EL-ROUBY-CLINIC

Rhinoplasty (Nose Reshaping or Nose Revision) (Nasal Symphony)

Since the nose is a the most prominent part of the face and is regarded as the most important feature of the face and a manifestation of beauty, in addition, because it is the first part of the respiratory and immune systems and it is also involved in phonetics. Therefore, any problem in nasal shape or function should be considered.

What is Rhinoplasty?

Rhinoplasty is a procedure that restructures the nose in order to improve its appearance and function.

Rhinoplasty can be performed as either an aesthetic procedure, basically re-shaping of the nose to improve its appearance. It can also be performed as reconstructive nasal surgery, which means correcting birth defects and disfigurements that are result of injury.

Rhinoplasty can also relieve nasal obstruction and improve one’s breathing. There are many ways in which a nose can be altered through rhinoplasty, including reducing or increasing the size of the nose or nasal tip, changing the shape of the tip or the bridge, narrowing the span of the nostrils, changing the angle between the nose and the upper lip or correction of saddle nose.

This particular procedure has become one of the most requested ones today and many of these individual have their own reasons for wanting rhinoplasty. However, in any situation, the individual must have realistic expectations about their operation. The individual must also note that the cosmetic surgery is meant to achieve improvement and not perfection.

With the increasing popularity of various cosmetic surgery procedures, including Nose Re-shaping procedure, it is imperative that the prospective patient research and understand different issues like what the procedure can and cannot treat, inherent risks, costs, and so on. Keep in mind, cosmetic surgery is just that – a surgical procedure whose results cannot simply be erased. When considering any form of cosmetic surgery, it is important to have a good understanding of the procedure before making a decision. Take some time to view the introductory information we have provided on Nose re-shaping. While the information contained in this website will provide you with a basic understanding of the procedure, it may not answer all of your questions. To get complete answers to the questions you are seeking, we recommend that you contact us.

What is it about your nose that you would like to change? Is it the shape or the size? Would you like to reduce airway obstruction and improve breathing? People have Rhinoplasty surgery for a variety of reasons. You've clicked on this site looking for information on possible improvements to Mother Nature's creation. Knowing what you like and dislike about your nose and having realistic expectations of what Rhinoplasty can do is essential to a positive experience. Spend some time thinking about what you truly want. The new nose will be beautiful and fit the proportions of your face, but it must retain the ability to bring air to the lungs.

The Best Candidates for Rhinoplasty:

- The best candidates are those looking for improvement, not perfection, in the way they look. Those that are physically healthy, psychologically stable, and have realistic expectations make the best candidates.
- Rhinoplasty can enhance your appearance and self-image, but it will not make you look like a movie star.
- Age can also be a consideration. Rhinoplasty must not to be done on teenagers until after they have completed their growth spurt (18 years). It is also important to consider the teen's emotional state and if surgery is what they, and not their parents, truly want.

What is the structure of your nose?

The nose is formed by five cartilages and two small bones. the upper two thirds is formed by the nasal bones and upper two cartilages, while the tip is formed by lower two cartilages. the septum divide the nasal cavity into two smaller cavities.

There are two valves, the external at nostril, and the internal at the junction of lower point of upper lateral cartilage and the septum with angulations 15 - 20 degrees. these valves are responsible for air humidity and smell sensations, and any changes in these areas cause feeling of nasal obstruction.
In addition any deviation in the nasal septum cause obstruction and sinusitis that need septo-rhinoplasty.
Therefore, Rhinoplasty could be considered a cosmetic or reconstructive procedure.

These structures are covered internally by the mucous membrane and externally by the muscles, fibro-fatty tissues and the skin. The size of the cartilages and the covering soft tissues are the main factors that determine the size and dimensions of the nose. Cartilages continue to grow up till 18 years. Any mild trauma may cause deformity of there growth till this age.

