RHINOPLASTY | NOSE SURGERY

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    Esplugues de Llobregat (BCN)
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TECHNICAL RHINOPLASTY DR.BARCELÓ

Dr.Barceló’s own technique: Functionality and aesthetics are totally related: Technique presented at the Congress of The American Academy of Plastic and Reconstructive Surgery (Boston 2010).


WHAT IS A RHINOPLASTY AND WHAT DOES IT CONSIST OF?

Rhinoplasty refers to nasal intervention in which only an improvement in nasal aesthetics is sought. It can be performed through local anesthesia and sedation, although I do not particularly advise it for a safety reason, we must understand that acting at the level of the airway It is vital, literally it is not the same as, for example, surgery at the hand, elbow or foot level.

ADVANTAGES OF THE OWN RHINOPLASTY DR.XAVIER BARCELÓ TECHNIQUE?

 

For all these reasons, after many years of experience, and considering that the nose must be treated in an integrated way, in which functionality and aesthetics are totally related, Dr. Barceló Colomer designed his own technique.

It combines the best of closed rhinoplasty and open rhinoplasty. A technique where there is no external scar and with which it is also possible to observe the nasal anatomy without alterations and in a symmetrical way.

Furthermore, it is possible, placement of grafts and sutures described in open rhinoplasty. The great advantage is that it is possible to check the aesthetic results of the surgical maneuvers in a wayimmediately and without the need to reposition the skin just as it should be done in an external or open rhinoplasty.

With the technique ofrhinoplasty in Barcelona
Dr. Barceló Colomer can relate the anatomy of the nose and the aesthetic consequences that result from it, observing what are the necessary corrections and thus achieving a very natural nose and good breathing.

Rhinoplasty in my case I always do it through general anesthesia because the patient does not know anything and it is also much safer.

ORIGIN OF RHINOPLASTY

Rhinoplasty techniques originate from the Joseph technique that through an incision or internal cut at the level of a nasal wing allows us to access to correct the nasal dorsum, usually we must make an incision at the level of each nasal wing, it is A good technique to correct alterations of the nasal dorsum such as an aquiline nose or with a minimal irregularity of the nasal pyramid, but it has some important technical limitations when we also want to correct the nasal tip.

The nasal tips with this technique often present unnatural results because it does not allow us to adequately expose the entire anatomy of the nasal tip, that is, we do not see the 2 fully exposed cartilages with their medial, intermediate and lateral cure so that only We see the amount of cartilage that we have removed from the nasal tip, but the final aesthetic result is determined not by what we have removed, but by what is left of the structure of the wing cartilages, with which the tips are usually asymmetric, rotated or excessively pinched and unnatural so that it is easy to see that you have undergone rhinoplasty

TYPES OF RHINOPLASTY GENERAL TECHNIQUES

External or open rhinoplasty was popularized by Anderson in the 1980s and represented a very significant advance in how to understand and treat nasal cosmetic deformities.

This technique is based on making an incision at the level of the columella and from here we expose the wing cartilages completely and the entire nasal dorsum, the main advantage of this rhinoplasty technique derives from the fact that we observe very well all the nasal anatomy has differentiated of closed rhinoplasty.

External rhinoplasty has gained extraordinary popularity in recent years so that in many countries it is the most common technique.

Particularly I started to do it in the late 80s with great enthusiasm but I was able to verify that at least according to my experience the results were not as expected, first of all because the vast majority of my patients before and now also request an improvement nasal breathing which adds a factor of destructuring and weakening of the nose by having to also correct the nasal septum.

According to my experience, external rhinoplasty presents several drawbacks, the first is the need for an external incision that is more or less always appreciated. Furthermore, throughout the intervention we keep the skin and subcutaneous tissue raised, with which we are altering the nasal aesthetic anatomy considerably and this results in that the sectioning maneuvers of the wing cartilages, their suturing or the resection of the nasal dorsum are not adequate.

