“Nose plastic surgery is undertaken for both beauty and health reasons. Sometimes a nose reconstruction is needed for children with congenital disabilities, after diseases or trauma – in such cases, it is related to physiological matters. On the other hand, the aspect of beauty should also not be forgotten. If changes to one’s looks boost an individual’s self-confidence, free them of their complexes and improve their psychological wellbeing, it’s an excellent result. Even the World Health Organisation defines health as ‘physical and psychological wellbeing’,” advises Renaldas Vaičiūnas, plastic and reconstructive surgery doctor at the Klaipėda-based medical centre Northway.
According to the experienced plastic surgeon, women usually inquire regarding reducing the size of their nose, removing a nose hump, thinning the nose, lifting the tip of the nose, changing the shape of the nostrils and changing the angle between the nose and the upper lip. Men however usually look to repair trauma damage to the nose. In such cases, the nasal septum has to be repaired and breathing function restored. “If necessary, prior to surgery, we consult otorhinolaryngologists. There are cases when otorhinolaryngological (LOR) surgery needs to be carried out prior to a rhinoplastic procedure. Nevertheless, usually everything is performed during a single day,” Vaičiūnas explains.
Nasal surgery is recommended for people who feel physical or psychological discomfort due to the shape or size of their nose, whose nose is disproportionate relative to the rest of the face, whose nose tip is too wide, too high or too low and those with a nose hump or breathing problems due to nasal septum distortion. It is an invasive reconstruction procedure during which the shape of the nose is adjusted and breathing through the nose is restored.
It is essential that an individual who choses nasal surgery is patient and maintains a positive mindset with realistic expectations. “Beauty is a subjective concept and interpretation of beauty can differ markedly between doctor and patient. The plastic surgeon should also be a good psychologist to establish exactly what is troubling the patient about their looks – the size or shape of the nose, the nose hump, the width of the nostrils – and what expectations they have,” Vaičiūnas continues.
“There cannot be just one benchmark for the beauty of a nose that fits everyone, so in each individual case, the necessary changes to the nose are modelled based on the patient’s wishes and physiology. As a plastic surgeon, I am concerned with ensuring that facial proportion is maintained and that the nose matches the shape of the face. It is great that nowadays during consultations one can use modelling programs and show the patient on a computer screen what their face could look like after surgery. It does happen that patients perceive themselves completely differently. Then we discuss, plan and review various options until we find the most appropriate one,” the surgeon explains.
The individual’s satisfaction with the result depends not only on the surgery itself, but also on consultations and it is essential that the patient understands the potential risks involved. Computer simulations illustrate the face after nasal skeletal changes, but they cannot evaluate the thickness and elasticity of the skin, the subcutaneous fibre and scarring processes.
“If we shorten the nose by a few millimetres, realistically, it can shorten by two or three, but it could be that it won’t reduce at all. It depends on the scarring process. The patient must be informed about this prior to the surgery and must accept the risk. While nasal correction is among the most popular surgery procedure in the world and many undergo them successfully, no surgeon can guarantee the results of rhinoplasty. The more time one spends on explaining everything, showing the potential results and selecting what is most suitable, the fewer the questions afterwards. If the patient rushes to celebrate their new nose immediately after the surgery, they will unfortunately not have understood what was discussed,” the doctor says.
According to Renaldas Vaičiūnas, during nasal surgery it is necessary to take into account three dimensions – height, width and length, while working with several types of tissue: bone, cartilage and subcutaneous tissue. Experience in nasal skeletal reconstruction surgery is especially valuable. If you perform numerous such surgeries, you will know how the tissue reforms and appreciate other factors, making rhinoplasty seem not so very difficult.
Nasal skeletal reconstruction surgeries are performed under general anaesthesia and usually last from an hour and a half to three hours. The surgeries are carried out in one of two ways – open and closed. “Open surgery is a little more difficult and has a longer rehabilitation period, but I always say that just like everywhere in life, the more you put in, the more you receive in return. The final result after open rhinoplasty is easier to predict and is more effective,” Dr Vaičiūnas states.
After surgery an external brace is placed on the newly formed nose and the patient must wear it for 1-2 weeks. During this period, bones fuse and both swelling and bruising disappear. Calm home rest is advised for this period. Patients are not entitled to sick leave after these surgeries and so have to plan a holiday in advance. The good news is that during recovery, the nose does not hurt at all - it simply remains hard and insensitive for a while.
Rhinoplasty is one of the more difficult plastic surgery types. As such, whatever is altered, whether the nose tip, the nostrils or the nasal skeleton, the result will take time. The first results can only be evaluated after six months, as the bones and cartilage which were traumatised during the operation, scar and soft tissue settles and adapts to the newly formed nasal skeleton. The forming and maturing of scar tissue takes around a year or longer and only then is the final aesthetic result of the operation evaluated.
Every individual’s tissues heal differently, thus sometimes it does happen that the result is not quite what was expected and repeat surgery is required. According to the doctor, in some countries revision rhinoplasty is performed in 20 per cent of cases. That said, often it is not a case of repeat surgeries, but only specific corrections. “All problems can be resolved, you just have to be brave enough to discuss them,” the surgeon advises.
