Nose correction
Table of contents:
What is a classic nose correction?
Rhinoplasty is surgery to reshape the nose. This procedure can make the nose larger or smaller, change the angle of the nose in relation to the upper lip, alter the tip of the nose or correct bumps, indentations or other defects of the nose.
Advantages
- The nose is positioned in the centre of the face and therefore has a big impact on the way you look.
- If you look good, you will feel good.
Disadvantages
- Difficult surgery and therefore risky if you go to the wrong surgeon.
How does a rhinoplasty work?
During a rhinoplasty, Dr van Nimmen makes incisions to access the bones and cartilages that support the nose. The incisions are made inside the nose, so these are invisible after the surgery. In most cases, he will also make a small incision over the columella (the skin in between the nostrils) in order to have a much better view on what he is doing. After this incision has healed completely, it will not be visible for other people at a normal distance. Depending on the desired result, some bone and cartilage may be removed, or some tissue may be added (either from the septum of the nose or from one of the ears or a synthetic material). After Dr van Nimmen has rearranged and reshaped the bone and cartilage, the skin and tissue are redraped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose as it heals. This splint should be worn for six days uninterruptedly and then another two weeks during the night to make sure the nasal bones do not move.
Dr van Nimmen almost always administers general anaesthesia for this procedure. Only in case of small corrections to the tip, he might do it under local anaesthesia. He prefers that the patient stays one night in the clinic, but you can also undergo a rhinoplasty as an outpatient procedure.
Who is a good candidate for a rhinoplasty?
- You may be a good candidate for rhinoplasty if the nose you were born with makes you unhappy or if you dislike the way your nose has aged.
- Expectations are an important criterium in what makes a good candidate. The best nose surgery candidates simply want to improve their nose appearance, but do not seek perfection. The ideal candidates are well-adjusted and otherwise happy with their lives and do not expect that the rhinoplasty will transform them into someone else.
Minimum age for Rhinoplasty
We prefer to wait until the patient is 18 years old and can better understand the consequences of a rhinoplasty. This is because the nose continues to grow. If you do have a correction carried out, the growth plates can become damaged and the shape can change as the nose continues to grow.
Who is not a good candidate for a rhinoplasty?
Apart from the conditions mentioned above, a good health is an absolute requirement. If you have major health issues, these should be dealt with first.
How to prepare for a rhinoplasty?
There are no special preparations. Of course, your stomach needs to be empty at the time of surgery which means no eating or drinking as of six hours before the surgery.
How is an open rhinoplasty performed?
The open or external rhinoplasty approach makes use of a small bridging incision, called a trans-columellar incision, to connect the right and left nostril incisions.
In fact, most rhinoplasty experts regard open rhinoplasty as the procedure of choice for noses with a difficult anatomy of any type, and many of the most effective techniques of contemporary rhinoplasty can only be performed through the open approach. When performed correctly, the healed trans-columellar incision is often invisible and seldom results in an objectionable scar.
Sequence of procedures
If needed, Dr van Nimmen starts the surgery by taking some ear cartilage, but this is rarely necessary as most of the time there still is cartilage available for grafting in the septum.
- Injection of local anaesthesia.
- Correction of septum (correction of deviation, lengthening, shortening) and graft taking for a strut to support the tip.
- Preliminary reduction of the hump/ lowering of the dorsum of the nose.
- Correction of the cartilages that support the tip (medial and lateral crura).
- Creation of the tip (double dome technique, lateral steal, interdomal sutures).
- Osteotomies (lateral and medial, intermediate on indication).
- Final lowering of the dorsum.
- Insertion of spreader grafts if necessary (to ensure a good air passage through the nose).
- Closure by suturing.
- Basal excisions (nostril size reduction, alar flaring reduction).
What to expect and do during the recovery period after a rhinoplasty?
The day of the procedure
- Pain—Strange enough, pain is not really an issue after a rhinoplasty.
- Congestion—The most obvious and slightly annoying symptom after a rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion in the first few weeks afterwards, until the swelling slowly subsides. This is usually at its worst in the first few days after the surgery. After two to three weeks, your breathing should have normalized.
