Preoperative period runs from the time the patient decides to the operation to the time the surgery begins. According to me, what they have experienced and they feel during this period is very important. The patient selects the doctor during this period and makes her/his first interview with the doctor. Establishing good communication with doctors during this period is very important.

During this period, patients’ concerns about the operation diminish considerably as much as they establish a healthy relationship with doctors based on trust. I have some recommendations to my preoperative patients, among them:

  • Clearly explain your doctor what you want,
  • Also explain your doctor what you do not want as well,
  • Have realistic expectations,
  • Breathing quality is as important as the shape of the nose,
  • Thoroughly understand how the surgery is done,
  • Thoroughly understand the limitations of surgery,
  • Thoroughly understand complications and how to deal with them,
  • Thoroughly understand what you need to pay attention in preoperative period,
  • Understand what you need to pay attention in postoperative period,
  • Try to think positive before and after the surgery and clear your mind of negative thoughts (patients with positive thoughts easily overcome these periods),
  • If you are a smoker, quit smoking for at least 4 weeks before the surgery is very important for your comfort in operation,
  • If you notice signs of flu such as runny nose or sore throat or symptoms of any other sickness, please report it to your doctor,
  • After the surgery one person may accompany you and also plan to have somebody leave you home from the hospital because we do not recommend driving car after surgery.
  • You should not be eating and drinking at least 6 hours prior to the surgery. If your surgery is in the morning, you should not eat anything after 12 at night and if your surgery is in the afternoon then you should not eat anything after breakfast.
  • Aspirin and its derivatives should be discontinued one week before the surgery.
  • The night before the surgery, take a warm shower and sleep early. A rested body is important before surgery.

 

Day of Surgery

And here is the most exciting day. When the day of surgery comes, please try to be positive. It will only make you and your loved ones worry unnecessarily to fill your mind with negative thoughts. Imagine that you enter the operating room and you would have a fresh new look when you wake up.

In the day of surgery, women should not wear jewellery, should not make up and should remove any nail polish on the hands and feet before coming hospital.

Instead of tight clothes that worn through head, patients should prefer wide and the front buttoned clothes.

It will be better for you to come to the hospital a few hours before the operation in order to finish blood tests, to make interview with doctor and to adapt to the hospital environment.

You will be taken to your room after the admission to hospital is made on behalf of your doctor. The nurse will take blood from your arm which is required for preoperational analysis. This process will not hurt because it takes very short time. After a while, the doctor who is responsible from your anaesthesia will examine you and will decide whether you can receive general anaesthesia after analyzing your blood tests.

I also visit my patients personally after anaesthesia examination in their room and I talk with them to motivate them. Most of the patients said to me that this reduces their tension that occurs before the surgery. After the completion of preparations for the operating room, nurses will want from you to wear the surgery clothes and will give you a pill. You will then be taken to the operating room.

Operating rooms are always very cold… Patients always think so. Here coldness refers both to the room temperature and to the overall appearance. But the operating room perhaps is the most favourite, loved and the happiest place for surgeons. This is also true for me and in addition doing nose surgery gives me a great pleasure and a joy.

After lying on the operating table, serums will be applied to your arm and an anaesthesiologist will inform you about what you will experience when you wake up. Then the anaesthesia will be given by the anaesthesiologist through the serum which will make you sleep. After this moment, you will remember nothing and feel no pain…

While you are sleeping, all vital activities of your body are monitored through today’s most advanced anaesthesia devices and everything can be responded immediately. Today, anaesthetic drugs are very safe and can be removed from the body very easily after waking up.

The things you need to pay attention in the preoperative period briefly consist of these… I hope reading this article can reduce your fear and tension about surgery and can relax you a little bit.

 

Postoperative Stage

For someone who wants to have a rhinoplasty, postoperative period is probably the most frightening and most interesting period. This period starts with the moment that you are transported to your room after the surgery and it takes over your entire life. After surgery, people want their nose immediately to take the new shape and they cannot wait to get the compliment of this new view from family members and friends. I think this situation is very normal for someone who has had a facial plastic surgery because people tolerate this much stress and difficulty to get immediate results in having a beautiful nose which is in harmony with their face. They are right, but the truth is somewhat different.

The swelling around the eyes occurring after rhinoplasty gradually disappears within 3-4 days. Similarly, swellings also occur in the nose as a result of oedema formed in the subcutaneous tissues. This type of a nasal congestion caused by swelling dissipates more slowly as it gradually decreases until 6 months and totally disappears between 6-12 months. This means that the emergence of fully new form of the nose takes 6-12 months after nasal surgery. This requires the patient to be tolerant in this period after surgery.

Oedema is reduced first of all in the middle and the ridge of the nose and finally in the end where it joins with the forehead. Your doctor may recommend you to make massage on your nose to reduce swelling.

