There are more and more studies that demonstrate how important nasal respiration is for health, therefore, it is very important that before carrying out any intervention, properly explore the nostrils through an endoscopic study that allows us to assess whether there is a septal deviation, a hypertrophy of the lower turbinates, nasal polyposis, or chronic sinusitis. The importance of the previous exploration of the nostrils lies in the fact that the techniques used by most plastic surgeons tend to collapse the area of the nasal valve and if in a patient who previously already had a deviation at this level, although preoperatively, he was asymptomatic and does not report any respiratory difficulties, it will probably worsen after rhinoplasty. Good nasal breathing is essential for health. Normal human breathing is through the nose, mouth breathing is either an aid or an alternative but it is not how efficient nasal breathing is. When the air passes adequately through the nose it is conditioned to adequately reach the pulmonary alveoli in the adequate humidity and temperature conditions. When we breathe without difficulty through the nose, the air correctly reaches the lungs even though we are at 30º or 30º below zero, because by rubbing against the nasal mucosa especially at the level of the lower turbinates and also the middle turbinates, it is heated or cooled as necessary. The cilia of the nasal mucosa also help to clean the air breathed of the pollution, impurities or allergens that it can transport so that if we breathe well we may have rhinitis but we will probably avoid bronchitis that is much more serious. We must consider that the nasal mucosa and the mucosa of the lower airways are very similar from the pathological point of view.
Nasal breathing allows the inspired air to reach the pulmonary alveoli in the right conditions, however, when we breathe through the mouth, most of the air is blocked in what is called the “dead space” between the trachea and the bronchi but without reaching to the distal alveoli, which does not produce an adequate gas exchange with the blood. Nasal respiration creates the resistance necessary for the diaphragm to work properly so that it descends, increases the ventilatory capacity of the lung, and at the same time facilitates and increases the air reaching the distal alveoli. A person with good nasal breathing can reach 70% of their maximum aerobic capacity, that is, when we make an aerobic effort such as running, a person with good nasal breathing can reach 70% of their maximum effort using only this route. In other words, athletic and / or sports capacity is greatly increased. In rhinoplasties, in addition to improving aesthetics, we must be very careful to improve nasal breathing and always use surgical techniques for resection of wing cartilages and osteotomies that prevent the collapse of the airway. In my experience there are also certain disorders such as anxiety and even certain slight depressions that improve considerably when we improve nasal breathing after rhinoplasty, which is logical because most methods of meditation and / or relaxation are based on nasal repiration. Some of my patients after years of mild anxiety and depression have improved considerably by being able to breathe normally through the nose because it has a very beneficial relaxing effect. Nasal breathing is essential for health because it facilitates the physical and emotional wellbeing that is so necessary in the times that we have had to live, that’s why at Rinopastia Barcelona we not only value aesthetic improvement but we also consider it as very necessary to improve nasal breathing to contribute to the quality of life of the patient.
Extracorporeal septoplasty is a technique in which the entire nasal sepum is removed, trying to straighten it as far as possible and repositioning it.
The main problem that this technique has has nothing to do with its difficulty or the indications that it may have, but in the confusion that this denomination creates. very complex or advanced surgical procedures and nothing further from reality. Whenever we perform a nasal graft placement, it has a time that is extracorporeal.
In patients with a sinking of the nasal dorsum in Barcelona rhinoplasty, which was achieved in obtaining cartilage from the atrial pablellon that remodeled and subsequently sutured the nasal dorsum, in this case, although obviously there is also an extracorporeal time, we cannot say that it is an extracorporeal rhinoplasty.
This is the option that is most suitable and which is the one that I perform in patients who have undergone a septorhinoplasty in Barcelona.
Septoplasty is usually a simple surgical technique, but this does not mean that it cannot have its difficulties, as in the case of a patient with a large anterior deviation in which it is difficult to ensure adequate nasal support to prevent the nasal tip from falling. and what is called a “boxer’s nose” occurs in which there is a sinking of the nasal tip.
Extracorporeal septoplasty was initially described in 1952 by King and Ashley, and only a few authors have subsequently performed it.
When we perform a septoplasty, different authors reposition a small part of the septal cartilage that we have corrected, that is, in a way it is a limited extracorporeal septoplasty, but I insist that the medical term used is inappropriate because it leads to confusion.
According to my experience in integrated functional and aesthetic surgery, that is, in septorhinoplasty, there are several factors that are really important when we carry out this type of intervention, the first is that we must maintain at least 1 cm of support in the most anterior part of the nasal septum, that is to say, in the outermost part and that the area of the nasal valve is perfectly corrected.
