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Dr Ömer Özkan

Cases Best Suited for Cosmetic Nose Surgery
Cosmetic nose surgery can improve your physical appearance and enhance your self-confidence. However, this does not necessarily mean that surgery will alter your facial appearance to the one of your dreams and that other people will treat you differently after surgery. Before deciding on surgery you should first ask yourself why you want surgery and what you expect from it; so give the matter considerable thought and discuss the matter with your surgeon. The most suitable patients for cosmetic surgery are not those in search of perfection, but those who look for an improvement and amelioration in their physical appearance.

How Is Surgery Performed?

There are two globally recognized approaches to surgery:
•closed surgery technique,
•open surgery technique.
In closed surgery all incisions are made inside the nostrils. It is performed on the basis of no abrasion of the skin, the hard tissues in the nose (bone, cartilage) being imperceptible to the touch and resulting changes being immediately perceptible. It is a beneficial, practical and popular method for patients with delicate nasal skin and not requiring aggressive nose tip corrections.
In the open surgery technique, in addition to the incisions inside the nose accompanying closed surgery, a horizontal incision is made to the skin structure between the nostrils known as the “columella.“ This is the sole incision made to the nasal skin. It extends some 4-5 mm in length and because of its position is not obvious to others.

Is Nasal Surgery Really Very Difficult?

Yes, nasal surgery is the most difficult type in cosmetic surgical practice. There are two main reasons for this.
•the location of the nose,
•its anatomical structure.
The nose is located in the exact center of the face. It is therefore impossible to conceal the slightest problem that may develop after surgery. This places severe pressure on both patient and surgeon.
Second, and more importantly, the nose is made up of a large number of interconnected, millimetric sub-components. In order to achieve the desired end, before surgery the surgeon has to examine the existing shape of the nose and the extent to which these structures contribute to it. Otherwise, these problems may escape notice during surgery or not be sufficiently corrected. Because no patient’s nasal anatomy is like any other’s. To put it simply, there are as many shapes of nose as there are people. We cannot take an existing type of nose and stick it onto a patient’s face. It is important to aim to produce a separate nose type for each facial type. In this way, the results of surgery will be natural, appropriate to the patient’s face and imperceptible to others.
Long years of training and surgical practice are essential in order to master this complex anatomy.
Despite all these positive endeavors, further nasal surgery for “touch-up” purposes is frequently encountered. The most optimistic assessment of this level is around 10%. That figure alone is sufficient to make the difficulty of nose operations clear.


Can one see what one’s nose will look like before surgery takes place?

Thanks to specially developed programs that have emerged in parallel with advances in computer technology, we plastic surgeons are able to manipulate the patient’s profile and other photographs. However, this can lead to problems since it is impossible to produce totally realistic results, and the technique is not favored by a great many surgeons.


Is cosmetic nasal surgery not advised for people who have trouble breathing through their noses?

One false idea that persisted for many years is that “surgery should be done to the inside of the nose for breathing and to the outside for improving esthetic appearance.” But this outlook has now been abandoned in the age of modern nasal surgery.


There is a close connection between nose shape and function. Examination of patients who have difficulty breathing through the nose reveals a shape impairment or cartilage softness in the great majority of cases. Septoplasty operations (correction of the nasal interior) in which these problems are not resolved sadly fail to achieve their aims and breathing difficulties remain uncorrected or increase.
The most appropriate form of treatment for a patient with nasal breathing difficulty and who also requests nasal shape amendment is for all those factors preventing nasal breathing to be corrected “simultaneously” during cosmetic surgery:
Over-large conchae (nose flesh) should be made smaller. If bent, the septum should be straightened. Cartilaginous structures on the external part of the nose (these function like a valve adjusting the amount of air entering the nose when inhaling and exhaling) should be strengthened if weak.

At What Ages Should Such Surgery Be Performed?
Nose surgery for cosmetic purposes should be performed from the age of 17 in women and 18 in men. If the patient’s main complaint is difficulty breathing through the nose and severe nose bending, such operations can be performed earlier.


What needs to be done as preparation for surgery?
As with all operations for cosmetic purposes, the individual must have no serious disease representing an obstacle to surgery. If they do have such a problem, they must obtain permission for surgery from the doctor looking after them. If using a drug, that drug has to be stopped for a certain length of time after surgery. Please consult the doctor prescribing the drug or notify the surgeon who will perform the operation. Aspirin, vitamin E, birth control pills and herbal supplements whose contents are unclear all have to be stopped 15 days prior to surgery.

Where Should Surgery Be Performed?
I prefer to operate in hospital under general anesthesia. While operations can be performed in the surgery, under local anesthesia and sedation, this is not really appropriate, and is also illegal. After surgery, the patient is free to return home that same evening, on condition that ice packs continue to be applied.

What Happens during the First Two Weeks after Surgery?
Contrary to popular opinion, there is no pain of any kind after nasal surgery. Slight feelings of pressure or discomfort, impaired breathing, a runny nose, sneezing and itching are of course quite normal. Patients who have not been properly informed may interpret these sensations as pain. Severe pain indicates a problem, and is never encountered after surgery in which everything has gone normally.
In particular, there may be a bloody after surgery on the nasal structures known as the conchae, though this disappears in 1-2 days. As a result of a good blood supply to the operated area, infection is so rare as to be almost unknown.
If a pad is used in the nose, this can generally be removed in 2-3 days. The recent production of more comfortable pads, and even the use of biodegradable ones, means that pad removal is no longer a painful and unpleasant experience.
Individuals who do not mind the presence of nose plaster casts can travel about freely 2-3 days after surgery, so long as they do not tire themselves. Heavy exercise and excessively hot environments such as saunas and steam baths should be avoided for some months.
The plaster cast is removed 7 days after surgery and replaced by soft plasters to be left in place for another week.

