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If you are dissatisfied with the shape of your nose and have opted for a rhinoplasty (nose job), it is best to consult a nose surgery specialist. A rhinoplasty may be required for medical or aesthetic reasons. If you want to get a nose job, then you are welcome to seek advice from one of our Rhinoplasty experts.

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Here you will find german TOP-specialists for nose shape correction 2020-03-19 Rhinoplasty
Rhinoplasty

Nasal disproportion (a big nose and a small chin) is a common problem: every third person is not satisfied with his/her nose shape. The most easy and efficient method to enhance your appearance is a plastic surgery. Specialists of the plastic surgery clinics in Germany offer the whole range of operations, including rhinoplasty (“a nose job”, big nose shaping). The rhinoplasty (a nose surgery) requires a wide area of expertise. The German plastic surgeons provide the unsurpassed work and perform about 40 000 nose correction (including the reduction of a big nose) procedures annually, which is twice as many as their peers in Switzerland or France do.

The modern surgical techniques allow making nose smaller just in an hour. Aesthetic nose correction gives a unique opportunity to harmonize the face proportion and make you look more attractive. A prominent (long, big hooked or Roman) nose doesn’t always look aristocratic. The patients report that after the operation they felt more confident and happy.

What is rhinoplasty?

Each plastic surgery is a complicated process that includes two aspects: solving of aesthetical problems, and preservation or restoration of specific functions of the organ (in this case – nasal breathing).

Therefore, rhinoplasty can be made for both medical and aesthetic purposes. The optimal age for rhinoplasty is 25-35 years. However, this restriction can be avoided in some cases. Main medication indications for the surgery are as follows:

  • Inborn deformation of the nasal septum.
  • Polyps and enlargement of the nasal turbinate.
  • Trauma and post-traumatic changes of bone and cartilage, physiological (conditioned by incorrect tissue development) or compensatory deflection of the nasal septum.
  • Abnormal nasal breathing, or absence of it.

Pretty often, the main reasons of functional disorders and pathologies (complicated nasal breathing, enlargement or atrophy of nasal mucosa, rhinosinusitis, otitis, bronchial asthma, repeated respiratory diseases, snorting) are the changes of nose anatomical structure. Besides, such defects in children can cause brain oxygen deficiency, which slows down physical and mental development, and affects psychological development and behavior. Therefore, such operations can be performed before a child reaches 18 years.

However, in 60% of cases, rhinoplasty is made in patients who want to improve nose shape and their appearance. Plastic surgery is getting more popular. Aesthetic indications for the surgery are divided into two large groups:

  1. objective - disproportionate and unattractive nose size or shape;
  2. subjective, or psychological: there are no certain criteria of beauty, and each person can have his or her own stereotypes, which is why patients may not like their nose for some reasons.

These reasons often affect professional and personal relationships, make up for low self-esteem and feeling of dissatisfaction, and may even lead to social withdrawal, especially among women.

Rhinoplasty in aesthetic purposes is indicated when a person has:

  • Disproportional nose size in relation to the entire face – too big, or too small nose.
  • Inborn or acquired deformations.
  • Deformation of the nasal septum.
  • Broadened nostrils, a hump, two-pronged, asymmetrical, dropped, or raised nose end, or disproportion in relation to the height of the nasal arch, saddle shape.
  • Non-satisfying results of the previous operations.

In many cases, medical and aesthetic indications correspond and are caused by the same anatomical defects.

What actually happens with rhinoplasty?

With invisible cuts on the inside of the nose, the cartilage and bone structure of the nose is prepared with precision surgery and changed in shape and size according to your ideas and wishes. For this, the plastic surgeon uses the finest instruments that have been specially developed for cartilage, bones and mucous membranes of the nose.

In most cases, a nose bridge that is too high must be reduced in size, the tip of the nose raised, the nostrils refined, or the skeleton narrowed. Lopsided noses often have a malposition of the nasal septum that can also hinder nasal breathing. The straightening of the nasal septum is also part of the operation of the nose job. In individual cases, additional tissue such as cartilage or bone must also be planned to compensate for saddle noses or other defects.