Extracorporeal septoplasty is a technique that almost no surgeon uses as a surgeon, it could only be indicated in some cases and is highly debatable.
We must think that removing practically all the nasal septum bone and cartilage at once is a very difficult thing to do and that it also does not have any logic because we create a great destructuring of the entire nose, that is, we completely weaken the entire internal structure and that any The otorhinolaryngologist knows it perfectly, which I have never done in patients with septorhinoplasty in Barcelona.
Correction of the nasal septum should always take place progressively, first correcting the deviation of the anterior nasal septum (septum), that is, external and as we progress we proceed to correct the more posterior or internal bone septum.
When a technique is not popularized it is for some reason, in the case of extracorporeal setoplasty there are several. The first is the great difficulty of removing the entire nasal septum en bloc and the risk that this involves of destabilization and collapse of the nose.
The main problem however resides in the repositioning of a nasal septum that we have removed en bloc, then we try to straighten it but we can only really do it partially and finally the most difficult thing is to put this corrected nasal septum back into the nose and make sure keep it in the desired position.
Repositioning and maintaining the nasal septum in the proper position is very difficult if done as a block because we must fix it using sutures that generate symmetrical tension on both sides of the nostrils so that they do not subsequently generate a deviation of the nasal septum towards one of the graves.
Extracorporeal septoplasty generates a lot of controversy and not only because of the terminology used which is confusing but also because from the point of view of functionality it does not have much logic.
In cases where there is a large deviation of the septum in which it is not possible to ensure the adequate support of the nasal tip, it is more appropriate to place a columellar graft and if this is not enough, also add a cartilage graft obtained from the septal cartilage from the area K to the cartilaginous domus that in the sequence that I follow in these frequent cases of septorhinoplasty in Barcelona.
Extracorporeal septoplasty also presents another risk that the authors often seem to underestimate and it is the possibility of significant hemorrhage because it is one thing to correct an anterior devaccination of the caritlinal septum, and quite another to proceed to block resection the entire posterior bone septum with the Perperndicular lamina of the ethmoid and the foot of the vomer because it is precisely here where we can have significant bleeding that requires a nasal tamponade that makes it very difficult to reposition the nasal septum.
Rhinoplasty is considered one of the most difficult interventions. It has been traditionally accepted that between 3 and 5% of patients undergoing this type of surgery should be reviewed.
We in Barcelona rhinoplasty according to the last revision carried out, we remain in these figures
During the last years, however, this figure has varied considerably so that it has been discussed in the last congresses in which I have attended and where it has been considered that currently the revision figures in rhinoplasty are between 20 and 30%
The causes of this increase in reviews are due to the fact that there are currently a greater number of surgeons who perform this type of intervention and also to the higher expectations of patients.
In Barcelona, following the majority criteria, we recommend waiting at least 1 year to perform a revision of a rhinoplasty.
The great majority of patients in whom secondary rhinoplasty must be performed present problems at the level of the lower third, the most frequent being a deviation of the nasal septum, a fallen nasal tip and a deviation of the carilaginous back and to a lesser extent also of the bony back.
The best way to avoid secondary rhinoplasty is to perform a conservative intervention that avoids difficult problems to solve.
When we face the correction of a secondary rhinoplasty we must assess what is most uncomfortable for the patient if it is basically a functional problem due to deviation of the septum or nasal septum, it is aesthetic or both at the same time.
When we plan a secondary rhinoplasty, we must understand what the patient dislikes or is most uncomfortable with and explain which is the most appropriate solution. In some cases, we should explain that it may be possible to improve but not completely correct the deformity.
At Barcelona Rhinoplasty we consider that in order to achieve a functional and aesthetically correct nose in the case of secondary rhinoplasty, we must proceed to restructure the lower third of the nose so that we have to get the appropriate support to respect aesthetics and functionality.
If a nasal skeleton does not have sufficient supporting integrity, it is distorted or collapses due to scarring forces.
Reorientation and repositioning of the tip cartilage produces a more favorable and predictable appearance.
The maneuvers that we perform in Barcelona rhinoplasty to stabilize the nasal base are columellar grafts, expansion grafts and also reinforcing grafts of the wing cartilages in the event that they are greatly weakened by excessive resection.
In the case of cartilaginous back deformities, they may correspond to a “supratip” or “parrot beak” deformation above the nasal tip in which a resection of the anterior part of the septum will correct this intermediate deformity. Deformities of the cartilaginous middle third are usually due to a unilateral or bilateral collapse at this level. the solution we usually use is the uni or bilateral placement of sutured spedader graft between the triangular cartilage and the nasal septum.
If the deformity of the nasal dorsum is in a “saddle” in Barcelona rhinoplasty, we perform its correction by obtaining an atrial cartilage graft that is fixed by suturing to the nasal dorsum.