- Swelling and bruising—Swelling and bruising on the outside of your nose and cheeks is seen after surgery as well. This can sometimes be moderate and sometimes almost non-existent, but usually it falls somewhere in the middle of this continuum. Even in the worst cases, bruising is usually mostly gone within seven to fourteen days after the surgery.
The first week
- Most patients plan to take about a week from work and other major activities.
- You will have a cast on your nose and some stitches that need to be removed. This is all done six days after the surgery. Once the cast is removed, you will look presentable within one to two weeks after the surgery. You should not plan to have your wedding the week after, but your friends and colleagues should not be aware of anything. You can wash your face gently and put on a little cover-up makeup or foundation after one week.
The first month
- Two to three weeks after the surgery, about 70% of the swelling is gone, so you should be starting to appreciate some changes. You will not really see the details yet though until about six weeks after surgery when about 80 to 85% of the swelling has gone down. While you will be looking pretty good after two weeks, you might still feel a little self-conscious. That is because your nose (especially your tip) will feel a little (or sometimes a lot) numb after surgery, no matter what technique was used. It can take anywhere from several weeks to six months or more for the feeling to return completely. During the first six weeks or so, your nose just will not feel like your own. Things like smiling and talking animatedly will feel strange.
- Many patients are very afraid that they will do something to harm their result. While it is true that a major bump in the nose can cause unwanted healing problems, there are not too many things you can do to really harm the result, so there is no use in avoiding touching your nose. There are some things you can do, however, to speed up the healing process and get you back into camera-ready shape more quickly. Keep your head up after surgery. Keep some cool compresses over your eyes and cheeks in the first 48 hours. For a few weeks, avoid bending, lifting anything over a few pounds, exercising or anything that gets your blood pressure up. This may increase swelling and cause bleeding. Get a lot of sleep. Go outside and take some light walks. Eat well. In the first weeks, things will not look perfect so try to avoid staring in the mirror or over-analysing small changes.
- Some other symptoms are also common in the months after surgery. Your nose may run more easily, especially when irritated. Your nose will tend to swell up a little when you exercise or do anything exceptional. The skin over your nose can break out more easily and can be more sensitive to sunburn. It is important to remember that with each subsequent revision surgery, this entire process of recovery is slowed down a bit. As a result, it is not uncommon that it takes up to two years or more to see some of the changes you seek if you have already had a revision procedure.
What are the risks of a rhinoplasty?
- Anaesthesia risks
- Bleeding (hematoma)
- Infection
- Poor wound healing or scarring
- Change in skin sensation (numbness or pain)
- Nasal septal perforation (a hole in the nasal septum) is rare.
Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication. - Difficulty to breathe
- Unsatisfactory nasal appearance
- Skin discoloration and swelling
- Possibility of revision surgery
How long can I expect the results of a rhinoplasty to last?
The results of a well-performed rhinoplasty last forever. Nevertheless, keep in mind that the natural aging process may mildly affect the shape and size of the nose.
What is a nose correction using rib graft?
In some cases, after one or several rhinoplasties the nose of the patient has been over-resected to such an extent that the nose needs to be reconstructed using cartilage taken from one of the patient’s ribs.
As this is very specialized work that demands a lot of expertise, this procedure is performed in our clinic by the internationally known Dr Enrico Robotti from Bergamo. He is very famous all over the world for this type of nose reconstruction. Twice a year, in November and in June, he comes to o2 Clinic to operate the patients that we have selected for him.
Before and after photo (frontal comparison) of a woman after a nose correction or rhinoplasty.
Advantages
- Very stable results.
- Even the worst cases of nose destruction can be successfully treated.
- The rib donor site is inconspicuous.
- Any functional problem can be corrected at the same time.
Disadvantages
- Duration and complexity of the procedure (surgery requires time and special care).
- A rib graft needs to be taken.
- Your nose will feel rather rigid.
How does a secondary rhinoplasty using rib graft work?
