Most people are afraid of their ugly nose with defects, and everyone wants to change it.
However, you should first figure out what kind of problem this is and what nature it is - aesthetic or pathological.
When changing the shape of the nose (osteotomy), that is, artificially, the nose is broken and its position is changed and everything unnecessary is removed, and this is a serious operation.
In this article, you will become familiar with the operation of nasal osteotomy, namely what it is, how it is performed, to whom it is indicated, and what recommendations should be followed after this operation.
What is osteotomy of the nasal bones?
Age restrictions. If, nevertheless, the problem is connected specifically with pathology due to illness or injury, then the age of the patients is not taken into account, because defects can spoil the appearance, and also seriously complicate a person’s life, for example, make it difficult to breathe.
Also, defects can contribute to constant inflammation of the nasal mucosa. If the problem is aesthetic and he wants to change his nose, then the age of the patient is necessary.
In females, the nose finishes forming by the age of eighteen, while in males the process will last until twenty to twenty-two years. Naturally, it is not recommended to carry out such an operation at the age of seventeen or eighteen, because as soon as by this age the bone mass and the main cartilages of the nose are formed, and therefore correction and reshaping should be carried out. In a situation where this is directly related to injury or illness, then the age criterion is naturally removed.
How predictable is the result of non-surgical correction?
When it comes to correcting the tip of the nose or straightening a hump, the results are almost always 100% successful. If the effect is not fully achieved, then the situation is almost always corrected by adding fillers, especially since they can be kneaded after injection and carefully distributed. In addition, the cosmetologist must have an antidote, which is administered if something goes wrong, and thus removes the injection of fillers.
Finally, it is worth saying that there is no need to prepare for non-surgical rhinoplasty; there is no need to undergo any special tests. There are no special contraindications in this area of cosmetology, with the exception of general ones: after the administration of botulinum toxin, you should refrain from visiting the sauna and swimming pool, taking antibiotics and alcohol for two weeks. In the case of fillers, the restrictions are the same: the main thing is not to introduce an infection into the small wound left by the cannula.
Nasal osteotomy surgery
Preparatory stage
Analyzes
Before the operation, the patient is required to undergo a large number of tests. Based on the results of such tests, the doctor looks at and decides whether to perform surgery or not. This also applies to surgery in aesthetic terms.
If there are illnesses
As for sinusitis, surgery is possible for any disease, unless, of course, it is acute at the time of surgery. Often, sinusitis is caused by a deviated nasal septum, and this cause can only be eliminated by rhinoplasty or osteotomy.
That is why aesthetic rhinoplasty is often combined with surgery as prescribed by a doctor (ENT). All these nuances are indications, which is why the range of preliminary analyzes is very wide. The patient's first order of business is a tomogram. In these x-rays, the doctor looks at the areas of the problem and what caused them.
Risks
The first stage of consultation with a doctor will be to explain the patient’s desires in terms of his nose, that is, what he wants. After this, the doctor will advise what needs to be done and give recommendations. After this, there will be a conversation about the risks and problems that a person may encounter on the operating table. This operation, as already mentioned, is very complex.
The doctor is asked to find out whether the patient will agree to the operation. Every aspect of the operation will be demonstrated so that the patient has a clear understanding of what he is about to do. Very often there have been cases when the patient’s wishes cannot be fulfilled due to the capabilities of medicine. This is why some patients refuse osteotomy surgery around the consultation.
Simulation (computer)
This is the so-called computer visualization, but with all its capabilities, it will not be able to give a real version of what your face will look like after surgery. This is just an approximate idea, because after surgery anything can happen.
Although the percentage of similarity between simulation and reality after surgery is very high, from eighty-five to ninety percent. In any case, you can trust 3D computer modeling.
Features of surgical intervention
At the moment, the duration of the nasal osteotomy operation is no more than sixty minutes. One of the most unpleasant consequences of such operations is bruising and swelling of the face, which lasts up to fourteen days. At the moment when the plaster is removed from the nose, the swelling is almost invisible.
However, they may form over the next two days. We advise you not to leave the house during the rehabilitation weeks. Only in forty to forty-five days will everything return to normal. The final cessation of all processes of appearance can be seen only six months after the operation. The operation has two types - open and closed; with the open one, scars may remain, while with the closed one there will be no scars. The choice of type of operation depends on the wishes of the patient.
It also very much depends on the doctor’s experience, and how accurately he can perform such an operation using one or another technique. Good hospitals use the most advanced technologies, for example, using lasers instead of coagulators to minimize bleeding. This contributes to a very rapid recovery of the patient and instant healing of wounds.
Features of the rehabilitation period
Patients are often concerned with questions such as “Is it true that the nose becomes more fragile and sensitive after surgery?”
In general, this is true, but not forever, but only for six months, and after twelve months the final formation of callus will occur. Until this moment comes, you should be very careful for the first six months.
After six months of recovery, the callus will have formed up to eighty percent and your nose will be strong again. As mentioned earlier, a completely skeletal skeleton will be formed in one year.