Considerations Before Rhinoplasty Surgery:

- Some people are not happy with the shape of their nose. Parts of the nose may seem out of proportion to each other or the rest of your face. You may not like the position, size or shape of the nostril. These concerns are cosmetic or appearance related. As such they are not covered by most insurance plans.

- Cosmetic surgery is elective, surgery that is designed to enhance the way you look, not to correct a condition that is affecting your health. If your nasal problem is great enough it may be a good idea to have the surgery but not if you have significant other medical problems.

- Cosmetic concerns, abnormalities and appearance are real problems. They are often dismissed as shallow or narcissistic, making individuals unhappy. Why live with something you do not like if you can have it changed? Many patients who elect for a cosmetic change in appearance tell the doctor they wonder why they waited so long and did not have the surgery sooner.

- When rhinoplasty is performed by a qualified plastic surgeon, complications are rare and usually minor. Nevertheless, there is always a possibility that complications may occur. You can reduce your risks by closely following the doctor's instructions both before and after surgery.

- As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an "open" technique is used, the small scars on the base of the nose are usually not visible. Other scars near the bridge of the nose can come from changing the nasal bones from externally.

- Occasionally a second procedure may be required-for example, to correct a minor defect. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

How do you can assess and analyze your nasal aesthetics?

Firstly, (Front View): you can divide your face by six vertical lines , one pass through the ear prominence, the second pass by the external angle of the eye and the third by the internal angle of the eye and so on. These lines are separated by equal distances the equal on fifth of the facial width.
The nasal base should be enclosed within the two lines that pass by the internal angle of eyes. Also, if you draw a line start from point mid way between eyes and to tip of the nose, this line should be parallel to previously mentioned lines. the nasal tip is like an inverted triangle.
If there is any discrepancy, you may have a broad nose, a bulbous tip or deviated nose.

Secondly, (Frontal View): you can divide your face into three parts by four transverse lines pass by hair line, nasal root, nasal junction with upper lip and chin. These three thirds should be equal and middle third contain the ear and nose completely.
If there is any discrepancy, you may have a long nose.

Thirdly, (Side and Basal Views): to determine the tip projection, you will need a side view photo. The nostrils are considered to be two thirds of the basal view, the nasal-forehead angle should be 110 - 120 degrees in women and 110 - 90 degrees in man. The angle between the lip and base of the nose is 90 - 110 degrees. The line between the nasal tip and chin should just touch the projected part of the upper lip.
If there is any discrepancy, you may have a droopy tip.

For Reconstructive purpose, the nose consisted of 8 aesthetic units. Each one has its boundaries and should be reconstructed separately. These units are the dorsum of the nose (Orange), the tip (Light blue), the 2 nasal sides (Green), the 2 alae (Red) and the 2 soft triangles (Blue).

Planning Your Rhinoplasty Surgery:

Good communication between patient and the plastic consultant doctor is essential. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a deformity, the procedure may be covered. We will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.

First Rhinoplasty Consultation:

During the initial consultation, We will gather information to perform a complete nasal history assessment.

- We will ask what you like or dislike about your nose, discuss the possibilities with you, any nasal problems, your general medical history, and if you've ever had injuries resulting in an undesirable change in your nose. Next

- We will analyze the face to determine proper proportions and surgical options. Photos may be taken to assist in the analysis and computerized simulation of the results. The Computerized simulation has 70 -80 % accuracy.

- We will present our assessment, answer any questions you may have and explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. We want all of your questions answered before scheduling surgery.

- For those with breathing problems or previous injuries, a more thorough examination will help us find any obstructions inside the nose. We may use a device to see the anatomy inside the nose. This information will help us better advise you of any corrective procedures that may be needed.

- We will also explain the techniques and anesthesia to be used, where the surgery will be performed, the risks and costs involved, and any options you may have.

- A second consultation may be needed.

Allergies For Rhinoplasty Patients:

We will investigate possible allergic and environmental problems with some patients seeking nasal surgery. Allergies occur when pollen, dust, or pet dander are breathed in through your nose swelling your passageways and closing off the nostrils. Allergies can be seasonal. Partial obstruction means it takes less swelling before your nose can be closed off. People with enough chronic irritation even develop growths in the lining of the nose called polyps. Such growths can also close off the nostrils.