A piece of cartilage, of about three cm long, will be harvested from a patient’s rib. In women, the scar will be hidden in the crease under the breast. The rib will be divided into slices of cartilage of about 1 – 1,5 mm thick, which can be used to build up the nose.
What can a secondary rhinoplasty using rib graft do for you?
With this procedure we can create a very straight and firm nose that stays stable over time and ensures a good breathing through the nose.
Who is a good candidate for a secondary rhinoplasty using rib graft?
Any patient in good health whose own cartilage of the nose has been over-resected resulting in an unattractive nose, often accompanied by breathing problems.
How is a secondary rhinoplasty using rib graft performed?
Through an incision of 3 cm long over a rib in the region of the skinfold under the breast, a piece of cartilage is taken. A small catheter for the injection of a painkiller during the first 24 hours after surgery is left in the wound and the wound is closed in layers. The rib graft is cut in slices of about 1 – 1,5 mm thick and kept in saline (water with a bit of salt).
The open or external rhinoplasty approach makes use of a small bridging incision, called a trans-columellar incision, to connect the right and left nostril incisions.
In fact, most rhinoplasty experts regard open rhinoplasty as the procedure of choice for noses with a difficult anatomy of any type, and many of the most effective techniques of contemporary rhinoplasty can only be performed through the open approach.
When performed correctly, the healed trans-columellar incision is often invisible and seldom results in an objectionable scar.
A sketch of the donor area when undergoing a secondary rhinoplasty using a rib graft.
Sequence of procedures
- Injection of local anaesthesia into the nose.
- Correction of septum (correction of deviation, lengthening, shortening).
- The reconstruction starts at the bridge of the nose. Two pieces of cartilage pointing downwards are fixated to the bony part of the septum.
- Another piece of cartilage is fixated on one side to the anterior nasal spine (at the junction between the upper lip and the nose) and to the two pieces of cartilage mentioned under 3. This way, the basic frame that will support all other cartilages to reconstruct the nose is built.
- Thin pieces of rib cartilage are used to reconstruct the lower lateral cartilages that give support to the wings of the nose, so it does not collapse during forced inhalation.
- Osteotomies of the bony part of the bridge of the nose (lateral and medial, intermediate on indication). Sometimes bone can be manipulated by osteoplasty instead of, or in addition to, osteotomy. Such bone manipulations are currently carried out by electrical or piezoelectrical instruments (small and precise burrs and saws)
- On indication, rim grafts or small on-lay grafts can be used to further give the nose its desired shape.
- Insertion of a piece of temporalis fascia (strong fibrous layer around the muscle in the region of the temples) that can be wrapped around some diced cartilage (cartilage cut in very small pieces) on top of the bridge and sometimes the tip of the nose. This makes everything very smooth and avoids irregularities.
- Closure by suturing.
- Basal excisions if needed (nostril size reduction, alar flaring reduction)
- Internal and external splinting of the nose. Splints will be removed after a week.
What to expect and do during the recovery period after a rhinoplasty using rib graft?
The day of the procedure
- Pain—Strange enough, pain is not really an issue after a rhinoplasty.
- Congestion—The most obvious and slightly annoying symptom after a rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion in the first few weeks afterwards, until the swelling slowly subsides. This is usually at its worst in the first few days after the surgery. After two to three weeks, your breathing should have normalized.
- Swelling and bruising—Swelling and bruising on the outside of your nose and cheeks is seen after surgery as well. This can sometimes be moderate and sometimes almost non-existent, but usually it falls somewhere in the middle of this continuum. Even in the worst cases, bruising is usually mostly gone within seven to fourteen days after the surgery.
The first week
- Most patients plan to take about a week from work and other major activities.
- You will have a cast on your nose and some stitches that need to be removed. This is all done six days after the surgery. Once the cast is removed, you will look presentable within one to two weeks after the surgery. You should not plan to have your wedding the week after, but your friends and colleagues should not be aware of anything. You can wash your face gently and put on a little cover-up makeup or foundation after one week.
