Why did the Danish astronomer have a golden nose? A brief excursion into the history of rhinoplasty

The nose is not only a respiratory organ, but also an important detail of our appearance, which, unfortunately, is often far from the aesthetic ideal. A crooked nose or a nose with a hump, a nose that is too large or too small - this is what our patients very often complain about, because any, even the most insignificant, flaw in appearance can lead to the development of complexes, and in general, significantly spoil life. And this is not to mention that a deformed nose can make breathing difficult or cause snoring. Agree, these are not the most pleasant things either. Rhinoplasty, or, more simply, nose surgery, is designed to solve all these problems.

How is rhinoplasty performed?

There are two ways to perform rhinoplasty: open and closed. The second option is considered more preferable, since all cuts during the operation are made from the inside of the nose and after rhinoplasty there are no visible marks left on your nose - they are all inside. The open method (that is, dissection on the outside) is rarely used - with very complex plastic surgery options.

The operation in most cases is performed under general anesthesia and lasts from half an hour to two and a half hours. It all depends on the specific case. At the end of the operation, you will have self-dissolving sutures, which will disappear within a week, and cotton swabs will be inserted into your nostrils (these will be removed after 24 hours). In difficult cases, a plaster cast is also applied.

Medical website Surgeryzone

The nose is the most common object of plastic and reconstructive surgical interventions (in most cases, rhinoplasty) with the aim of correcting and changing its congenital and acquired deformities. Acquired deformities of the nose are primarily associated with the central location and its protrusion above the level of surrounding tissues, and therefore injuries to the nose in most cases are the most severe and have to be observed relatively more often than injuries to other parts of the face. With closed injuries, fractures and displacements of the nasal skeleton are observed. Damage to the nose occurs in 80% of the world's population for a variety of reasons: birth trauma, at work, during sports games, as a result of transport accidents, in a fall during an epileptic fit.

In clinical practice, lateral displacement of the nose (rhinoscoliosis) is most common. Another type of post-traumatic deformation of the external nose is rhinokyphosis, in which the formation of a hump is noted. The treatment for these diseases is rhinoplasty.

Often, chronic nasal fractures lead to post-traumatic deformities of the nasal septum as a result of thickening and displacement, less often of the bone and more often of the cartilaginous parts, as well as curvature of the external shape of the nose relative to the midline. Deviations of the bony part of the septum can be in the form of unilateral hump, unilateral clivus depression, bilateral clivus curvature and nasal root deviation. The curvature of the cartilaginous part of the septum is caused by displacement of the quadrangular cartilage relative to the anterior nasal bone of the upper jaw. Thus, G.S. Protasevich notes three degrees of severity of deformation of the nasal septum, and Mladina in her classification lists seven types of deformation. A.S. Lopatin, rightly considering their classifications to be insufficiently convenient and accurate, identifies five types of deformities of the nasal septum, while emphasizing that post-traumatic deformations of the nasal septum, due to the bizarre form of fusion of comminuted fractures with sharp angles and fracture lines, do not fit into the described ones for systematization they are kind.

Belousov divides deformations of the nasal septum into: 1) deformations of the middle and posterior sections, 2) anterior sections, B) the entire section (C-shaped and S-shaped). Thickening of the nasal septum is expressed in the formation of spines and ridges, usually at the junction of the cartilage with the upper edge of the vomer. Sometimes they form in the anterior, and sometimes in the posterior sections of the nasal septum, but more often - along its entire length, narrowing or completely blocking the nasal passages, making it difficult to breathe through the nose.

It has been established that deformations of the nose and intranasal structures, first of all, lead to disruption of aerodynamics and, consequently, disruption of its main functions - respiratory and olfactory. The sense of smell affects behavior, memory and emotions, and many autonomic functions of the nervous system that are not controlled by consciousness.