In the case of the upper bony third of the nose, the deformity may be a minimal irregularity of the nasal dorsum that a scraping will be able to solve, or a deviation (laterorrinia) due to the inadequate or insufficient performance of laterobasal osteotomies, in which case we must assess whether we perform new osteotomies, we proceed to a scraping or we must place a graft that in this case is really difficult to maintain in the proper position due to the surgical difficulty of access.
We must consider that no matter how much experience the surgeon presents, he will always have a secondary rhinoplasty rate.
Another factor to keep in mind when performing this type of intervention is if the previous rhinoplasty was performed by another surgeon, with which we cannot know for sure what was performed or what type of complications occurred.
When we use the term rhinoplasty, we refer to a surgical intervention that fulfills the function of changing the shape of the nose.
The main motivation that people have to perform this procedure is to change the image that this part has in their bodies, although it can also be applied with the objective of improving breathing or both purposes simultaneously.
What is the function of rhinoplasty?
The main function of rhinoplasty is to change the size and shape of the nose of any person who feels unhappy with it or has a problem that is affecting their health and requires surgery.
This procedure offers the possibility of repairing deformities that have been caused by injuries or even correcting other cognitive defects that can significantly improve the appearance and respiratory function of the nose.
History of Rhinoplasty
The process of nose surgery has a history even before Christ, when it was understood that it could be modified even though it was not at all advanced.
The truth is that there were several techniques to reach the process of rhinoplasty that exists today, for example:
There were processes of external operations, which was one of the first and was represented by Dr Dieffenbach On the other hand, there is Dr. J.O. Roe in the 19th century who discovered the perfect way to make intranasal incisions to make a different process than what they were used to.
However, there is a renowned German doctor called Jaques Joseph who practiced in the 1900’s, who would popularize these techniques and perfect them, occupying a space of importance for this technique of almost 30 years, either internally or externally, he always managed to innovate, even inventing most of the implements used for this process today.
What are the results that can be expected after a rhinoplasty?
The changes made during this type of intervention are minimal, and can even represent a few centimeters of difference. However, each of these centimeters will represent a great change in the image of your face.
In the majority of cases, the surgeons who apply this procedure can obtain results in which both parties feel completely satisfied, although it must be clarified that in some cases, a single intervention is not sufficient to achieve what is desired.
This is one of the reasons why some surgeons tend to recommend a second rhinoplasty in this same patient, considering that the nose may continue to suffer changes over the years.
Is rhinoplasty a simple operation?
This surgical procedure has never been considered simple by the surgeons who perform it, and this is due to several factors.
The first one is that the nose has a somewhat complex shape when treated in 3D since it is located in the center of the face and for this reason the changes made during rhinoplasty are minimal.
However, these changes can represent an automatic variation of image, and you will also be able to take full advantage of the functionalities of your nose.
What is the recovery time you should expect to have after a rhinoplasty?
After having been operated on by a rhinoplasty, the most recommendable thing is that you take a full week of rest at home so that you can avoid doing any kind of activity.
During the course of this week, you will begin to feel continuously better and after having spent the whole week, you will feel better than ever.
However, you must take into account that after having a rhinoplasty, there is a high probability of suffering from swelling in your face, although this swelling is painless and most of the time it is not noticeable.
For this reason, we only recommend a week of rest so that you can resume your daily activities in the best way possible.
Can you see how your nose will look after the rhinoplasty?
Nowadays, contrary to what many patients think, you can see how your nose will look after a rhinoplasty.
This is because your surgeon will take pictures of multiple angles of your face and then, these pictures can be digitally manipulated so that you have an image of how your nose may look after the intervention.
What are the risks that you may suffer from a rhinoplasty?
As with any surgical procedure, rhinoplasty can cause an interesting amount of risks that anyone can be exposed to during this procedure.
Among the most common are bleeding, infection, or negative reactions to the anesthesia applied at the time of surgery.
In addition to the above risks, there are other types of consequences that are not entirely safe, meaning that some people may suffer from them while others may not:
A hole in the septum
Difficulty breathing through the nose
A need for additional surgery
The possibility of an uneven looking nose
Pain, discoloration, or swelling that may persist
Permanent numbness in and around the nose
Before having a rhinoplasty, the best recommendation is that you talk to your surgeon so that he or she can tell you which procedure you should have done so that you suffer the least amount of risk possible during the operation.
Is rhinoplasty a painful procedure?
Contrary to what many people think, rhinoplasty is not considered a painful surgical procedure, since people usually classify this procedure with a pain that varies from 0 to 4 based on 10.