Most used techniques designed with packing of the nose. If you have nasal packing it will be removed after a few days and you'll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.

How is the Nose reshaping or Rhinoplasty Procedure Performed?

- Rhinoplasty is done under general anesthesia (and sometimes local). With general anesthesia, you'll sleep through the operation. With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll be awake during the surgery, but relaxed and insensitive to pain. General anesthesia is usually better for more extensive rhinoplasty or septal surgery. Local anesthesia is usually better for small adjustments or hump removal.

- Rhinoplasty takes about one to two hours.

- Rhinoplasty could be done by open or closed method. (with or without Collumelar incision)

- The incision done before the tip (Collumela) and inside the nostrils, then exposure of the cartilages is done.
- Then re-shaping of nasal cartilages and bones according to sex and racial factors using permanent stitches and cartilage resection or augmentation by grafts.
- Hump is removed now.
- Deviated septum could be corrected at this step and nasal bone could be modified by osteotomy also.
- Thinning of nasal soft tissues (removing of fibro-fatty tissues) then could be done before closure of the wounds.
- An external splint will support the outside of the nose. Sometimes soft rubber splints will be used to support the inside. Packing is not necessary in some cases.

- Saddle nose is another example of nose that should undergo Rhinoplasty using a cartilage graft or synthetic materials like med-pore to form a normal nasal dorsum of even hump.

- Some cases need Genioplasty to bring the chin into better balance with your other facial features.

- Some cases may need revision rhinoplasty after eight months up to two years to refine the results.

What to Expect on the Day of your Rhinoplasty Surgery:

- Most nasal surgery is performed on an outpatient basis (no need for hospital stay).

- After the surgery you can expect to feel uncomfortable with a possible headache. Keeping the head and neck elevated will help reduce swelling and discomfort.

- A little drainage is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. You should not to blow your nose for a week or so, while the tissues heal.

Rhinoplasty Surgery Recovery:

- Most rhinoplasty patients are out of bed within two days, and able to return to their jobs on a limited basis a few days to a week or so following surgery.
- Any stitches or splints will be removed in five to seven days and any swelling or bruising will last about seven to ten days.
- You will start to see results in as little as two weeks with further details revealed over the next six months up to one year.
- Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.
- You can wear contact lenses as needed, but glasses will have to be propped on your cheeks for another six to seven weeks, until your nose is completely healed.

Your New Look After Rhinoplasty Surgery:

It is normal in the days following surgery to feel a little depressed. It is hard to determine the effects of the surgery or if it was worth it. Keep in mind that this is only temporary and that you will be looking better in a few weeks. Each day, your nose will begin to look better and your attitude will improve. Within a week or two, you'll no longer look as if you've just had surgery.

Still, healing is a slow and gradual process. The final results of rhinoplasty will be uncovered over the next year. In the meantime, you may receive unexpected reactions from family and friends. The reason for this is that, they may not see a major difference in your nose. Or they may not approve of the change, especially if the surgery altered what they perceive as an ethnic or family trait. Try to keep in mind why you decided to have this surgery in the first place. The surgery should only be judged by how successful it was in meeting your goals.

While extensive rhinoplasty can result in swelling and bruising, we will design after surgery care to minimize these problems. You can help before surgery by avoiding Aspirin, Ibuprofen, and other medication or herbal substances that can increase bruising.

What are the typical costs associated with Rhinoplasty Surgery?

Often the price says nothing about the quality of the work. Most multicenter clinics charge much more than private doctors — their advertising budget is more and the owner of the clinic has to take his 20% or 30% off the top. In my opinion, you are less likely to get a quality procedures at these multi-center locations.

Although price is a factor when deciding on surgery, the most important factor is that you feel you are getting a good quality, natural-looking result from the procedure.

