doubts-rhinoplasty-nose-surgery

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If there is a functional problem of bad breathing the otolaryngologist should always be the professional in charge of it. If, however, no improvement of nasal breathing (rhinoplasty) is performed, the operation can be carried out by a plastic surgeon. The septorhinoplasty is considered one of the most difficult operations, so it is advisable that the surgeons have a wide previous experience in this field. In any case, a fiber endoscopy exploration of the nose should always be performed to confirm the diagnosis of a deviated nasal septum and/or turbinate hypertrophy, as well as to rule out other possible causes.

The nose operated with success is the nose nobody would say it has been operated. That is, when we look at such person, her nose should be completely unnoticed, being well integrated into her face, and besides it can allow her to breathe properly. People you will know in the future must not realize that your nose has been operated. Noses with exaggerated aesthetic results are due to the use of inadequate surgical techniques, with excessive resection of the alar cartilages producing a pinched nose or incorrect osteotomies producing a collapse of the bony pyramid.

Septorhinoplasty operation requires a highly specialization, since that should be the only kind of operations the surgeon performs. From the technical point of view, it is not advisable to conduct the operation jointly by an otolaryngologist and a plastic surgeon, because both techniques are quite antagonistic specialties and reveal the limitations of both.

It is essential to analyze the postoperative results of the surgeon who will operate you with pictures of his other patients, from before and after the operation. While looking at the photographic “book” you should ask what bothers you about each picture and what you want to correct in your case. You should ask him to explain the techniques to solve your problem and above all, assess the results showed by your surgeon.

A complete photo studio of your nose seen from the front, basal, profile and oblique on both sides must be systematically performed. A nasal fiber endoscopy is also performed with an optical fiberscope to monitor where the patient can see the deviation of the nasal septum and the inferior turbinate hypertrophy, thus enabling the explanation of the corrections to be carried out. A complete preoperative study with a general analytic, thorax X-rays and electrocardiogram is also performed. The anaesthetist evaluates the preoperative studies and makes appropriate changes in medication if necessary (anticoagulants removal or replacement) as well as an examination of the patient to detect possible difficulties of intubation. If you smoke, you should give it up or reduce the number of cigarettes the days before the operation.

Usually 24 hours after the hospital admission.

This operation requires a psychological preparation by the patient, because although it is not characterized as a painful procedure, the patient suffers from a psychological point of view, since he will not be able to breathe through his nose. This entails anxiety, and pain, but if any, it is slight because it is a feeling of packing or pressure. Usually there is an abundant watering because tears cannot leave the nose through their nasal output, that is to say, the nostrils. There is also a throat discomfort due to the dryness produced by the exclusively oral breathing.

It is a very safe procedure and, therefore, the possibility of bleeding is really improbable. The patient wears a packing with nasal sponges that are removed after 4 days. These sponges compress nasal structures very slightly, avoiding pain. During the first 2 or 3 days this packing is commonly soaked with secretions.

Postoperative hematoma depends on whether osteotomies are performed (nasal fractures) to correct bony pyramid (in case of the nasal dorsum hump or a deviation of the nasal pyramid). But it is usually unimportant and disappears within 1 or 2 weeks at most.

No, if we only make a correction of the nasal septum with a correction of the nasal tip or only a correction of the nasal tip, there will not be any type of hematoma.

During the first 4 days you should drink water often to hydrate your mouth (oropharynx) enough. It is better that food is not very hard because when chewing, muscles gently pressure the nasal packing, which drains secretions containing in it. You can have cold drinks but avoid the very hot ones and, above all, remember that since you will not able to breathe through your nose, you should eat food in small quantities.

Nasal packing are thoroughly wetted before their removal because after 4 days, they are attached to the inside of the lateral nasal wall. The day of the surgery a plastic material is also placed in order to stabilize the nasal septum and to allow the packing slipping on it. That is, the first cure is a bit unpleasant and slightly painful.

If you really perform a correction of the nasal septum with osteotomies, we need structures to be reset to the desired position and also to avoid possible bleeding. Removing such packing before could produce worse functional outcomes (nasal breathing).

Nasal packing depends on the surgery performed. That is, if we do not perform a correction of the nasal septum or the inferior turbinate and only a rhinoplasty with correction of the nasal dorsum and/or the nasal tip is carried out, the packing can be removed 24 or 48 hours later.

Not systematically, but it is performed in 90% of patients undergoing a correction of the inferior turbinate and one of the nasal septum at the same time.

In my experience, radiofrequency is a good technique to reduce hypertrophied turbinate with local anaesthesia, because it is not very aggressive and does not require packing or it requires a minimal one. But if we make a septorhinoplasty operation under general anaesthesia, it is more appropriate to perform a reduction of inferior turbinate with surgery, because it also will require having a nasal packing four days.

Four days after packing removal, an improvement of breathing occurs, but quickly, in a few hours, an edema is generated inside the nostrils which, together with plastic plates to stabilize the nasal septum, do not allow nasal breathing. However, it eye tearing greatly improves and the sensation of pressure disappears. A week later, after removing plastic plates from inside the nose, the improvement is then considerably important. But during the first 2 or 3 weeks breathing is still not normal at all because there are secretions that prevent air passage.

Blowing is completely contraindicated during the first month because doing so exerts a pressure that can displace the nasal septum to the opposite side. What you can do is washes with saline solution or seawater.
If, in the septorhinoplasty, we perform osteotomies with fracture of the nasal pyramid, then we will require an external splint done with a mouldable plastic material for 2 weeks.

You can perform exercises such as crunches or stretches ten days later; soft bicycle 2 weeks later and running, in about a month. During the first weeks lifting weights should be avoided and, if so, do them with your mouth open.

Standard time off work is from 10 to 14 days depending on the type of operation. That is, in case of a surgery of a nasal tip correction that does not require osteotomies, recovery will be very fast, without postoperative edema. But in the case of a highly deviated or very projected nose, with a nasal dorsum hump requiring osteotomies, edemas may take 2 weeks to completely disappear. In any case, it also depends on the kind of work. If you make a sedentary work, you may come back to work in about 10 days. But if you have an intense physical work, it is better to wait for 4 weeks.

In case of osteotomies (nasal hump or deviation of the nasal pyramid) glasses should be avoided for 6 months.

In case of osteotomy, better avoid sunbathing during the first months.

Unlike most plastic surgeons that perform external osteotomies through mini skin incisions, I perform osteotomies at an endonasal level and with an endoscopic control, which greatly facilitates their accuracy and contributes to significantly decrease postoperative edema.

In order to make a diagnosis of why you have difficulties in breathing through your nose, it is essential to perform a nasal endoscopy and if a deviated nasal septum and/or hypertrophy of the inferior turbinate is confirmed, proceed to perform a formal septoplasty, combined or not with surgery of the inferior turbinate.

In order to make a diagnosis of why you have difficulties in breathing through your nose, it is essential to perform a nasal endoscopy and if a deviated nasal septum and/or hypertrophy of the inferior turbinate is confirmed, proceed to perform a formal septoplasty, combined or not with surgery of the inferior turbinate.

In my experience, it should not be considered before being 18 years or when the physical development is finished.

Whereas a septoplasty can be perfectly performed in a 70-year-old patient with a good general condition, requesting an improvement of his nasal breathing, we must take into account that a septorhinoplasty operation with osteotomies presents a much more morbid postoperative course.