, we must intervene at a distance from the first operation. But sometimes there is no need to operate again, the imperfection can be corrected with simpler gestures such as injections ofhyaluronic acid“, says the surgeon.

Thanks to Dr. Michel Rouif, plastic surgeon and General Secretary of the French Society of Aesthetic Plastic Surgeons (SOFCEP)