Anatomical position, variety of defects and deformities and people's desire to be attractive are considered to be one of the main reasons for the prevalence of nose surgeries. The analysis showed that with regard to methods for eliminating deformation of the nasal septum, the views of surgeons are very diverse. In 1757, E. Quelmalts published a work that described a method for repositioning a deviated nasal septum using daily digital pressure, and W. Adams, to solve this problem, proposed a fracture of the deviated nasal septum with subsequent splinting. For the first time, the idea of ​​resection of a deformed part of the nasal septum was implemented in 1882 by EFIngals, although as a result of such intervention perforations were formed in the quadrangular cartilage, the technique found its supporters and was later applied by R. Kreig (1889) and G. Boeningaus (1890). FHBosworth performed this operation using a saw, preserving the mucosa on one side. Taking into account the main disadvantage of this operation, C. Watson developed a technique for septoplasty with preservation of the mucous membrane. MJAsch, in turn, proposed a method for modifying the septal cartilage. A number of famous rhinologists of the 19th century, among whom the names JORoe, Gleason, Douglas can be mentioned, also used a variety of methods for correcting the nasal septum. At the beginning of the 20th century, OTFreer (1902) and G. Killian (1904) independently developed a method of submucosal resection, the principle of which was to remove the part of the septum causing the obstruction. At the same time, the authors recommended maintaining the caudal support of the nasal dorsum in the form of a 1 cm cartilaginous septum. This operation is widely known as a classic technique for submucosal resection of the nasal septum. We share the opinion of A.S. Lopatin that, despite the significant disadvantages of this technique, such as: the need to remove a significant part of the osteochondral skeleton; impossibility of correcting deformities of the caudal end; restrictions on access to the premaxillary region and the nasal spine; inaccessibility of the area of ​​retraction of the nasal valve, as well as possible complications and undesirable consequences of this operation such as perforation; atrophy of the mucous membrane; watery nasal discharge; vibrations of a rigid partition, deprived of its support; suction of the septum, complicating nasal breathing, saddle-shaped deformation of the back; columella retraction; change in the shape of the tip of the nose; described by specialists, in most otorhinolaryngological clinics, submucosal resection of the curved part of the septal cartilage is performed routinely and unreasonably often. However, in plastic surgery it is customary to perform rhinoplasty and septoplasty while preserving the integrity of the septal cartilage, which has the following important functions: supporting the dorsum of the nose; regulation of nasal breathing; fixation of the mucous membrane of the nasal passages. If excision of a small area for segmental curvature of the septal cartilage is considered a harmless intervention, then resection of a large area inevitably leads to retraction of the nasal dorsum. In this case, getting rid of one problem, patients acquire another, no less important, problem - an aesthetically unacceptable shape of the nose.

A number of authors, in search of more advanced techniques, have proposed alternative methods for correcting a deviated nasal septum while preserving the skeleton of the septum. For example, the disc method, revolving door method, resection of cartilage strips, cross-hatching method, shaving, free processing method, auto-reimplantation of cartilage and other rhinoplasty methods. The advantages and disadvantages of these operations have been published more than once in the specialized literature and are well known to practicing doctors dealing with the problems of nasal surgery. Mourice Cottle proposed a maxillary-premaxillary approach with preservation of the mucosa. The author emphasizes that his technique is devoid of the disadvantages of classical submucosal resection of the nasal septum and, therefore, has found its supporters, especially among plastic surgeons. However, among specialists in ENT departments, only a few master the technique of performing the Cottle operation, and in general, the method is considered difficult and practically inaccessible to master.

Modern reconstructive surgery of the nasal septum has improved the technique of performing these operations using endoscopic equipment. Another innovation in rhinology is developed in 1995-1998. in Russia, under the leadership of V.M. Svistushkin, a method for correcting the nasal septum, which does not require anesthesia and surgery, in which, using laser radiation, the cartilage is evenly heated to a certain temperature and, as a result, becomes elastic like plasticine, which allows you to give it the desired shape using your fingers . However, thermoplasty of the quadrangular cartilage turned out to be ineffective for complicated, severe curvature of the nasal septum. The latest methods have not yet found widespread application due to the high cost of the necessary equipment and the inconvenience of training specialists.

Over the past 15 years, the number of rhinoplasties for congenital and post-traumatic deformities of the nose has increased significantly in the CIS. If earlier rhinoplasty was performed mainly by otolaryngologists and only for severe post-traumatic deformations of the septum and dorsum of the nose, today it has become one of the main areas of activity of plastic surgeons.