What results can be achieved with a nose job?

With a plastic nose correction, the shape and size are refined according to your ideas and brought into harmonic proportions to the other facial features. Nose bumps and oversized nostrils can be effectively reduced in size, a wide nose narrowed and a crooked nose straightened. The desired shape can be best modeled during rhinoplasty if there is a good bony and cartilaginous nasal structure and a normal nasal mucosa.

With pronounced crooked noses and saddle noses, cartilage or bone must be transplanted in individual cases in order to achieve good shape and function. Previous injuries or surgeries must be carefully considered when planning the desired nose job, as they could otherwise cause problems with the formation of the nose or the function of nasal breathing.

Coarse-pored and oily skin can hinder the formation of a fine tip of the nose, whereas very fine skin allows the contours of the bone and cartilage structure to be more clearly visible. The desired result can be achieved in most cases with modern plastic surgical methods. Small irregularities in the area of ​​bone or cartilage corrections, which can result from internal adhesions, sometimes require a subsequent correction.

Form of anesthesia and hospitalization

Most nasal surgery is done under general anesthesia. However, some corrections are also possible under local anesthesia and general sedation. The operation takes one to two hours. The necessary preliminary examinations for anesthesia are usually carried out on the day before your surgery in the clinic. You also have the opportunity to discuss the anesthetic with the anesthetist. Depending on the procedure, a hospital stay of one to seven days can be expected.

How do I prepare for rhinoplasty / rhinoplasty?

You should avoid painkillers with acetylsalicylic acid (e.g. aspirin, ASA) as early as 14 days before the operation, as these delay blood clotting. You should also avoid alcohol and sleeping pills if possible. During the preliminary examination for nose correction, the function of breathing and the condition of the nasal mucous membranes are checked. For sensitive mucous membranes, it is advisable to use a nasal ointment such as Bepanthen or oily nose drops two to three weeks before the operation. Chronic inflammation in the area of ​​the nose, throat and ears should be clarified and treated in good time.

Types of rhinoplasty

According to the aim and the surgical technique used, nasal plastic operations are divided into:

  • Reconstructive – they serve to restore anatomical abnormalities that appeared due to incorrect fetus development, traumas, or diseases.
  • Aesthetic – correction of drawbacks.

According to the same criteria, the following types of rhinoplasty exist:

  • Enlargement or reduction of nose size.
  • An evening of the nasal arch – correction of saddle shape, or a hump.
  • Correction of the nose end.
  • Correction of the nasal septum (septoplasty).
  • Post-traumatic reconstruction.

All operations are divided into:

  1. primary;
  2. secondary, or repeated.

Methods of access

Depending on the methods of access variant, the nasal surgeries are divided into:

  1. Closed rhinoplasty, the cuts can be made within the nasal cavity. The closed access can be edge (along with the inner surfaces of the wings of the nose), intra-septum, or via the cartilage. After the cut, soft tissues are separated from cartilage and bones making up the structure, which allows performing all manipulations freely. This method is less traumatic in comparison with the open access and it eliminates the risk of artery damage and poor tissue nourishment, and post-surgery scars aren’t visible being located inside the nasal cavity. This method is used more often, especially for aesthetic operations.
  2. Open rhinoplasty — the cut is made along the columella (skin fold between the nostrils) and on the wings of the nose where they’re connected with the lip. This method is applied when the closed access cannot be used to solve the problem. Open access allows lifting soft tissues and cartilage up and making manipulations in the inner nose sections while preserving full visual control. Open rhinoplasty is used to correct serious deformations and performs technically challenging and time-consuming operations, for instance, serious nose deformations, especially with lateroposition; a combination of nasal deformation with developmental abnormalities, such as ‘hare lip’ or congenital cleft of the palate; reconstruction with use of implants. The main drawback of this approach is a post-surgical scar, as well as forced damage of columella arteries, which results into a serious and long-lasting post-surgical tissue swelling.

The operations are performed under general anesthesia and usually take 1-2 hours. Sometimes their duration reaches 3 and over hours.

