The goal of rhinoplasty is to achieve a natural-looking, beautiful nose that harmonizes with the patient’s entire face, in accordance with their wishes. No matter how beautiful the nose may be on its own, if it does not harmonize with the patient’s face and appears unnatural, the result will not be satisfactory. It is important to remember that every patient’s facial features are unique. Some patients have a narrow, elongated face; others have a broad, flat face; some have a narrow forehead, while others have a wide one. Therefore, the goal is not to create the same nose for every patient, but to create a nose that is appropriate for the specific characteristics of each patient’s face. To achieve this, it is essential to accurately understand the patient’s expectations, analyze together with the patient whether the desired nose shape truly suits their face, provide the patient with proper information, and most importantly, ensure that the patient’s expectations are realistic. In a successful rhinoplasty, people should not be able to tell that the patient has had surgery once the healing process is complete. For this reason, the nose must look as natural as possible.
It should never be forgotten that the nose has a very important function—breathing—in addition to its appearance. For this reason, every possible measure must be taken to ensure that the nasal passages remain open. Otherwise, even if the nose looks aesthetically pleasing, a nose that cannot breathe will always be a major problem for the individual. Therefore, during the examination, the doctor must thoroughly evaluate the nose not only from a cosmetic perspective but also from a functional one. Sometimes, minor deviations inside the nose that may seem insignificant before surgery can lead to severe nasal obstruction after rhinoplasty due to narrowing of the nasal bridge. On the other hand, cartilage deviations inside the nose are the primary cause of deviations in the nose’s external appearance. It is not possible to fully correct the external appearance without first correcting the internal structure of the nose. A surgeon performing aesthetic nose surgery must possess the knowledge and experience to both correct the external appearance of the nose and resolve internal issues.
In some patients, the nose may be severely deformed. There may be significant deviations in the nasal bridge and severe blockages inside the nose. Such patients must be operated on by experienced surgeons. This is because, while correcting the interior of the nose in these patients, it is essential to ensure that nasal support is not lost or that it is reconstructed. Otherwise, the nasal contour may collapse very soon after surgery.
WHICH TECHNIQUE SHOULD BE USED FOR RHINOPLASTY SURGERY?
Two main techniques are used in rhinoplasty surgery. One is closed rhinoplasty, and the other is open rhinoplasty. In closed rhinoplasty, no incisions are made on the external part of the nose or the nasal skin. In open rhinoplasty, however, an incision of approximately 3–4 mm is made in the skin at the base of the nose. Both techniques have their own advantages and disadvantages. The most significant advantage of the closed technique is that there is no risk of a scar remaining on the patient’s skin due to the incision. In the open technique, a faint scar may rarely remain at the incision site, depending on the patient’s skin type. However, this is very rare. The most significant advantage of the open technique is that it provides full visibility of every part of the nasal skeleton.
The choice of technique in aesthetic rhinoplasty is determined by the specific deformity present in the patient’s nose. If the tip of the nose does not require significant intervention, the closed technique may be applied. However, if the deformity at the tip is severe, the open technique should be preferred. A surgeon specializing in rhinoplasty must be proficient in both techniques. Surgery should be performed in the manner most appropriate for each patient. In my own practice, I generally perform surgery on 75% of my patients using the open technique and 25% using the closed technique.
WHEN IS RIB CARTILAGE USED IN NOSE SURGERY?
In cosmetic nose surgery, the first choice is always to reshape the nose using the patient’s own bone and cartilage tissues from inside the nose. However, in patients who have suffered severe nasal trauma or have undergone multiple nose surgeries, there may not be sufficient supportive tissue inside the nose. In such cases, the cartilage needed for reshaping the nose is harvested from the ear lobe or the rib. When performed properly, this procedure does not cause any deformity in the ear lobe or the rib area.
WHAT IS THE SURGERY AND POSTOPERATIVE PROCESS LIKE?
Rhinoplasty surgeries can be performed under local or general anesthesia. Personally, I have been performing these surgeries under general anesthesia for the past 10 years. General anesthesia is not only comfortable for the patient but also allows the surgeon to perform the procedure more easily. Rhinoplasty surgeries typically last between 1.5 and 3 hours. At the end of the surgery, a cast or silicone mold is placed over the nose. Within the first 24 hours after surgery, there will be some swelling and bruising around the eyes and nose. This swelling subsides within a few days. One week after surgery, the external cast is removed, and a few bandages are applied to the bridge of the nose. These bandages are removed 4–5 days later. A nasal massage is typically performed around the 20th day. Postoperative care is very important. By the end of the first month, healing is approximately 90%. However, it takes about 6 months for the nose to fully settle into its final shape.