Many years of experience testify to the variety of surgical approaches for rhinoplasty, which are described in hundreds of publications, where, along with achievements, a number of controversial issues can be traced. Thus, the opinions of scientists are contradictory regarding rhinoplasty methods. Today, there are closed and open methods of rhinoplasty. Closed rhinoplasty methods are performed using endonasal incisions. In open rhinoplasty techniques, endonasal incisions are combined with incisions in the skin of the columella or lobule of the tip of the nose. Thus, a wide variety of incision patterns were proposed, that is, each of the rhinosurgery specialists tried to add their own touch, because the success of rhinoplasty, first of all, depends on the optimally convenient incision, which will allow the intended volume of the operation to be performed. Each rhinoplasty method has both advantages and disadvantages. An assessment of closed rhinoplasty methods determined their only advantage is the formation of invisible scars after them, but at the same time they have quite significant disadvantages: limited field of action; change in nostrils; destruction of the adhesions between the upper and lower lateral cartilages; asymmetry of the tip of the nose in the area of ​​the domes and medial crura; intersection of fibrous adhesions and relaxation of the supporting apparatus of the tip of the nose. In addition, endonasal incisions follow the direction of the lateral pedicle of the greater cartilage of the wing, as a result of which they do not provide sufficient mobilization of the skin flap and a wide view of the nasal structures.

The advantages of open rhinoplasty are: a wide view of the nasal structures; possibility of resection of bone and cartilage tissue under visual control; the possibility of using more conservative surgical techniques; preservation of the supporting structures of the nose; isolation of tissue in the avascular layer; symmetrical application of fixing sutures; strengthening the tip of the nose and skin septum; highest level of accuracy; maximum predictability of results and their high quality. The open method of rhinoplasty does not satisfy specialists and patients only with the following disadvantages: a noticeable external scar; pronounced postoperative tissue swelling; a large investment of time to perform the intervention; the possibility of hematoma and skin necrosis; the medial leg of the alar cartilage is cut off - non-physiological. Having analyzed the types of open incisions during rhinoplasty, one can notice that the incisions according to Potter are located too low due to which the blood supply to the columellar flap is disrupted with the possible occurrence of skin necrosis, and the lines of transverse incisions according to Rethi are too high, that is, on the lobule, which leads to the formation of a noticeable external scar on the tip of the nose. The vertical direction of the incisions on the columella, that is, perpendicular to the direction of the natural folds of the skin, and sometimes this incision combined with the birdie incision, forms a visible scar. Consequently, the above-mentioned disadvantages of open rhinoplasty methods, in our opinion, are associated with unrefined techniques for performing rhinoplasty and imperfect tactics for managing patients in the postoperative period, but in general, the open method is the method of choice. Some Russian and Latin American experts have come to this opinion in recent years. Thus, A.E. Belousov believes that the surgeon should perform the first 100 rhinoplasties using open access in order to get used to the high accuracy of the implementation of the operation plan.

Another important point in rhinoplasty is the determination of indications for surgery and the volume of intervention depending on the purpose pursued by the planned operation. It should be recognized that scientists, in an effort to improve surgical techniques, pay little attention to the development of objective criteria for assessing the shape and function of the nose. The assessment of topographic deformations of nasal structures and the objectification of the results of nasal breathing studies remain extremely relevant. There is clearly not enough research in this area. To solve these problems, most specialists use the classical method of determining the function of the nose - rhinomanometry and acoustic rhinometry, and to study the topography of the nasal structures - radiography of the midface. With the technological advances of modern computer science, reports have appeared in publications regarding the use of tomograms and linear zonograms. The authors, focusing on the use of innovative examination techniques, evaluate computed tomography as one of the most informative additional research methods. Very interesting are the works of K.B. Lipsky et al., who routinely performed spiral computed tomography of the facial skeleton in 30 patients who applied for rhinoplasty. Having studied the results of the study in 17 (56.7%) cases, the authors found functionally significant curvature of the nasal septum of varying degrees and came to the conclusion that performing computed tomography of the nose in patients who applied for aesthetic reasons and had difficulty breathing is extremely necessary and appropriate. In the course of studying these works, it turned out that the analysis of the results of these studies is not sufficiently covered and there are no comparative results of studies after surgery. In the literature available to us, we did not find any reports where the value of computed tomography in the diagnosis and treatment of post-traumatic deformities of the nose was determined.