Correction of nasal form

During the operation on widened nostrils, the skin in the lower part of the nostrils is being cut, and its excess is removed. Cut tissues are joined with stitches that are held for 5-7 days. Such invasion always leaves scars which are almost unnoticeable. In this case, if the nose is slightly flattened, augmentation rhinoplasty (lifting of the nasal bridge) is made. A similar operation is performed for a small or short nose. It’s called “grafting”. Patient’s cartilage or bones taken from other body parts serve as the frame. Most often, surgeons take bones from ribs, skull, or elbow, and cartilage – from the ear. In rare cases, synthetic materials are used, but they can be rejected by the body. Such operations are among the most complicated plastic surgeries, which is why they should be trusted to top surgeons only.

Surgery on the nose tip

During such operation, the form of the nose tip is improved. Most often, it’s done by the closed method: invasion affects cartilage and the soft tissues, and often – columella. Cartilage is cut, or excess tissues are removed from one place and moved to another. Most often, during the operation, the place above the tip is made thinner, while the tip of the nose is slightly protruded. Sometimes patients want to decrease the nose tip lengths, but such cases are rare. Together with such operation, patients also ask to change the nostril and columella form, as well as nose contours. If the operation presupposes alteration of the nose tip only, it’s simple, and recovery is pretty fast.

Contour plastics

Contour plastics is a very exquisite work during which the nose contour is slightly changed. Under the nose skin, surgeons make “pockets” where they inject implants or transplants. Today, this technology isn’t widespread, because bio gel injections are much simpler to use.

Laser rhinoplasty

During such operation, laser beams serve as a scalpel. This technology allows decreasing blood loss and accelerating recovery after the operation. Besides, working with cartilage is easier with a laser. Heated up by laser, the cartilage becomes softer and pliant. Laser cuts tissues seals vessels and eliminates bacteria. Under laser effect, recovery processes in tissues accelerate. Using a special laser device, surgeons can correct the nasal septum. There are methods that allow both eliminating aesthetic drawbacks and improving nose functions. The operation with a laser is the same as a traditional one. The operation can be closed or open. Cuts are usually made along the bridge and in the lower part of the nostrils. Sometimes, laser and a usual scalpel are combined during the operation. Such invasions are preferable since very fine cuts cannot be made with a usual laser, in comparison with the traditional approach. However, if the skin is cut by a laser, it recovers without scars. A cut is thin, it’s not bleeding, and cells are ready for recovery. Therefore, laser technologies are successfully applied in plastic surgery, including the operations for nose correction combined with usual surgical methods.

Reconstructive rhinoplasty

Reconstructive rhinoplasty is correction of nose form after a trauma or an inbuilt developmental defect. It’s impossible to predict which state the nasal frame has. Sometimes, reconstructive operations aimed at frame recovery presuppose taking cartilage right from patient’s ribs, ears, or nasal septum. The tissue grafts are taken from the patient’s body, and it doesn’t affect overall state or appearance. Reconstructive operations are usually made to restore normal appearance in case of upper palate or lip gaps. Sometimes, several operations are required. Besides, reconstructive surgeries are made after traumas that have caused the damage of bones and cartilage. In the most serious cases, surgeons work with patients who totally lost their nose. During the operations, microsurgical technologies are used that allow restoring normal patient’s appearance. One of the most widespread nose deformations surgeons deal with is saddle-shaped, or ‘boxer’s’ nose. This deformation can be caused by a strong punch into the nasal bridge, or infectious diseases of nasal cavity. In such case, the cartilage forming the bridge can be totally broken, and a surgeon needs to restore the cartilage bridge and nose frame. Such operation can last up to 6 hours. A patient is given the general anesthesia. Outside, only the area of columella is cut – all the other cuts are made within the nasal cavity. Therefore, all post-surgical scars aren’t visible. The operation affects all types of nose tissues: soft tissues, bones, and cartilage. After the operation, tampons are inserted to preserve the new nose shape and are left for 3-6 days. The plaster splint is removed in 5-12 days depending on the complexity of the operation. In a day after the operation, a patient can go home. In a week, a patients returns to have the stitches removed. During 8 weeks, patients aren’t recommended to wear glasses, and physical activity is prohibited during 2 weeks. In three weeks, the nose shape gets closer to the final results, and the further changes aren’t noticeable. However, the traces of operation disappear within 6-12 months. For a long time, a patient needs to be examined by the doctor.