The first month
- Two to three weeks after the surgery, about 70% of the swelling is gone, so you should be starting to appreciate some changes. You will not really see the details yet though until about six weeks after surgery when about 80 to 85% of the swelling has gone down. While you will be looking pretty good after two weeks, you might still feel a little self-conscious. That is because your nose (especially your tip) will feel a little (or sometimes a lot) numb after surgery, no matter what technique was used. It can take anywhere from several weeks to six months or more for the feeling to return completely. During the first six weeks or so, your nose just will not feel like your own. Things like smiling and talking animatedly will feel strange.
- Many patients are very afraid that they will do something to harm their result. While it is true that a major bump in the nose can cause unwanted healing problems, there are not too many things you can do to really harm the result, so there is no use in avoiding touching your nose. There are some things you can do, however, to speed up the healing process and get you back into camera-ready shape more quickly. Keep your head up after surgery. Keep some cool compresses over your eyes and cheeks in the first 48 hours. For a few weeks, avoid bending, lifting anything over a few pounds, exercising or anything that gets your blood pressure up. This may increase swelling and cause bleeding. Get a lot of sleep. Go outside and take some light walks. Eat well. In the first weeks, things will not look perfect so try to avoid staring in the mirror or over-analysing small changes.
- Some other symptoms are also common in the months after surgery. Your nose may run more easily, especially when irritated. Your nose will tend to swell up a little when you exercise or do anything exceptional. The skin over your nose can break out more easily and can be more sensitive to sunburn. It is important to remember that with each subsequent revision surgery, this entire process of recovery is slowed down a bit. As a result, it is not uncommon that it takes up to two years or more to see some of the changes you seek if you have already had a revision procedure.
What are the risks of a rhinoplasty using rib graft?
- Anaesthesia risks (like any surgical procedure)
- Bleeding (hematoma)
- Infection
- Poor wound healing or scarring
- Change in skin sensation (numbness or pain)
- Nasal septal perforation (a hole in the nasal septum) is rare.
Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication. - Unsatisfactory nasal appearance
- Skin discoloration and swelling
- Possibility of revision surgery
- Pneumothorax (collapse of a lung, extremely rare) which is caused by a small whole in the lung which should be closed.
How long can I expect the results of a rhinoplasty using rib graft to last?
The results of a well-performed rhinoplasty last forever. Nevertheless, keep in mind that the natural aging process may mildly affect the shape and size of the nose.
Frequently asked questions
What is the cost of facial surgery?
You can find estimated prices here, after your consultation you will be informed of the exact prices of your operation. Prices are average and may vary depending on: the exact treatment or surgery needed; the exact area you want to have treated; your bone structure; your expectations and wishes...
We have a specific procedure to get a quote from the doctor. To receive a personalized quote, please visit the following link to see your different options.
Is there a payment plan or financing option for a surgery?
No, payments have to be made following our payment policy. It is not possible to pay for a surgery via monthly/... payments.
What is the cost of a forehead lift?
You will find all the prices of our treatments and operations here.
How long will the results of a forehead lift last?
A forehead lift has a long-term result of 10 to 15 years. Of course you also have to take into account the natural ageing process of the skin as you get older.
What are the risks of a forehead lift?
Any disadvantages or possible complications can be found here.
Who is a suitable candidate for a forehead lift?
People who suffer from low-set eyebrows, deep frown lines on the forehead and between the eyebrows, drooping eyelids and tension headaches caused by frowning.
How to prepare for a forehead lift?
For this procedure, you do not need to make any specific preparations apart from the standard preoperative instructions. You will receive these by email.
What is the cost of a mid-facelift?
You will find all the prices of our treatments and operations here.
How long will the results of a mid-facelift last?
A mid-facelift is very effective in tightening the skin around the cheeks, and most people are satisfied with the results. The results usually last for about 10 years.
What are the risks of a mid-facelift?
Any disadvantages or possible complications can be found here.
Who is a suitable candidate for a mid-facelift?
A mid-facelift can be a good option for people who want a more youthful appearance, prominent cheekbones and a radiant look, but who do not require surgery to their jawline or forehead.
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