Another drawback is that we do not really appreciate the aesthetic consequences of the maneuvers that we have carried out until the end of the intervention when we proceed to close the columellar incision, however from my point of view the main problem is that when rhinoplasty is combined with septoplasty That is, a septorhinoplasty and we must proceed to place an important nasal tamponade, this exerts a great pressure on the columellar scar so that it can favor its devitalization and or necrosis with the result of an ulceration at the level of the columella, although this is fortunately infrequent It is very difficult to solve and dramatic results for the patient due to the great aesthetic impact it produces.

It is common in many forums to comment that it is better if the closed rhinoplasty or open rhinoplasty and many authors speak according to their experience and results from my point of view, both techniques have their indications but they also have some very important technical limitations.

 EXCLUSIVE TECHNICAL RHINOPLASTY PROCESS

  •  PRE-OPERATIVE

As in all interventions, a previous medical examination is essential to detect any possible abnormality that could contraindicate the operation. The skin of the nose and its surroundings must be free of inflammations or infections and, as is logical, it must take care of any flu or catarrhal process that causes symptoms of nasal congestion.

One of the most important questions in each rhinoplasty is the pre-operative prior study so that we must understand why the nose has a certain shape and which are the most appropriate surgical maneuvers to correct it, keeping in mind that each maneuver we perform in a rhinoplasty presents a margin of efficacy and side effects, that is, for example when we give some stitches in the nasal tip there is a narrow margin in which these are effective and improve or correct the deformity of the nasal tip but if they are not sufficiently tight or Too much tension can make the nose worse aesthetically.

The same happens when we proceed to resect or remove a part of the wing cartilage to correct a wide nasal tip in which there is a narrow margin between the cartilage that we must resect to correct the nasal deformity and the one that we must keep to avoid a collapse of the nasal tip.

As in any type of surgery, one of the most important factors of the results in rhinoplasty is the experience that the surgeon has, so it is considered that he is an expert when more than 300 rhinoplasty procedures have been performed.

Apart from the complete pre-operative study, we should stop taking anticoagulants the days before surgery, depending on the type of medicine that is being taken, several 3 to 7 days before. It is advisable to stop smoking the days before. It is an intervention that It requires mental preparation since, contrary to what most patients think, it is not characterized by pain but emotionally it is hard, especially if it is necessary to wear a nasal packing. These days there is a lot of tearing because the tears can not come out through the nostrils, in addition it is difficult to eat food that must be done in small amounts and that are not very solid, it is also advisable to frequently ingest small amounts of water.

It is normal the spotting of the nasal packing the first days and that there is also a slight hematoma that usually disappears in 1 or 2 weeks.

During the first weeks we will not be able to breathe normally through the nose due to postoperative inflammation and the presence of secretions

EXCLUSIVE TECHNICAL RHINOPLASTY PROCESS

  •  POST-OPERATIVE

Contrary to what most patients believe, it is not characterized by being painful, but there may be a sensation of interocular or supraobitary pressure.

It is an intervention that requires a mentalization on the part of the patient because it is emotionally hard, because during the first 4 postoperative days, in which nasal tamponade is required, you cannot breathe through the nose, which implies that we cannot sleep all night, because we will wake up periodically generating a tension that can cause anxiety.

Currently, we place nasal sponges that generate minimal tension on the nasal cavities and facilitate the correct repositioning of the structures and absorb the serohematic secretions that occur as a result of surgical trauma. During the 4 days in which the patient wears the nasal tamponade, there is an eye tear because the tears cannot flow out through their natural drainage, which is the lower meatus of the nasal cavities.

These tamponades are not compressive, thus avoiding postoperative pain. In exchange, we can observe a slight anterior drainage of the nostrils and, occasionally, posterior with secretions at the level of the mouth.

The postoperative edema, usually mild, disappears after a week, but occasionally a slight violet coloration may persist for 2 to 3 weeks.

