Rhinoplasty and Rhinoseptoplasty


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What is a rhinoplasty?

Rinoplasty is a surgical intervention practiced to correct nose deformations, modifying nasal osseous and cartilaginous structures to achieve a better appearence and improve the facial harmony.

Nose plastic surgery is the most artistic, difficult and complex of all the plastic surgery procedures.

Dr. Máiz is very experienced in nose plastic and functional surgery, as with the solution of complex cases of secondary surgeries.

Before and after. Case treated by Dr. Javier Maiz.

What is a Rhinoseptoplasty?

Rhinoseptoplasty is a highly delicate intervention to correct both the external shape of the nose and the deviation of the septum in order to obtain good nose functionality. If the patient is down to earth and emotionally mature, they will face the intervention with enthusiasm and will obtain satisfactory results.

All the photos of this page are of Dr. Javier Máiz's rhinoseptoplasty patients and are authorised by them.


What is a secondary rhinoplasty?

It is a surgery procedure performed on patients who had once or more times nose surgery and did not obtain the desired aesthetic and/or functional results. In this cases the nose anatomy is altered, which make this cases more complex. This requires the doctor to be very experienced since they will need higher technical knowledge and more artistic sensibility. These procedures may need even 5 hours of surgery in order to restore the tissues in detail.


Who is the ideal candidate?

The ideal rhinoplasty candidate is a person who wants to improve the appearance of their nose without looking for absolute perfection. If you are physically healthy, psychologically stable and down on earth with your expectations, you are a good candidate.

Before and after. Case treated by Dr. Javier Maiz.

Results

Rhinoplasty will improve your appearance and confidence, but it will not make us look like another person or be treated differently by other people.


Why to choose an otorhinolaryngologist?

Otorhinolaryngologists are nose specialists and in order to become that they must have acquired a deep knowledge of the function and anatomy of the nose. To and otorhinolaryngologist the respiratory function will be a priority.

These pictures show rhinoplasties performed during the early 20th century.

Before and after.

How is it done?

Both rhinoseptoplasty and rhinoplasty are performed under general anaesthesia and the incisions are done inside the nose even though in some cases small external incisions may be done (open rhinoseptoplasty). It is often needed fracturing the nose bones. After the intervention the nose is plugged and a splint is placed.

It is important to have in mind that the doctor doesn't compromise to get a specific aesthetic result but an improvement, in appearance and function. The aesthetic result depends on each nose possibilities and the scarring of the tissues, thus satisfying more or less each person. Just as there are not two noses that look the same, it is impossible to do two interventions the same way. The nose obtained after the intervention must be adequate to each individual, not a copy of anyone else's nose.

We would be pleased to inform you about any doubt you or your family may have, even if it seems irrelevant, for communication is the only way to get the best results. It is very important that you and we agree with the eventual surgical results, however you must know that specific results cannot be guaranteed, we can only assure we will do the best we can to correct your problem.


Post surgery

During the first hours after the surgery the nurses will attend the patient's needs in order to make them feel as comfortable as possible. The majority of patients leave the hospital the next day without special discomforts and generally without pain.

After the intervention the nose will be completely plugged between one and five days. In some occasions some plastic foils are placed, which have to stay on longer. When there has been external incision the stitches are taken out between the 5th and 8th day. The external splint must remain on for at least a week.

Rhinoseptoplasty is not very painful although analgesics may be prescribed if needed. Oedemas, inflammation and small bruises on the nose, face and eyes are normal, and they will not be completely gone until after a month. During the first weeks some discomforts such as nose dryness or scabs may appear. The inflammation of the nose will not disappear completely until after 6-12 months.


Risks and side effects

Every surgical intervention presents some risks, but fortunately the risk factors of a rhinoseptoplasty are small. The vast majority of patients do not have problems; however there are some rare cases of post surgery bleeding or small irregularities and asymmetries that often do not depend on the surgeon.

Some patients with a highly deformed nose cannot have every deformity corrected in only one intervention and may need a second minor procedure some months after the first operation in order to improve the results and/or correct inappropriate scarring.

Vital risks are rare, even though they exist as in every procedure that requires anaesthesia. This risks, both before and after the intervention, are those typical of any major surgery and are intimately related to age, general state of the patient and related pathologies.

The most frequent specific risks are post surgery nose bleeding, infection, septum bruises and facial bruises.

The most frequent side effects or sequels are synechiae (adhesion of the septum and turbinate), perforation of the septum, persistence of the obstruction and nose deformity or the apparition of a new aesthetic imperfection. All this situations may require another surgery.

Before and after. Case treated by Dr. Javier Maiz.

Is it possible to get someone to look like somebody else form a picture?

Pictures of other people may be a good reference to set what the patient would or would not like. However, it is impossible to recreate another person's nose.

The goal of this surgery is to improve the nose the patient already has, not changing his faces for another person's face. The doctor will take pictures which will be used to study the facial structure and decide which changes are ideal to get a harmonic, natural and realistic result according to the characteristics of the patient.


Can a very big nose be improved?

