Doctor Luís Freitas

Otolaryngologist 
(ENT Specialist)
 

Doctor  Luís Almeida Dores 

Otolaryngologist 
(ENT Specialist)

Rhinoplasty between aesthetics and function

HPA Magazine 11

The nose is a central structure of the face which, in addition to having an aesthetic component, also performs essential functions such as breathing and smelling. The nose should be in proportion to the rest of the face and, because it can of various sizes and shapes, it is often the object of great dissatisfaction. 
Its appearance or function does not always meet the expectations of its owner. This can impair quality of life due to a chronic nasal obstruction or self-esteem due to an aesthetically unsatisfactory nose.

The nose is a central structure of the face which, in addition to having an aesthetic component, also performs essential functions such as breathing and smelling. The nose should be in proportion to the rest of the face and, because it can of various sizes and shapes, it is often the object of great dissatisfaction. 
Its appearance or function does not always meet the expectations of its owner. This can impair quality of life due to a chronic nasal obstruction or self-esteem due to an aesthetically unsatisfactory nose.
Rhinoplasty (the facial aesthetic surgery most performed in the world) is indicated for people who are dissatisfied with the shape of their nose, where the main purpose for surgery is the correction of deformities, resulting a harmonious effect with the rest of the face.
This surgical intervention may be associated with other nasal procedures (correction of functional nasal aspects) correcting for example chronic nasal obstruction, such as correction of the nasal septum.
Most of the times a Rhinoseptoplasty is done to correct deviations of the nasal septum, to allow better nasal breathing and a rhinoplasty, to improve the aesthetics of the nose. 
The surgeon must therefore master the anatomy and surgical concepts as a whole and not by sections, taking into account aesthetics and the functionality of nasal breathing.
During the first appointment with the Otolaryngologist, a candidate for a Rhinoplasty is subjected to a complete assessment of the entire nasal structure, from the outer nose and its relationship to the remaining facial anatomy, to the endo-nasal structures, such as the septum, nasal turbinates, and the perineal sinuses. The help of simulation programs is sometimes also an excellent tool to facilitate communication between the doctor and the patient. Photographs are taken before and after surgery, from various angles, to complete the assessment. The desired result is a harmonious nose, without the "operated nose" stigma.
Although a detailed and individual planning of each surgery is carried out, the truth is, that on average 10% of the noses operated will need small adjustments or "retouching" (1 in 10), and this revision, as a rule, takes place one year after the first surgery. Most cases are easily solved with fillers. 
Rhinoplasty has also undergone advances in both concepts and techniques over the last decades; so, despite the apparent aggressiveness it is almost painless and very well tolerated by the patient. Facial haematomas, mainly periocular (around the eyes), only occur when an osteotomy is necessary (fracture of the nasal bone for repositioning).
The greatest discomfort is almost always, some degree of nasal obstruction and secretions during the first week after surgery. It should be noted that the act of "unpacking" is painless, and does not cause trauma as a plasticised inner dressing is used, that slips out of the nose. As a rule, a mouldable external protective splint is used, which remains on the nose for 6 to 7 days. 
During the first few weeks, some nasal congestion is common due to oedema, which progressively decreases during the first month. Initially stiff and swollen, the nose gradually becomes malleable as the oedema disappears. The final result of a Rhinoplasty can take about three to six months.
As with all skin surgeries, sunscreen should be applied daily to avoid sun exposure, reducing the likelihood of complications and resulting in a rapid recovery.