M.I.Makhmudnazarov and A.S.Lopatin o. In our opinion, it is impossible to improve the external shape of the nose in post-traumatic deformities of the nose without intranasal intervention. As for inflammatory pathologies, they must be cured by the time of surgery by using adequate local therapy, since their presence is a contraindication to surgical intervention. A.E. Belousov draws attention to the close relationship between these two functions of the nose and suggests performing rhinoplasty taking into account the unity of its aesthetic and respiratory functions.

In rhinoplasty, little attention is paid to the peculiarities of postoperative patient management; there is no uniform approach to the selection of material for packing and no specific instructions regarding the duration of tamponade of the nasal cavities, immobilization of bone fragments, or external dressing. To date, various modifications of the technique of nasal tamponade and fixation of the nasal septum after intervention on it have been proposed using such a variety of materials as: strips of Teflon, foil, rubber, celluloid, gauze, etc. . This list of various materials is explained by the fact that tamponing of the nasal cavities causes irritation, infection of the paranasal sinuses, ulceration and bedsores of the mucous membrane, with disruption of its production of mucociliary mucus, as a result of which some authors recommend removing tampons after 24 hours, and xenomaterials after a week. Others leave gauze swabs in the nasal cavities for 3-5 days. It is proposed to use biological tissue glue instead of nasal tamponade. However, in our opinion, tamponing for only one day is insufficient, since after removing the tampons, deviation of the mobilized cartilage and bone fragments that have not yet fused together can easily occur. The use of allo- and xenomaterials for this purpose is inappropriate due to their foreignness and unstable intranasal fixation of the septum.

As for the external immobilization of the operated nose, the variety of shapes and materials used as external fixing bandages are in no way inferior to internal ones. Thus, A.V. Brofman proposed adhesive-roller pellots and headbands, which were not widely used due to the impossibility of modeling and their weak fixation of tissues. Then bandages with built-in rigid plates appeared in practice, which turned out to be not entirely comfortable due to the lack of a relief shape. Also, over the years, collodion dressings, a plexiglass splint, corrective negative masks, a silicone rubber bandage, and a reinforced corrective plastic splint have been developed. Due to labor-intensive production and high cost, these dressings have not received sufficient distribution. In addition, in our opinion, it is not correct to make external fixation bandages before surgery, since it is impossible either by computer or plaster modeling to predict or plan in advance what the nose will be like. In this regard, the original proposal was the use of a plaster cast proposed by N.M. Arbuzov, subsequently modified by A.E. Kitsera and A.A. Borisov. Supporters of plastic and rubber splints do not support the use of a plaster cast due to its poor fixation on the face, which, in our opinion, is erroneous. It can be argued that the problem in this case lies not in the plaster itself, but in the shape of the mask, which only needs to be modeled correctly. The presented data indicate that each rhinologist has his own tactics and personal approach to this issue, which is a serious gap in rhinosurgery, where it is especially necessary to adhere to a clear sequence of actions and strictly adhere to the uniform rules of postoperative management.