Yes. According to each patient's specific needs and after doing a photographic analysis, the different possibilities that exist to improve the size and shape of the nose by surgery are studied. Any possible modification must be considered according to the structure and shape of the whole face. With the years the tip of the nose is inclined to lean downwards, which may make it look bigger or longer. A surgical procedure like rhinoplasty can get back the shape the nose used to have, making the patient to look younger.


How is an aquiline nose fixed?

This kind of facial alterations are usually corrected with very precise instruments which sculpt the excess of bone and cartilage. The skin readapts to the new shape of the nose gaining a more natural appearance in relation to the whole facial structure.

Before and after. Case treated by Dr. Javier Maiz.

Can a very small nose be improved?

Yes. A nose can be too small due to various reasons: traumatisms, accidents or illnesses. New technologies allow enlarging the nose accurately and naturally. In some occasions the cartilage of the septum is used as a graft. Sometimes cartilage from other parts of the body (ears and ribs) is used instead. Nowadays other materials can be used to get excellent results.


Can a wide nose be narrowed?

Yes. Various factors may make a nose appear too wide, such as the space between the nasal bones, to cartilages of the nose or the thickness of the skin. After a careful analysis it is possible to perform various procedures in order to reduce the width of the nose and to get the desired result.


Will the procedure leave scars?

Rhinoplasty is performed inside the nose, therefore it does not leave external scars. In some cases an external incision is done to narrow the alae of the nose. However, these incisions are small and usually imperceptible by other people.


Is there pain after the surgery?

No, nose surgery usually does not hurt. The patients feel their nose congested as if they had a cold, but it improves after two or three days.


I would like to have a rhinoplasty done but I am very nervous. How can I solve that?

It is normal to feel some anxiety before having surgery done. One way to free yourself from that anxiety could be asking Dr Máiz any worry you may have during the consultation. The patient can make a list of questions, and after getting the answers from their doctor and discussing any worry and planning the treatment they will feel calmer. Looking other patients pictures taken before and after the procedure may help and if the patient would want to, they could even contact with another person who has gone through the procedure to listen to their experience.


How long does the recovery take?

Recovering from nose surgery is fast, and after a week the patient will be able to do their usual tasks. However, they will have to wait a little longer to do sports and exercise.


Dr Máiz's advises:

Before the surgery:

  • Do not take any drug that contains salicylic acid (aspirins) and derived products.
  • Do not smoke during the previous month to the surgery.
  • Inform about allergies to any medication.
  • Have realist expectations about the results.

After the surgery:

  • You will not have to follow any special diet.
  • For 8 days the nose will remain immobilized, and the dressing which will immobilize it must be taken care of (no wetting or taking it off). You must not take too hot baths since the vapor could detach the dressing. If it got detached you must visit your doctor so that they can reattach.
  • Light mucus with blood may come out the nose after the surgery, which is normal. Lint will be placed under the nose to retain it, which can be replaced if needed. However, if it bleeds a lot you should tell us immediately.
  • Reddish coloration in the eyes or eyelids is normal and it will disappear during the recovery time. In some occasions there can be inflammation and hematomas around the eyes, which will disappear after 15 days. It is recommended to apply cold for some minutes various times per day during the first two days in order to reduce the inflammation.
  • During the first two days sleep with your head raised 30º (put a pillow under the mattress) and do not sleep face down.
  • You may read, watch television or use the computer as much as you want.
  • You should not leave the house for 3 to 5 days after the procedure.
  • Even though the pain is usually minimum, you will be prescribed an analgesic. Take is as it is indicated. If the pain were severe or persistent, tell us immediately. Do not take aspirins or any other drug that contains salicylic acid.
  • A tamponage is usually placed in your nose and will be removed in 24 to 72 hours.
  • During the first days you may feel your nose constantly congested and you smell and taste may be altered. That is because of the apparition of scabs and blood remains; that is why it is important to clean the nose constantly with saline or seawater.
  • Avoid blowing your nose too hard.
  • Sometimes plastic plates are placed to prevent synechiae (adhesions between the mucous of the septum and the turbinates). These plastic plates will be removed after 8 to 15 days.
  • If there have been done stitches, they will be removed in 7 days.
  • To prevent your nose form being hit, do not hold little kids or pets in your arms after the surgery.
  • If you suffer from any related allergy it may improve with the surgery but I will not disappear completely, so you must not stop taking your medication for it.
  • You will not be able to wear glasses for a month and a half. In case they were absolutely necessary you must protect your nose with a cushion.
  • To prevent the persistence of the nose inflammation you must not let the sun hit it directly during the first 2 months. When you are outside you must use protection (a hat or a parasol).
  • Do not do intense exercise or sports in three weeks after the surgery.
  • You will probably be able to return to your job in 8 days as long as you will not be exposed to drastic temperature changes, physical efforts or risks to be hit in the face.
  • The final result of the rhinoplasty is note definitive until after 6 to 12 months. Nose cosmetic surgery is a very specialized and demanding procedure, so any procedure, however small it may seem, is not easy. It is possible that you may need another surgery to achieve a result closer to that which was desired, which can only be done after 6 months from the first surgery.