 

Points on Postoperative Considerations

  • Do not blow your nose until the time specified by your doctor. You can clean it with a soft tissue when it is necessary.
  • If there is, you can change the gauze under your nose.
  • The tapes and plaster placed on your nose will be removed approximately one week after the operation in the clinic. Never remove plaster and tapes and try to keep dry.
  • Avoid foods that require chewing for a long time. Otherwise there are no food restrictions.
  • Avoid excess physical activity and try to have more rest and relax than before.
  • Brush your teeth gently with a soft toothbrush. Try not to touch too much to your upper lip and to keep your nose motionless.
  • Avoid long calls and activities that require long conversations for at least 10 to 14 days.
  • You can wash your face and take a shower with warm water. The special plaster on your nose is water resistant.
  • Avoid excessive facial movements at least for 1 week.
  • Wear front-buttoned clothes during the first week. Do not wear tight clothing worn from the head.
  • Do not enter the solarium and avoid excessive sun exposure for 6 weeks unless required. Sunlight causes the increase of swelling as a result of oedema in your nose and on your face and consequently leads to slower improvement.
  • Do not swim for 1 month and stay away from sports that may cause trauma to your nose such as tennis and basketball for at least 3 months.
  • After the plaster and bands removed do not worry about existing swelling or discoloration around nose, eyes and upper lip. It usually resolves completely within 2 to 3 weeks. The complete disappearance of swelling around the nose requires 6 months for some patients.
  • Use only medications prescribed by your doctor.
  • Do not use the glasses for 4 weeks because it may cause weight and deformity on your nose.
  • Contact lenses can be used 2-3 days after the operation.
  • After the bandages removed by your doctor you can clean gently your nose with Vaseline intensive care lotion.
  • Please contact Dr. Emre Ilhan if you have question in your mind.

Problems that may arise and Warnings

Rhinoplasty is the most requested surgery among all types of plastic surgery. The difference from the other aesthetic surgeries involves its blending role of art and science and balancing role between function and aesthetics.

Each case has its unique challenges. In a rhinoplasty surgery, disorders of the nose and relevant techniques to overcome these disorders should be evaluated carefully, the operation should be done in a planned way and the surgeon should work with high attention, tact and patience. It is the most difficult among all other aesthetic surgeries in terms of achieving good results.

Even the smallest negative detail in the results can be called as complications because the expected results of rhinoplasty are precise and clear. The results are satisfying and good in the hands of an experienced surgeon and significant complications can be observed very rarely.

EVERY OPERATION MAY HAVE ITS OWN UNIQUE SURGICAL COMPLICATION AND ONLY SURGEONS WHO DO NOT MAKE SURGERIES DO NOT ENCOUNTER WITH COMPLICATIONS

If you are a candidate for rhinoplasty, you must have knowledge about the possible complications and problems that may arise after surgery. You must ask questions to your doctor regarding these situations and when deciding an operation you should fully understand complications you may encounter in surgeries even if they occur in rare cases. This is very important in terms of the trusted relationship between doctor and patient. Because if you know certainly what risks you have taken through this surgery, it will also relieve your doctor.

We take a lot of risks at the moment we left our home to go from one place to another during our daily lives. Every car in traffic takes a certain risk of accident. We even take a certain risk when we cross the street. The risk diminishes as long as you follow the rules. You also take a certain risk with the surgery, as mentioned in all these cases above. Similar to drivers in traffic, Surgeons always work with certain rules and they follow these rules strictly. It means, they never violate the vital rules in order to minimize the risks of infection, complication and etc. Because of these rules are associated with the human health and human life.

No matter how it is paid attention, in every operation some unexpected situations may occur. Already, complications are defined as unexpected situations that require individual care and attention during or after surgery.

In the literature, the prevalence of complications in aesthetic nasal surgery varies from 4% to 18.8%. These complication rates are reduced in the hands of an experienced surgeon.

The complications associated with rhinoplasty can be examined under three headings:

  • Complications that may occur during surgery
  • Complications that may occur in early postoperative stage
  • Complications that may occur in late postoperative stage

Complications that may occur during surgery

These complications may occur rarely associated with general anaesthesia. Anaesthesiologist will give you the necessary information in this regard prior to the surgery.

One of the other unexpected situations that may occur during surgery is having a lot of bleeding from the nose tissue. Although we use anaesthesia with low blood pressure and drugs reducing bleeding, sometimes in rare cases the patient’s nose bleeds more than the usual during surgery. This situation may occur as a result of the use of aspirin or aspirin-like substance containing drugs, up to one week before the surgery. These type of bleedings are taken under control usually with the help of the anaesthetist by lowering the blood pressure.

Complications that may occur in early postoperative stage

Nausea and vomiting may occur within the first few hours of the postoperative stage. This is a side effect of general anaesthesia and resolved with anti-nausea medication. I use these drugs for all my patient just seconds after the beginning of surgery and my patients do not encounter with problems such as nausea and vomiting.

Bleeding is also a complication that may occur in the early stages. This occurs more frequently especially in situations if the patient underwent concha and sinus surgery. The bleeding of nose can occur until the 15th day after the removal of nasal tampons. Usually it stops automatically without the need for additional cushioning. The bleeding rarely occurs as much that to require us to make additional cushioning or do some blood tests. (Leakage of blood happens in every patient after surgery and is not considered as complications).