As for complications in rhinology, most authors regard surgery on the nasal septum as a relatively safe intervention, but at the same time they provide descriptions of various complications of a local and general nature. Complications of a local nature include: intraoperative (bleeding, ruptures of the mucous membrane, injury to the cribriform plate, perforation of the anterior wall of the sphenoid sinus), immediate postoperative and undesirable consequences (impaired sense of smell, anosmia, degenerative changes in the mucosa, secondary deformation, difficulty in nasal breathing, whistling when breathing , nosebleeds and headaches). The literature describes cases of collaptoid condition, cardiac arrest, sudden blindness, paralysis of the extraocular muscles, toxic shock syndrome, tonsillitis, lymphadenitis, sepsis, cavernous sinus thrombosis, subarachnoid hemorrhage, meningitis, subdural abscess and brain abscess as a result of generalization of infection and reflex effects during rhinoplasty A.O Gusan et al. they rightly note that all of the listed complications are in one way or another connected with the actions of doctors, due to miscalculations during rhinoplasty. A special place in terms of possible complications is occupied by errors during resection of the bone and cartilaginous parts of the nasal dorsum. As is known, during resection of the cartilaginous part of the dorsum of the nose, the nasal passages through the open mucous membrane in this area communicate with the tissues that form the shape of the nose, as a result, in addition to translocation of the infection, heavy bleeding from the mucosa occurs, which interferes with the surgeon’s further work. Many experts consider this, as well as the development of the “open roof” syndrome, to be an inevitable result of the necessary stages of rhinoplasty and propose several methods for correcting these complications, which are based on suturing the mucosa, osteotomy of the frontal process, and the use of cartilage grafts. We have not encountered methods to prevent these undesirable consequences, the use of which could significantly facilitate the performance of rhinoseptoplasty and provide an aesthetic appearance of the nose. It should also be noted that a large number of publications devoted to aspects of rhinoplasty indicate that the above problems have not been resolved. Reports, as a rule, mention the possibility of such complications, but very rarely the frequency of their occurrence is given, or their percentage to the total number of operated patients is not fully disclosed. In our opinion, the causes of errors and complications during rhinoseptoplasty should first of all be sought in the lack of an integrated approach, and this is adequate preoperative preparation and postoperative management of patients. As a rule, aesthetic and reconstructive nasal surgeries are performed on a commercial basis throughout the world. Despite the fact that in many countries rhinoseptoplasty is considered one of the most expensive operations, the actual costs for patients are significantly saved or, in an effort to please patients, doctors succumb to their persuasion. For example, it is known that patients are most afraid of general anesthesia, citing possible consequences, and as a result they choose local anesthesia. In addition, patients often, in order to hide the fact of the operation and reduce hospital costs, do not want to stay in the hospital for a long time, as a result of which, a few hours after the operation or the next day, they are discharged for outpatient follow-up care. This approach is quite suitable for novice, inexperienced doctors in private clinics. But if we analyze the consequences of such decisions, it becomes obvious that the complications and the results obtained can ultimately cause a lot of mental distress and economic costs for both the patient and the doctor. Well-known Russian scientists share the same opinion, arguing that rhinoplasty should not be a tribute to fashion or material interest and should be based on extensive, long-term training of doctors.

Have questions or something is unclear? Ask the article editor - .

Thus, having studied the works devoted to nasal surgery, we have traced some ambiguities in the technique of performing rhinoplasty, preventing the development of complications and managing patients in the postoperative period.
The article was prepared and edited by: surgeon I.B. Pigovich.

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What can rhinoplasty do?

Correction of the tip of the nose

This surgical option allows you to make the tip of your nose thinner or thicker, or correct the angle or projection. It is carried out internally. The surgeon adjusts the soft tissue and cartilage.

Correction of the nasal septum

This correction is also called septoplasty. It is carried out using an endoscope, which is essentially a micro-camera that allows you to “look” inside the nose and makes it possible to use the internal version of plastic surgery even when it comes to the nasal septum.

Nose wing correction

There are two options here: decreasing and increasing. In the first case, part of the wings on the outside is removed (as shown in the figure). In the opposite situation, the surgeon’s main task is to restore the support of the wings of your nose. For these purposes, a small fragment of cartilage tissue is taken either from the auricle or from the nasal septum.

Nose reduction

In this case, the part of the nasal bone that “spoils” your nose is removed. Thus, the operation allows not only to reduce the size of the nose, but also to correct its shape.

What to do before rhinoplasty?

If you decide to have rhinoplasty, then you will have to follow some simple rules:

• during the week before surgery, do not drink alcohol or drugs that thin the blood;
• if you are taking any medicine as prescribed by your doctor, you will need to inform our specialist about this during the preliminary consultation;
• at the time of the operation, your nose must be completely healthy (no ARVI or acute respiratory infections - this will also need to be taken care of).