Secondary rhinoplasty

Secondary nose plastics takes place only when a patient has already experienced surgical invasion in this area. Final formation of the nose ends within 6-12 months. This is the most optimal period for the secondary operation. It’s done in the following cases:

  • the desired results cannot be reached within one stage;
  • dissatisfaction with the results of the primary operation;
  • the necessity to correct the problems that stayed after the primary operation.

According to global statistics, 25-30% of patients who have undergone the primary plastics need a secondary corrective operation. This is a normal case. As a rule, the operation takes up to 30 minutes and is made under the general anesthesia. Secondary correction rhinoplasty allows eliminating drawbacks of scarring and making nose shape satisfactory for both patient and the surgeon.

In case of primary low-quality plastic surgeries and the unsuccessful recovery period (which often depends on individual peculiarities), it’s harder to perform the secondary surgeries. Such operations require a better research and a more accurate preparation. This is fully-fledged plastic surgery made by some of the above-mentioned methods, but in fact, it’s much more complicated and may even to total deformation of the shape or part of the nose (for instance, nose tip), or the entire nose.

Complications and preparation to the operation

Nose rhinoplasty is considered to be one of the most complicated plastic surgeries: its result depends on surgeon’s experience. Complications happen in 4-15% of cases. They can take place during the operation (bleeding, skin tearing, separation of the mucus-cartilage part, damage of the bone frame, breaking of the bone section, etc), and after the surgery.

Secondary nasal surgery (rhinoplasty) is surgery after a failed first surgery by another pre-surgeon. In contrast to the revisions, the result is usually not fundamentally satisfactory and only requires a fine adjustment, but so blatantly disfiguring that confidence in the pre-operator has been lost and another operator is entrusted with the repair. These interventions are much more difficult in rhinoplasty than interventions on unoperated noses or fine adjustments on well-operated noses. They often require cartilage transplants e.g. from the ear or from the rib. It is nice that there is a wide range of options available for these patients to reconstruct aesthetically beautiful noses from love and devotion, some of which were catastrophic. Here it is often crucial not to choose the simple, small route for revision, but the strategy that is most likely to achieve a good result, even if the effort is greater. In particular with noses that have been operated on several times, it may also be the case that despite all love, effort, experience, care and talent, no perfection but only damage limitation can be achieved. Each subsequent operation (rhinoplasty) is more difficult than the previous one, since tissue is increasingly scarred, the circulation is poor and the healing process becomes more unpredictable.

Possible complications after rhinoplasty

  • functional — atrophic rhinitis, a complication of nasal breathing, loss of sense of smell, temporary or permanent decreasing or loss of skin sensitiveness of nose and the upper lip;
  • aesthetic — absence of changes, or worsening of the previous drawbacks;
  • psychological — patient’s dissatisfaction with the results of the plastic surgery;
  • infectious — long-lasting swelling and irritation, purulency;
  • pigmentation of the skin, the formation of the vascular tree, synechia of mucous membrane, and huge scars;
  • periodic nasal bleeding, necrosis of soft tissues and cartilage.

Preparation includes:

  • Consultation of the plastic surgeon during which the technical possibilities and patient’s preferences are defined.
  • General tests — clinical and biochemical analyses of blood, research of blood coagulation, general urine analysis, hepatitis tests, HIV, syphilis (RW), electrocardiogram.
  • Special research (if needed) – images of the maxillary sinus, endoscopic research of the nasal cavity to reveal corresponding abnormalities and pathological changes.
  • Computer modeling that allows comparing the initial state of the nose with the planned results of the future rhinoplasty.
  • Consultation with the therapist and specialists (if there are chronic diseases).
  • Examination of anesthesiologist after the tests.
  • 2 weeks prior to operation, the patient shouldn’t take medications that alter the process of blood coagulation - acetylsalicylic acid and its analogs, anticoagulants.
  • Cessation of use of sedative and sleeping medications on the day of operation.