All about rhinoplasty with osteotomy
Everyone who is thinking about rhinoplasty dreams of making their nose beautiful. That is, improve its appearance. But the good thing about the section of plastic surgery that deals with these issues is that it is able to simultaneously solve both aesthetic and functional problems. That is, not only to make the face more attractive, but also to help get rid of breathing problems.
The nose only seems simple in terms of its “device”. Like any other part of the face, it is a rather complex organ, and at the slightest disturbance in its functioning it becomes noticeable: it becomes more difficult to breathe. This same circumstance requires doctors performing rhinoplasty to have the highest level of qualifications. Especially when it comes to nasal surgeries that require an osteotomy.
This term hides one of the most difficult actions - changing the shape of the nose through surgical dissection of bone tissue. Simply put, to fix your nose, you must first “break” it. This manipulation is quite complex, so its implementation must be determined by the most serious reasons. Among them is the need to get rid of the hump, change the height and width of the nasal wall, and restore breathing.
Most often, osteotomy is necessary when the bridge of the nose is very severely curved and the nasal bones are quite massive. When the hump is small and the bones are thin and narrow, the surgeon can camouflage it using cartilage or bone autografts (that is, taken from the patient’s body).
In other cases, when it is necessary, for example, to correct the tip of the nose or its wings, the surgeon will only need to transform the cartilage tissue. This may also require injections of fillers or installation of grafts. In all other cases, rhinoplasty with osteotomy will help.
Operation stages
Let us immediately note that rhinoplasty with osteotomy is a very serious operation, which on average lasts about an hour and in some special cases longer. Since it is associated with changes in many tissues (primarily bone), it is always performed under general anesthesia.
As an example, consider surgery to reduce the nasal hump - it is the most common. Also, for illustration, we chose closed rhinoplasty, performed using incisions on the inner surface of the nostrils, without touching the skin septum between them - the columella. Although, of course, rhinoplasty with osteotomy can be performed using the open method, but since it is less aesthetic, it is used less and less.
First, the surgeon makes incisions to separate the soft tissue from the osteochondral framework upward to the level of the nasofrontal angle. Then pockets are created on both sides, and this way the doctor gains access to the nasal bone. To reduce the back, he uses an osteotome (surgical chisel) or a bone rasp, depending on the amount of bone that needs to be removed. An osteotome is needed to cut the bone, a rasp is needed to smooth it.
The surgeon then manipulates the cartilage tissue, but must consider the possible impact of the osteotomy on the patient's nasal airway. After all, the structure of the nose is unique for each person, therefore it is important to prevent violations, and for this the doctor chooses a certain technique, which will be discussed below.
Operation methods
Depending on the tasks facing the plastic surgeon, he can choose different types of rhinoplasty with osteotomy, or combine them if necessary. There are four main ones.
1. Lateral osteotomy.
Used to narrow or straighten the bony pyramid of the nose. There are two ways to perform it: linear (one incision is made on the bone tissue) and perforation (several percutaneous incisions).
The linear method helps correct very crooked noses or noses with thick side walls. Perforation is used when it is necessary to move the walls of the nose to the side. It is also preferable after a serious injury, when the first priority is not aesthetics, but the preservation of the structure of the nose as a whole.
2. Medial osteotomy.
This technique is better suited for transforming the side walls, correcting curvature, or narrowing an overly wide nose. Here too, there are two ways to perform the operation. Oblique - when the line of bone separation runs at an angle of about 30 degrees towards the longitudinal axis, paramedian - the line runs parallel to the septum.
3. Intermediate osteotomy.
Needed to narrow a very wide nose with sufficient height; correct a crooked nose, but one side wall is much longer than the other; straighten an overly arched nasal bone. The technique is performed together with a lateral osteotomy along the middle part of the lateral walls of the nose.
4. Tunnel osteotomy.
The most modern technique. It is most often used to correct rhinoscoliosis (crooked nose), uneven nasal slopes or its step-like deformation. The main advantage of the method is that the connections between the periosteum of the nasal bones and the skin are preserved. This allows the nasal bone fragments to move excessively relative to each other.
During a tunnel osteotomy, two horizontal incisions (5 mm on each side) are made inside the nostrils between the upper and lower lateral cartilages. Then channels are formed, directed upward to the bridge of the nose. There they are connected using thin neurosurgical scissors. Other types of osteotomies are made through the tunnels.
Preparing for surgery
Rhinoplasty with osteotomy is a fairly serious operation and therefore requires careful preparation. First of all, you need to check the general health of the patient. To do this, you will need to donate blood and urine for general and biochemical analysis, as well as check blood clotting. You will also need to undergo an ECG and fluorography. If we are talking more about the functional rather than the aesthetic side of rhinoplasty, you will need an X-ray or, in particularly difficult cases, an MRI.
You will definitely need to consult an otolaryngologist, although the most experienced plastic surgeons who practice rhinoplasty are usually experts in the ENT area of medicine.