Postoperative edema only occurs in the case of performing osteotomies (nasal fractures), for example in the case of a patient with a deviation of the nasal pyramid and / or a bone-cartilage hump of the nasal dorsum.

In the patients who correct the nasal tip, there is no postoperative edema because we performed surgery on the alar cartilages without the need for osteotomies.

During the operation, we placed plastic plates on each side of the nasal septum that allow us to ensure that it will remain completely aligned during the postoperative period and also makes it easier for us to remove the sponges since they slide on said material.

The plates are removed a week. In case of performing osteotomies we need the placement of an external splint for 2 weeks to keep the structures in the proper position.

During the first postoperative weeks it is common for the nose to become more or less obstructed by secretions, which is why we recommend periodic cleaning with seawater preparations. We should avoid blowing our nose because when we do we generate a pressure that can easily divert the nasal septum.

In case of performing osteotomies, we advise against wearing nasal glasses and masks during the first 6 months. That is why we recommend adaptation to contact lenses and we should also avoid sunbathing the first few months.

Regarding physical exercise, although a week we can already do sit-ups, stretching or cycling, it is better to wait a month to run.

The usual sick leave for a person with a sedentary office-type job is about 10 days, but if you are a patient with a significant physical job, it is better 4 weeks.

Can nasal plugging be removed within 4 days? Yes, it is possible, but the functional results do not improve. In addition, we must consider that when we remove the nasal tamponade, we generate an edema inside the nostrils that makes breathing difficult and that does not improve until 3 days later we remove the nasal plates along with the secretions.

There are surgeons who place a nasal tamponade that they remove after 24 hours but then we must consider whether they have really done a functional job of correcting the nasal septum and / or the turbinates.

The septorhinoplasty intervention is characterized by an emotionally difficult post-operative, but with little or no pain. Dry mouth appears and occasionally pain at the level of the oropharynx due to dryness, therefore advising a periodic and abundant intake of water.

We can eat what we want, but due to the impossibility of breathing through the nose we must do it in small amounts. If the food is very solid, the chewing action generates a pressure on the nasal packing that causes it to drain slightly. The post-operative period is usually good and only the first 4 days are a little hard. Generally in a week or 10 days maximum, the post-operative period has passed.

THE RHINOPLASTY ACCORDING TO THE TECHNIQUE OF DR. BARCELÓ COLOMER

Closed rhinoplasty, with its many varieties, is based on making an incision (cut) in both nostrils. It has the drawback that it is very difficult to foreseeably correct a problem of the nasal tip because the access it provides to it is limited.

 

OPEN RHINOPLASTY TECHNIQUE.

To solve this problem, the so-called open or external rhinoplasty technique was designed, which consists of making a cut at the level of the columella. This technique allows great access to the cartilage and the nasal dorsum, understanding what the aesthetic problem is and seeing what maneuvers must be performed to correct it.

The problem is that the incision is made at the level of the columella and this scar is under great tension, due to the nasal tamponade necessary to prevent bleeding if a septoplasty and / or a turbinoplasty is performed simultaneously.

OWN TECHNICIAN DOCTOR BARCELÓ.

For all these reasons, after many years of experience, and considering that the nose must be treated in an integrated way, in which functionality and aesthetics are totally related, Dr. Barceló Colomer designed his own technique.

It combines the best of closed rhinoplasty and open rhinoplasty. A technique where there is no external scar and with which it is also possible to observe the nasal anatomy without alterations and in a symmetrical way. Furthermore, it is possible to perform all the cartilage resection techniques, graft placement and sutures described in open rhinoplasty. The great advantage is that it is possible to check the aesthetic results of the surgical maneuvers immediately and without the need to reposition the skin as it should be done in an external or open rhinoplasty.

With the technique of rhinoplasty in BarcelonaDr. Barceló Colomer can relate the anatomy of the nose and the aesthetic consequences that result from it, observing what are the necessary corrections and thus achieving a very natural nose and good breathing.