Contraindications and rehabilitation

Absolute contraindications to rhinoplasty

  • Chronic diseases in their heavy form (endocrine, cardiovascular, pneumonia, etc).
  • Acute infectious diseases.
  • Disorders of blood coagulation.
  • Menstruation.

Rehabilitation after rhinoplasty

General recovery after rhinoplasty takes up to 3 weeks. However, the final period of rehabilitation period when the results are evaluated by the doctor begins in 6-12 months. During this period, certain restrictions should be followed.

In 1-1.5 weeks after the surgery, the plaster splint and stitches are taken off. During the first two weeks, hot bath and washing in hot water are prohibited, because it may cause bleeding, hematoma and swelling spreading all over the face and neck. A person should sleep on his or her back in the uplifted posture, which improved breathing and reduces swelling. In dusty places, a person should wear a protective mask. Bending and weightlifting isn’t recommended.

During next 3 months, a person shouldn’t wear glasses and heavy caps. Swimming pools and sunbathing is prohibited for 3 months. A patient should use an umbrella or a hat with wide flaps during hot weather and in the sun.

When planning the variants of rhinoplasty, an experienced surgeon sticks to three kinds of limitations: limitations defined by the surgeon, limitations stated by the patient, and the limitations connected with patient’s overall health and anatomical peculiarities of the nose.

Rhinoplasty Videos

Latest News in Rhinoplasty

What successes can be achieved with a nose job?

15.11.2019

With accurate planning, an experienced surgeon can achieve a good result in most cases. This means that the patient can breathe well and the nose fits harmoniously in the face. For patients who have thick skin or are already well-slimmed, this must be included in the surgical planning, as the skin's ability to shrink is a crucial factor in its ultimate success. Noses that have already been pre-operated are not only much more complex, but often the ideal shape can no longer or only to a limited extent be reached. The final result of a nose correction can only be estimated after about one year, but the final healing takes much longer.

Reasons for a rhinoplasty

The shape of one's own nose is perceived as conspicuous by many people. In most cases it seems too big for them, but it can also be asymmetrical and crooked. Even a short nose, where you can look from the front into the nostrils, is disturbing and is commonly referred to as a pig's nose. In addition, the nose can be too wide or too narrow. If the nose is crooked, an accident and a known or unrecognized nose fracture or nasal septum injury are often responsible. Rhinoplasty is not a very invasive surgery but is technically very demanding and requires a lot of experience. Whether a nose correction makes sense depends on whether the wishes of the patient can be achieved through surgery.

What risks are there with a nose correction?

Nasal correction is the procedure required by the surgeon, which has rather few complications, but the shape of the nose can change significantly over a period of at least 6 to 12 months.

Immediately after surgery, it may bleed from the nose, and when the bone has to be severed, it usually causes swelling and bruising around the eyelids and cheeks. Sensitivity disorders usually occur on the nose, but also in the area of the upper lip and usually form back again. But there are also patients in whom the sensitivity to feeling is also permanently limited. Nasal surgery can also cause a hole in the nasal septum, especially if you need to remove cartilage for a nasal buildup.

Ten important facts about rhinoplasty

12.11.2019

1. Rhinoplasty is a difficult aesthetic procedure. Therefore, you should leave enough time with an appropriate decision.

2. Each nose has small deviations from the perfect shape after surgery. Achieving a nearly perfect nose is very difficult. Think carefully about what you really want. Do you want an improvement or a perfection of your appearance?

3. Surgical ability is not always able to guarantee the desired success. A thick skin, a soft cartilage or a tendency to prolonged healing can have a lasting negative effect on the result of the rhinoplasty. It may also later - regardless of the rhinoplasty - come to deviations in terms of the desired result.

4. After the rhinoplasty , the nose will be swollen for a long time. There is no remedy that could effectively reduce this swelling. You will have to exercise patience.