Congenital deformities of the nose

In addition to defects that appeared during intrauterine development, a number of deformities of the nose, its non-standard size and shape can also be called congenital. Experts qualify them as follows:

• nose-saddle or retraction of the nasal bridge;
• humped nose or beak nose;
• a long nose;
• sharp and long;
• long humpback;
• barrel-shaped;
• crooked;
• button nose or very small;
• with a deformed tip: drooping, widened, curved, raised, etc.;
• combined deformities.

What to do after?

Just a day after rhinoplasty, you can go home. The stitches, as we have already said, will dissolve on their own, and the splint can be removed after ten days.

You will be able to return to your normal rhythm of life within a week at the latest, but for several months after this you will need to observe some restrictions:

• do not sunbathe in the sun or in a solarium;
• exclude thermal procedures, especially saunas and steam baths;
• limit physical activity;
• In addition, it is not recommended to wear glasses at first, as they will put pressure on the bridge of your nose, so if you need permanent vision correction, get contact lenses during this time.

As you can see, nothing complicated. Moreover, the reward for following these rules is a perfectly shaped nose.

Questions and myths

Rhinoplasty, like any other operation related to appearance, raises questions among patients, the answers to which many for some reason prefer to receive answers not from specialists, but on the Internet. Hence the many myths that accompany rhinoplasty. Let's try to figure it out.

Myth #1 – Rhinoplasty is painful.

As we have already said, the operation is performed under anesthesia, so there is no pain. Moreover, in comparison, for example, with breast surgery, rhinoplasty is considered a fairly simple and non-traumatic procedure.

Myth No. 2 – The effectiveness of rhinoplasty depends on the season

Some people believe that it is better to perform rhinoplasty in the summer so that the nose is not exposed to the cold, while others consider rhinoplasty to be an exclusively winter operation, because in winter it is easier to protect yourself from the sun’s rays. This is wrong. Rhinoplasty is equally effective at any time of the year. When exactly to carry it out is up to you to decide.

Myth No. 3 – It is very easy to identify a person who has had rhinoplasty.

Of course it’s easy, because his nose will become more beautiful and better. But seriously, rhinoplasty, as already noted, does not leave behind visible traces, so the likelihood that someone will find out about the operation is practically absent.

Finally

It should be understood that rhinoplasty requires from a plastic surgeon not only professionalism, but also the talent of a sculptor, because the doctor, in essence, creates a new shape of the nose. In this case, we are talking not only about the proper functioning of the respiratory organ, but also about its beauty. This is why it is very important to choose the right clinic.

The GENESIS Clinic is a staff of qualified specialists with a worldwide reputation. For more than ten years, plastic surgeries of any level of complexity have been performed within the walls of our clinic. Our clinic has hundreds of patients who, with our help, have already solved their appearance problems.

The GENESIS clinic always offers a comfortable visiting schedule. Your visit will be scheduled at the most convenient time for you. Modern gentle techniques allow us to shorten the length of your hospital stay as much as possible - we will let you go home a day after the operation.

Clinic "GENESIS" is a maximum of attention. Our specialists will take into account all your wishes regarding the upcoming rhinoplasty and answer any questions you may have.

Are you unhappy with the size or shape of your nose? Call the GENESIS Clinic and we will help you solve this problem!

Repeated plastic surgery

A significant proportion of patients require reoperation after primary plastic surgery. Nose correction can be divided into two stages or the result is unsatisfactory. Additional surgical intervention includes:

• elimination of scars;
• improved aesthetic result;
• modeling the ideal nose shape.

Typically, additional surgery does not take much time and is performed using local anesthetics. In medical practice, revision rhinoplasty is considered absolutely normal and occurs in 30% of cases. During repeated surgery, the nose is sculpted to an ideal state according to the patient’s wishes.

Additional surgery may be necessary if complications develop during the recovery period. The doctor prescribes a thorough examination and eliminates the problems that have arisen. When performing correction, the surgeon should not make any mistakes so that significant deformities do not occur.