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Rhinoplasty

Rhinoplasty is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose and achieving the harmony of the face. It can aslo be conducted to resolve a respiratory impediment (Septoplasty, turbinectomy, polipectomy, adenoidectomy).

The operation involves modeling cartilage-and-bone support framework and soft tissues of the nose by the surgeon’s manipulations. Currently, rhinoplasty is one of the complex operations in aesthetic medicine, as the nose is the most prominent part of the face and it is almost impossible to hide nose defects. The rhinoplasty should be conducted by the surgeon who has extensive experience in the field. It is widely known that Georgia represents an endemic zone for big and Roman type of noses. Among the Soviet countries Georgia was the first to start offering nasal operations, which provided the Georgian surgeons with a strong history and experience in rhinoplasty. Through the observation of individual cases, our surgeons were able to introduce important novelties in the techniques of rhinoplasty, allowing us to achieve consistently improved outcomes. We approach each patient individually because there are no standard nasal shapes and face proportions. In each case our goal is to find a nasal shape that fits well to the facial proportions. It is also known that nasal shape can be used as an indicator of a particular character, therefore we also consider the patient’s character. The purpose of the operation is not only the making of the beautiful shape of the nose, but its harmonious alignment with the face of the patient. At the same time the nose should look natural and should have no indications of being operated on. 

Indications for primary rhinoplasty are aesthetically unappealing nasal shaped – Roman nose, wide, narrow, double or asymmetric tip, and other congenital or acquired deformations. By changing the shape of the nose, you can reach harmonious facial appearance. Indications for primary rhinoplasty are also deformity in the cartilaginous septum of the nose, hypertrophy of the sidewalls, polyposis and respiratory impediments caused by adenoids. Repeated Rhinoplasty may occur is the primary surgery was not successful. 

The operation is conducted using intravenous anesthesia and it lasts for 1.5-5 hours.  Incisions are hidden inside the nose, or in an open procedure, an incision is made across the columella, the narrow strip of tissue that separates the nostrils. There is no visible scar after the nasal operation. Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose that will harmoniously fit the face. In case of respiratory impediment, the corrective surgery of cartilaginous septum of the nose takes place (septoplasty), or resection of the turbines (turbinoctomy), as well as polipectomy and adenoidectomy. In case of repeated rhinoplasty, sometimes it becomes necessary to use the transplants, which allows restoration of the nasal bone structure. 

After your procedure is completed, a splint, internal tubes or packing will likely be placed inside your nose for 3-6 days depending on the type of operation (aestheric rhinoplaty, septoplasty, reconstructive rhinoplasty. We use new type of packing that is easy and painless to remove. A splint or bandages is placed on the outside to support and protect the new structures during initial healing during 5-11 days. The patient is released for the hospital the second day after the operation, but remains on outpatient observation on the second, third and sixth days of the operation. The patient might experience loss of the sensitivity on the top of the nose. Patients can start driving on the third day from the operation. Full physical workload is allowed in 2 weeks from the operation. Swollen and bruised areas start to disappear in 1-2 weeks. It is not recommended to wear glasses for 2 months. The nose gets into its final shape 6-12 months from the operation, though the patient does not visibly notice small changes after the 3 weeks. Individual approach to our patients and active observation during the post-surgery period allows us to achieve consistently positive outcomes. 

Many clinics use traditional method of rhinoplasty, without arming the bone structure of the nose. After removing the bandage, most of such patients have straight nose with small snub at the tip:

Both surgeons and the patients are happy with the results. The doctor conducts a photo session (taking photos) and their interaction ends. However, within one month, due to the incorrect fixation of the nasal tip and gravitation effect, the nose tip lowers and takes the shape of a “hawk nose”. 

Patient after 2 weeks and 3 months of the operation.

 

 

 

Schematic figure showing the lowring of the nose tip.

 

As the pictures show, the nose tip gets lowered without the reinforcement and the nose gets a beak shape.

The analysis of the rhinoplasty surgery outcomes obtained in our clinic and through the introduction of new technology in rhinoplasty - nasal tip cartilaginous skeleton reinforcement - we were able to achieve a decent aesthetic and stable results.

 

The goal at our clinic is is to maximize harmonious alignment of the nose with the  patient’s face and personal character; At the same time it should not show any indication of the surgery and the result of the operation should be stable. To achieve this, we use the following method:

We use microsurgical method, which allows working precisely, rather than traumatologically on the soft skin tissues and nasal cartilaginous skeleton. As a result of the operation traumatism and postoperative edemas are reduced, and it is possible to obtain a good result, where traditional method would have been powerless. Any surgeon who is skilled in microsurgical techniques can successfully perform a rhinoplasty in case of nasal traumas and complex deformation cases, which many surgeons avoid to work on. For rhinoplasty we use nasal tip cartilaginous skeleton reinforcing methods, which allows us to get sustainable results and also can avoid the nose tip lowering during postoperative period and with aging.

 

Schematic illustration reinforcing the tip of the nose (the dock)

 

 

 

Patient’s image before the operation as well as 2 weeks and 3 years after the operation, which shows that nasal tip does not lower when the bone structure is framed well.

 

Our clinic conducts the modeling of cartilage-and-bone support framework using incision technology. Using this method, you can change a the width, length and height of the nasal tip without destruction of the cartilaginous framework.

 

Schematic illustration of modeling nose tip.

 

It is known that rhinoplastic surgeries were conducted in India 2600 years ago. At that time in India noses were amputated as religious, criminal, or military punishment. To restore the nose a Hindu method was used which entailed the forehead flap rhinoplasty procedure that remains contemporary plastic surgical practice. However, truly aesthetic rhinoplasty was performed in 1904 by a German surgeon Jacques Joseph. He was the first to use a closed method of the operation to remove the Roman arch to a young patient who developed an inferiority complex due to the shape of the nose.


 

One of the students of Jacques Joseph, Gustav Aufticht, reached a perfection along with few other colleagues in the standardization of the ideal nasal shape. In the contemporary work, surgeons view “Aufricht” noses skeptically. Terms such as “standard rhinoplasty syndrome” has been introduced to refer to unnaturally narrow nose, snub nose and small and open nostrils. In the modern world, more natural nose shapes are highly demanded. The next step in the development of modern rhinoplasty was the introduction of the open operation method. The first open operation was described by Rethi in 1934, however the method only became popular in 1971, when J.R. Anderson published several articles on the open method of rhinoplasty. In the contemporary world the open methods is much more widely used than the closed method.  In an open procedure one incision is made across the columella, the narrow strip of tissue, which allows modelling the nasal shape under visual monitoring. Post-operational scars are almost invisible.

The main advantages of the open method are:

  1. .     Less traumatic pressure on the soft tissues of the nose during the incision.

    2.     Minimal loss of the blood.

    3.     Less swelling during post-operation recovery.

    4.     Ability to monitor the procedures visually, providing better opportunities for modeling the cartilage and bone support framework

    5.     Ability to directly work on the septum, extracorporeal  remodeling and further replantation on the square-shaped cartilage.

    6.     Using auto transplants

    7.     Cartilage framework can be corrected using sutures as opposed to destructive resection. 

    8.      Ability to fixate the nasal tip, without which the outcomes of rhinoplasty can be unstable.

    9.      Ability to detect possible deformities and asymmetries during the operation and making relevant corrections. 

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