Rhinoplasty costs are variable according to the deformity and the used technique. Usually the cost is ranging from 1000 to 1500 U.S. dollars. When dealing with costs, you also need to take into consideration the fact that the procedure may need to be repeated. Most medical insurance providers do not cover the procedure but do for nasal reconstructive procedures.

Frequently asked questions from patients when considering undergoing Rhinoplasty?!

Personality analysis by nose!
"The shape of the nose is genetic, unless broken or fixed. Chiseled features have always been in vogue. Most popular is a nose that has a high, straight, full and fleshy tip with gently flared but protected nostrils. The fleshy tip indicates cordiality and warmth of personality and an empathic nature. These people can set high standards for themselves and are generally polite.
- Oversized nose tips: violent tendencies; the larger tip, the more prone to acts of violence.
- Eagle shaped - or hooked nose - portrays strong will, independence and enterprise with successful during middle ages.
- Upturned: luck in social circumstances and a love of socializing
- High bridge and pointed: energetic, curious person, self reliant
- Large: high energy, but may be more materially concerned than spiritual matters
- Small: shy and reserved
- Thin: emotional, high strung, fussy, annoying
- Wide nose indicates an expressive person who is often aloof
- Long: prudence and anxiety
- Short perky: natural personality generally happy
- Short snobby: friendly but secretive disposition, slow moving
- Straight: disciplined, methodical ".

Q - What is ideal shape of the nose?
A - Actually, there is different shapes differ by race, age, sex, religious ethnics and personal variations. So, there is no ideal nasal shape but the ideal nose for you is that proportional to your other facial features.

Q - Is it possible to do rhinoplasty in nose with scars?
A - Yes, but the success rate is less than 80 %.

Q - What is the meaning of success rate of 80 %?
A - i.e., 80 % of the goals are gained.

Q - Is it possible to rebuild completely lost nose (by trauma or congenital)?
A - Of course it could be done in multiple sessions with few months apart.

Q - What is the duration of the procedure?
A - Ranging from 1 to 2 hours.

Q - What is the type of anesthesia, and when I can return to normal life?
A - General anesthesia or local anesthesia with or without sedation, and you can practice your normal life 2 hours after the finishing the procedure but as the external splint remain for a week, many patients practice their routine life after one week.

Q - What are the symptoms that may occur in the first five days after rhinoplasty?
A - headache which could be managed by pain killer’s medications and there may be edema or swelling of the face.

Q - What are the guarantees that the success of the process?
A - There is no doubt that the followers of the medical instructions and close follow up visits are the main factors for the success of any surgical procedure. If not, the process to achieve the agreed outcomes before, the process repeats at reduced cost.

Q - When can we get the final results?
A - after the first six months up to one year.

Q - Is the nose seems naturally?
A - Yes, especially after one year.

Q - What is ideal age for rhinoplasty?
A - rhinoplasty should not be done before 18 year old. However, nasal reconstruction could be done at any age.

Q - If you are not Egyptian, What is the minimum period for follow up?
A - Seven days.

Q - What is the non-surgical rhinoplasty?
A - With fillers injection like collagen and restylane we can augment some depressed areas to get harmonious nasal features. This procedure done without anesthesia in outpatient bases and no need follow up and patient get the results immediately without swelling. However, it is restricted to some cases and the results remain for 6-9 months then re-injection is needed.

Q - What are the contraindications of rhinoplasty?
A - There are no absolute contraindications but the patients should inform their surgeons about any allergies, serious medical conditions, and medications they may be taking.
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Summary of Rhinoplasty:

The time of the procedure: from one to two hours.
Type of anesthesia: General or local anesthesia +/- sedation.
Location: hospital or clinic without postoperative hospital stay.
Expected Side effects: Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness.
Recovery time: return to work after one week and the final outcome within the first year.
Cost: according to deformity, ranging from 1000 to 1500 U.S. dollars, or 5000 to 8,000 Egyptian pounds.
Results: a lifelong.

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