Two weeks before the operation, you will need to stop smoking and drinking alcohol, and also consult with the surgeon about the medications, dietary supplements and vitamins you are taking, since some of them affect blood clotting. For example, aspirin and ibuprofen thin the blood. Also during this period you will need to stop using cosmetics and do not eat or drink eight hours before the procedure.
All of these issues should be discussed carefully with your plastic surgeon. As well as tell him about previous operations, chronic diseases, allergic reactions, for women - about the presence of pregnancy or the menstrual cycle, since the first involves serious hormonal changes, the second - increased bleeding.
Contraindications for rhinoplasty with osteotomy are:
- oncological diseases;
- disorders of blood clotting and the functioning of the cardiovascular system;
- breathing problems (not related to the nose);
- chronic diseases in the acute stage;
- diseases of the nose (for example, sinusitis);
- diabetes mellitus and others.
Also, rhinoplasty in general is not performed for persons under 16 years of age, since active growth of the body continues until this age, and there is a possibility that the nose will change shape. However, if there are medical indications, surgery is still possible.
Rehabilitation after surgery
Recovery after rhinoplasty with osteotomy is a rather long process, since we are talking about the healing of bone, cartilage, and skin tissue. The patient will spend the first day in the hospital under observation, then will be sent home with the recommendations of the plastic surgeon. These include bed rest, antibiotics and painkillers.
Since your nose will be covered with a tight bandage, you will have to breathe through your mouth. The same circumstance requires avoiding serious physical activity, visiting baths, saunas, beaches, swimming pools, and prolonged exposure to cold or heat. Air travel is prohibited for about a month due to large changes in atmospheric pressure. You should also be especially careful in general, as the nose will be quite sensitive to touch and very fragile for up to six months.
Bruising and swelling will persist for approximately two weeks. However, in order for the nose to come into the required shape, you will have to wait several months. No surgeon can give specific dates, since everything depends on the individual characteristics of the patient’s body and the complexity of the procedure. It is important to understand this when agreeing to surgery.
Can marks remain after surgery?
This question is a bit perplexing, because there is no clear answer. In some cases, the consequences of the operation are very minor, so much so that they simply cannot be distinguished.
At some points the changes are very obvious, mainly due to a failed operation. And the point here is not in postoperative scars or scars, but in the incorrect shape of the nose. That is why we advise you to choose the right doctor and clinic.
Rhinoplasty without osteotomy
Rhinoplasty without osteotomy (without fracture)
Osteotomy, i.e. surgical dissection of bone structures is now often one of the stages of open/closed rhinoplasty. This manipulation is performed during most surgical interventions on the bridge of the nose, for example, when removing a hump or reducing the width of the bridge of the nose. At the same time, you need to understand that “often” does not mean “always” and not every surgical correction of the nose is accompanied by global intervention in its structure and osteotomy. In particular, in the case of isolated plastic surgery of the tip of the nose and narrowing of the wide wings of the nose (during plastic surgery of the nostrils), the bone tissue of the nose is not dissected. In such situations, correction of the skin and cartilage tissue is quite sufficient.
It should be noted that when the nasal dorsum is bent, steotomy is advisable if the nasal bones are large enough and the deformity is severe. If there is a slight curvature of the nasal dorsum, especially when the nasal bones are narrow and thin, generally highly professional rhinosurgeons prefer not to perform an osteotomy, but to carry out correction through the implantation of cartilage or bone autografts obtained from the patient himself.
Autogenous cartilage grafts are usually taken directly from the nasal septum, but if the amount of this material is not enough, which often happens with corrective rhinoplasty, specialists can use the cartilage of the auricle or the cartilage of the patient's ribs. Bone grafts are cut out from the bones of the skull, from the hip or chest area. It is important that when osteochondral tissue is removed, the donor area does not suffer in any way, either functionally or anatomically. If for some reason it is impossible to obtain an autograft, biocompatible artificial materials are used, but the first option is considered more preferable, since the patients’ own tissues are not rejected and do not cause allergic reactions in them.
If osteotomy is still unavoidable, an experienced plastic surgeon will perform it only at the final stage of rhinoplasty, which will allow him to flawlessly perform all other planned manipulations and avoid the occurrence of severe postoperative edema. However, the patient must be prepared for the fact that bruises under the eyes are inevitable after this type of surgery and they can last for two weeks or even longer. In addition, you need to understand that the nose will take a normal shape no earlier than in a few months.
The question of whether an osteotomy is required for a particular candidate for rhinoplasty is always decided on a purely individual basis. In leading plastic surgery centers located in Germany, Israel, South Korea and Austria, already during the examination, the doctor tells the patient about all the nuances of the upcoming plastic surgery and, through computer modeling, clearly demonstrates the approximate result.
When surgical intervention is performed only on the cartilaginous structures and skin of the nose, the rehabilitation period is noticeably shortened and the stay in the clinic is a maximum of 5–7 days. If rhinoplasty requires osteotomy, the volume of the operation increases markedly and the duration of hospitalization becomes twice as long.