5. A successful nose impresses with its naturalness. She fits well in the face and does not stand out from him.

6. The one ideal nose shape for all does not exist. The noses of some celebrities and models from the TV would not fit in your face. They do not exist - one nose for all.

7. A nose is not perfect after rhinoplasty . However, an experienced nose surgeon can approximate them to your needs. Appropriate training, rich experience and in-depth analysis are critical to the success of rhinoplasty.

8. Subsequent correction is occasionally carried out because of minimal irregularities, although there is the risk of a deteriorated aesthetics and, above all, of a limited function. Almost as obsessed is sought by some the perfect nose. Subsequent correction is often much more difficult than the initial procedure and can cause some complications. Therefore, think carefully about whether the subsequent correction is really necessary.

9. A nose surgeon can not create a new nose for you. Ultimately, he can only change what already exists. The rhinoplasty has its clear limits, which can not be exceeded even by the operating physician. A realistic attitude is therefore required.

10. A rhinoplasty will not completely change your life. A rhinoplasty will not give your life a completely different direction. Your nose is only a small part of you, of your personality. The path to your happiness does not have a perfect nose shape.

Ultrasound procedure as an alternative to rhinoplasty

29.07.2019

Ultrasound treatments have long been topics in dental surgery and body modeling. Lately, noses can also be corrected with "Ultrasonic Rhinoplasty" (piezosurgery). In principle, it is a classic open nose operation, but in which neither chisel nor saw, but ultrasonic waves are used.

Using a special device, the waves reach the - previously uncovered - bone, which can then be prepared, removed or separated. The vibrations that are used to process cartilage and bone in this procedure are gentle on the soft tissue and the blood vessels. It is a relatively young process that works gently and precisely, but in my experience has not yet reached the existing methods of rhinoplasty with the use of fine instruments.

The vibrations that are used to process cartilage and bone in this procedure are gentle on the soft tissue and the blood vessels. In addition, very precise cuts can be made without exerting much pressure on the bone. But even here, small scars form, since the intervention must be initiated in advance via the "open" rhinoplasty method. So the healing process is similarly tedious.

Basically, it is easier for the attending physician to make rhinoplasty via the open method because all anatomical structures are visible. However, the patient achieves a faster healing process and the avoidance of scars through the endoscopic, closed rhinoplasty method.

A skilled surgeon achieves the desired result even with minimally invasive rhinoplasty and the finest instruments, for example when correcting a curved nasal septum, and can therefore do without the "ultrasonic rhinoplasty". The years of dedication and the proven successes speak for the suitability of the classical rhinoplasty procedures. The rhinoplasty is the royal discipline in plastic-aesthetic surgery.

These are the best rhinoplasty procedures

29.07.2019

Rhinoplasty can have many reasons: to reduce the size of the nose, to level it, or to treat pathological snoring. Due to the complex anatomy of the nose, such an intervention is one of the most difficult of plastic surgery. Rhinoplasty can be done in three different ways.

In the so-called "closed" method, endoscopic rhinoplasty is performed. This means that the doctor treats the cartilage and bone structures through the nostrils. For this, cuts are made in the inside of the nose so that no visible scars are created. In principle, with this endonasal method, all primary nose corrections such as straightening or reduction can be performed.

For regeneration, the nose is immobilized with a plaster cast for ten days. In this time should be renounced to sporting activities. Disrupted nasal breathing may occur in the first two weeks after rhinoplasty as the mucous membrane is still swollen and secretes wound secretions. Nosebleeds and increased sensitivity of nose tip and upper lip are also possible. This feeling disorder usually returns on its own. The costs for a rhinoplasty start at 4000 euros plus additional costs.

Larger interventions such as the modeling of accident noses or pre-operated noses often require a better view of the inside of the nose. The rhinoplasty is then performed using the "open" method. This is done on the exposed nose, that is, it is a small cut in the nose bridge area set to lift the nose skin and make the correction of bone and cartilage from the outside. Then the skin is placed over it again and sutured.

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