Rhinoplasty is one of the most common forms of aesthetic and plastic surgery. It has helped many patients in achieving more attractive looks and improving self-esteem.

Rhinoplasty is usually desired by patients who are unhappy with the shape of their nose, which has lost its aesthetics during growth, as a result of trauma, or following an anomaly.

A patient suitable for rhinoplasty

Patients who want rhinoplasty for aesthetic reasons are most commonly bothered by a lump, the tip of the nose being too large, wide or drooping, overly long or large nose, excessively large nostrils, or simply a nose that looks unattractive. Another very common desire is to adjust an externally bent nose. The latter also frequently comes with breathing difficulties.

A suitable candidate for rhinoplasty is a patient whose:

• Nose has a bump.
• Tip of the nose is too large, wide and/or droops.
• Nose is too wide in the osseous part.
• Nose is too large.
• Nostrils are too large or deformed.
• Nose is visibly bent, asymmetrical or deformed.

Consultation before surgery

The pre-surgery consultation includes inspection of the patient, photos taken of the face and nose, and a thorough analysis of the photos with the patient. Processing of the images is used to better understand the patient’s wishes and achieve a common understanding.

Each surgeon has their own beauty ideal and therefore, it is very important to review their portfolio of patients before and after surgery. This also gives the patient a more realistic idea of what can be achieved with rhinoplasty.

Methods of surgery

Two primary methods are used to adjust the shape and size of the nose:

Closed rhinoplasty involves making the incisions necessary to access the osseous and cartilaginous structures of the nose inside the nasal cavity. Therefore, no visible scars are left, unless excess skin is removed from the edges of nostrils where they transition into cheeks. In this case, the scar remains in the natural skin fold between the nostril and cheek and is barely noticeable. Closed rhinoplasty is more difficult to perform but the effort is outweighed by better and stabler results. Closed rhinoplasty has undergone a significant development in recent years. Earlier, closed rhinoplasty was predominantly used to carry out surgery on the back of the nose and not so much to correct the tip, whereas the modern closed method has no such restrictions.

The desired changes can be very successfully achieved both for the back and the tip of the nose. The closed method has recently also developed into the movement of preservation rhinoplasty. This is the most modern method of rhinoplasty, the nature of which the maximal preservation of the regular anatomy of the nose, and the desired changes are achieved by adjusting the size, shape and positioning of structures. The use of excessive cartilage grafts is avoided. This photo is taken immediately before and after surgery. All principles of preservation rhinoplasty were used.

Open rhinoplasty involves an additional incision in the skin between nostrils, in addition to internal incisions. The scar is generally small and barely noticeable. Some surgeons prefer the open method more as it allows very wide access to all structures of the nose and provides good opportunities to adjust the shape, size and placement of cartilage in the tip of the nose in particular. Unfortunately, better visibility does not outweigh the cons of open rhinoplasty, which are greater surgery trauma, longer recovery time, a harder to predict final result, and frequently also instability of results. For this reason, open rhinoplasty is used rarely in our practice.

The surgery

Rhinoplasty is generally carried out in full anaesthesia. As a rule, the surgery starts with removing the bump from the back of the nose, after which the shape, size and position of the tip is adjusted to the new height of the back. In some cases, filling or grafts need to be used during surgery. The most commonly used material is cartilage from the nasal septum, less often from the earlobe or rib. We do not use artificial implants in our practice.

The period immediately after surgery

All wounds are stitched with self-absorbing stitches which do not need to be taken out. At the end of the surgery, silicone plates are generally placed in both nasal cavities to support the nasal septum, which are removed after 5–10 days. Externally, the nose receives several layers of skin-coloured bandages and a plaster cast for up to 10 days. After the surgery, the mucous membranes of the nose swell and cause breathing difficulties. The recovery of nasal breathing may take several weeks.