Swelling and bruising around the eyes: a majority of patients usually do not have a serious swelling and bruising. Of course, this varies from person to person. I give this example to my patients: “People use such a term to have a tight or loose meat. A person with a “tight meat” never have bruising or swelling when she/he hit somewhere while a person with a “loose meat” have bruises and swells that lasts in a week even with a small impact.

I try to work through paying the best possible attention in every operation to minimize bruising and swelling and I ask from the anaesthesiologist to lower the patient’s blood pressure. However, in each case, the individual characteristics of the patient affect the degree of bruising and swelling as I mentioned above. If the patient’s personal tendency is higher, then swelling and bruising remains and reaches to a maximum within the first 48 hours and completely disappears in 3rd or 4th days.

Application of ice around the eye and nose during the first two days of the postoperative stage, holding the patient’s head high after the surgery (it may be provided at home by using some pillows) and avoiding very heavy works especially in the first one month of the postoperative stage particularly reduces swelling and prevents it to be permanent.

Prolongation of postoperative oedema and swelling occurs most often in thick and oily-skinned patients. This situation can be minimized by the surgeon’s elegant and detailed work.

Infections: Nasal infection is observed very rarely after the surgery. The most frequent causes of infections are related with tampons that stay too long inside the nose. Although the silicone tampons that we use in surgeries do not involve such a risk, I still give preventive antibiotics to my patients for the first of the postoperative stage.

In very rare cases, an infective situation can occur namely as ‘septal hematoma’ which is the collection of blood between the two mucous layers covering the middle cartilage called nasal septum. It is resolved generally by aspiration of the accumulated blood from these layers and with antibiotic treatment. We do not encounter this complication no longer because the silicone pads perfectly prevent this situation. Nevertheless it does not mean that we will not encounter anymore.

Dehiscence of sutures: It occurs when surgical closures in nose reopen due to broken or dissolved sutures after the surgery. In this case, the dissolved suture can be replaced with new in clinical conditions.

Death of the partial skin that covers the nose externally due to thinning: This case requires a careful removal of the nasal skin of patients who have had 2 – 3 times rhinoplasty previously. Because of the blood flow of these patients’ nasal skin is deteriorated so the skin becomes thinner and more fragile. Similar complications may occur very rarely in patients with first-time nose surgery.

The numbness at the tip of the nose, in front of lips and upper teeth may take several months after the surgery and it is temporary.

Nasal congestion: If the intranasal problems such as septum deviation, nasal allergies, concha growth and sinusitis in patients are omitted prior to surgery conditions and the surgery is only addressed the outside of the nose, the nasal congestion that we see as normal in the early stages due to swelling can also be continued in the late stages.

Complications that may occur in late postoperative stage

Septum perforation: It occurs very rarely as a hole in the wall made of cartilage forming the centre pillar of nose namely septum. This situation does not create a serious problem but sometimes causes a whistle during the patient’s breath. In this case, the most disturbing event for patients is that the recurrence of nasal congestion caused by permanent crusting around this hole. This situation can be corrected with a second surgery.

Development of nasal synechiae (adhesions): This is another problem that can be seen rarely and do not cause any complaint but it is discovered during a routine examination. It does not create nasal congestion if it is not located in the front part. This problem can be solved through a basic operation under local anaesthesia.

Scars in the nose tip: Principally wounds located middle of the face do not leave scars due to both sided blood flow and good distribution of blood in this area. However, as we mentioned before, nothing is guaranteed. So far, any of my patients have this type of a complaint. However, it does not mean that we will not encounter anymore.

The patients that have curved nose before surgery may confront a problem related with the tendency of the nose cartilage to turn again the previous direction after the operation and this can require a second but smaller operation.

As a result of less or more correction of the previous deformity in the aesthetic nose surgery, the existing deformity can continue or another deformity can emerge. This could result in a functional disorder. Some deformities are illusory and temporary, and that the improvement is observed during follow-up. If patients are dissatisfied with the cosmetic appearance or they lack of satisfaction with new appearance of the nose, the revision surgery can be done within 6 months to 1 year after the initial surgery. In this case, the complete recovery of the nasal tissue should be waited and the surgery should be performed after this. Besides, with regard to smaller problems, basic interventions called ‘retouches’ may require. They usually take 10-20 minutes and are performed under local anaesthesia.

EVEN IN THE BEST OF HANDS, APPROXIMATELY BETWEEN 5-10% OF ALL AESTHETIC NOSE SURGERIES IN THE WORLD RETURNS TO THE RETOUCHING SURGERY. THIS CAUSES BY THE DESIRE OF ALWAYS HAVING A BETTER RESULT.

THE IDEAL RESULT OF AN AESTHETIC NOSE SURGERY IS A HAPPY PATIENT AND A SURGEON FULL OF PRIDE.

IT SHOULD BE NOTED THAT THE COMPLICATIONS WE MENTIONED ABOVE OCCUR VERY RARELY OR NOT EVEN OCCUR AT ALL IN THE HANDS OF A GOOD AND EXPERIENCED SURGEON. HOWEVER, A PATIENT WHO WANTS TO GET SURGERY SHOULD NECESSARILY LEARN THE RISKS OF THE SURGERY, EVEN THOUGH THEY OCCUR ONCE IN A MILLION.

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