Returning to Normal
The majority of patients undergoing cosmetic nose surgery are generally up and about within two days and able to return to school or work, if this is not too tiring, after a week.
However, it may still take a few weeks to fully return to the normal tempo of life. Your surgeon will be able to provide more detailed information about returning to normal life. In general terms, you should avoid movement requiring high exertion) for between two and three weeks. You should protect your nose against blows or impact for eight weeks and avoid ruing it or sitting in the sun. Be gentle and very careful when washing your face and hair or putting on make-up.
You can put contact lenses in when needed, but glasses are different. Once the brace has been removed from your nose, the seat of your glasses must not rest on the bridge of your nose until healing is complete, in other words, for two months.
Your doctor will monitor your healing progress and will call you for frequent check-ups for a month after surgery. Do not hesitate to ask your doctor about any unusual complaint or any questions you may have about what or what not to do during these check-up examinations.

Your New Appearance
In the first days after surgery, when your face is swollen and bruised, it is easy to forget that you will eventually look better and more attractive. Most patients do not feel very good immediately after cosmetic surgery, and this is quite normal and understandable. One group of patients, however, are aware that this stage is a passing one. Your nose will start looking better and your spirits will rise with every passing day. One or two weeks afterward you will no longer look as if you have just had surgery. Nevertheless, healing is still a slow and gradual process.
A very few swellings, particularly at the tip of the nose, may persist for months. It may take a year or even longer for the true outcome of cosmetic nose surgery to become apparent.
You may at first receive unexpected reactions from friends or family. They may say they can see no change in your nose. Or, and especially if you have had a family trait or something they regard as a racial feature altered, they may be slightly offended. If this happens, try to remember why you decided to have this surgery done. If you have achieved your aim, then the surgery has been successful.

COSMETIC NOSE SURGERY

AFTER SURGERY CARE GUIDE
The healing process after nose surgery requires time and patience. It is as important for you to be actively involved in after-surgery care and the operation itself is.
Please implement the following measures. Do not hesitate to ask your doctor if there is anything you do not understand.
1. Because of the pads in your nose you may be unable to breathe through your nose when you leave the operating theater. You must continue to breathe through your mouth during this period. Your doctor will tell you how long the pads must remain in place.
2. It is important to take in sufficient fluids. Fruit juice, water and soft drinks sipped gently will go some way to reducing the dryness caused by breathing through your mouth. Do not use straws. Eat soft, easily chewable foods. Use gels or lip creams to keep your lips moist.
3. Only use drugs prescribed by your doctor. Do not take aspirin or drugs containing aspirin or drugs that prevent blood clotting.
4. If the dressings on your nose are still in place, sleep or rest with at least two pillows under your head. Try to keep your head upright as much as possible during the day; this will preserve normal blood circulation and help reduce after-surgery swelling.
5. Some degree of nose swelling is to be expected. This will be pink or light red, but if red blood keeps appearing, then you must notify your doctor by telephone.
6. On leaving the operating theater there will be two layers of plaster and a plaster brace on your nose. These are as important for protecting your nose as for shaping it. Do not touch or alter these dressings; your doctor will remove them inside a week.
7. The small pad beneath your nose can be changed when necessary (or even done away with entirely in the absence of any bleeding).
8. Do not rub your nostrils or attempt to blow your nose. “Keep your hands away from your nose” will be a good rule to follow. Be careful not to twist your nose. Wear clothes that button down the front. Avoid t-shirts or polo necks.
9. Brush your teeth carefully and use only a soft brush. Do not pucker your lips or try to raise your lower lip any higher than necessary.
10. For the first two weeks after surgery, avoid bending, stooping, lifting heavy objects (especially small children), strenuous exercise and sport.
11. Avoid exposure to direct sunlight for the first month.
12. When the external dressings are removed you will see a degree of swelling and discoloring in the surrounding tissue. Your nose may be swollen and tilted upward. This will resolve itself in due course.
13. You may feel a numbness at the tip of your nose and sometimes in your upper lip. This will disappear in a few weeks.
14. Once the pads have been removed you can gently clean your nose 2-3 times a day using cotton buds and tap water. Do not thrust the cotton bud upward through the nostril.
15. Your nose will be blocked, even after removal of the pads. This is a normal tissue response to surgery. Do not try to blow your nose for a week. If you blow your nose, do so very gently. Do not use nasal sprays or drops. If you have to sneeze, do so with your mouth open.
16. Fatigue and weakness are common after the tranquillizers or anesthetics you were given during surgery. You will feel stronger in a few days. Sleeplessness may sometimes arise. You can be prescribed sleeping pills for the first week to help you sleep.
17. Depression is by no means uncommon between 12 and 36 hours after surgery. The first sight of your nose after surgery may come as a shock. Remember that you must be patient and realistic. Do not forget that your nose has undergone a surgical procedure and that it will improve with time. It may take between 6 and 12 months for your nose to heal entirely.
18. You may return to your normal professional life once the dressings have been removed (depending on the kind of work you do). Make-up can be used to cover up small bruises.
19. Be sure to attend all your appointments after surgery. These are essential for your doctor to monitor healing and the progress of your nose and for photographs to be taken to monitor improvements in your appearance after surgery. Appointments are generally made for the 1st week and the 1st, 3rd and 6th months after surgery.
20. Do not use spectacles for the first two months after surgery unless you have to. They may only be used when the plaster wire is in place. After that, they should be attached to your forehead with a piece of tape. You will be shown how to do this.