The Procedure

What is the procedure ?

For the facial feature, nothing has a greater impact on how a person looks than the size and shape of nose. The different nose appearance can change the whole face feature. So,in every years half of million peoples looking for nose surgery to improve the face appearance. In Asian peoples with the flat nose seeking for the higher volume of nose bridge by inserting the silicone inside. But in the contrary a hand , for the western peoples with the big nose, very high nose bridge with hump or even the crooked nose need to improves it by shaping, some bone will be removed without silicone inserted or we call “Rhinoplasty” or “Nose Reshaping”. Rhynoplasty or nose reshaping is the procedure to correct the nose structure in the peoples with the asymmetry nose since when they were born such as the nose is not straight, crooked or have the hum in the middle or some accident attacked and in the additional goal of improving breathing due to sometimes the wall that separates the nose into right and left (nasal septum) of the peoples is twisted. This also can fix with as the combine procedure is called “septorhinoplasty” Or we can says in the easier way that Rhynoplasty is the surgery to fix the nose, And septoplast is the surgery to fix the nasal septum. But both procedures can be performed in the same times if you are a candidate for both procedures.

The Method

How the procedure is performed ?

Nose reshaping can be divided in 2 technique, Rhynoplasty is the procedure to correct the nose structure and Septorhinoplasty,the procedure to improves the breathing problem.

Rhynoplasty (correction the nose structure)

The procedure will be started with applying the general Anastasia on the patient to make them sleep during the surgery. Then, the surgeon will make an incision across the columella between 2 nostrils which is under the nose in order to access the inner structure of the nose.(In some patients undergo for the small correction, the surgeon will make an incision outside the nose, around alar base.) And when the surgeon can access to the bone, the method to contour the structure of the nose is depending what is the specific concern of you or which part of the nose you would like to correct. If you would like to make it thinning or remove the bump (the small bone at the middle of your nose), the surgeon will use medical device like chisel-tool called “Osteotome” with the rubber hammer which is very precisely done with the few tabs to correct or break the nasal bone and cartilage to reshape the nose structure the expected result of each person. But in some surgeons can also use the special rasp in the nose operation, it’s depend on the technique of each surgeon. In some case, the excess tissue inside the nose and the excess skin also can be removed. And after the nasal bone is corrected as should be, the surgeon will close the incision with the suture and put over the splint (metal or plastic) on the nose again. This will help support the new shape of your nose bone and reduce the swelling and bruising that you can go back to the normal life And also the soft plastic splints or nasal packs also may be placed in the nostril, this can keep the dividing wall between the septum stable.

Septorhinoplasty (Improving the breathing problems)

Septorhinoplasty is the procedure to improve the breathing problems which caused of the asymmetry deviated septum (the narrow wall of tissue that separates your nostrils), it’s mean the internal partition between the right and left nasal passage may be crooked on both sides, therefore, impinging the airflow. The incision will be made at the same position of Rhynoplasty, across the columella between 2 nostrils which is under the nose to correct the deviated nasal septum and reduce the enlarged turbinates, opens the air passages such that the equivalent improvement is that of going from a two-lane highway to a four-lane highway, with septorhinoplasty, you may be able to breathe better and have the appearance of your nose improved. And the surgeon will close the incision with the suture and put over the splint (metal or plastic) on the nose. This will help support the new shape of your nose bone and reduce the swelling and bruising that you can go back to the normal life sooner.

What type of Anastasia is necessary for the procedure ?

General Anastasia

How will the incision look like ?

For the incision of Nose reshaping, the surgeon will use a fine marker to mark the point of small incision at approximately the junction between the proximal one third and the distal two thirds of the columella. Most people use a horizontal incision with a small “v” in the center pointed either anteriorly or posteriorly which is connected to the other incision hidden inside the nose.

Ideal Candidates

Is this procedure suitable for the candidate ?

  • The candidate for Nose reshaping can be both of man and women but must be in good health, don’t have the serious medication problems or condition which can’t undergo the surgery
  • Must over 18 years old of the age because before this age,the nasal bone is not stop growing up yet which can be effected to the exact shape of the nose but exceptions are cases in which breathing is severely impaired
  • The people who don’t happy with the size of the nose, the shape or even the angle of the nose such as it’s too big , too high , have a hump at the middle of the nose , or the nose bridge is not straight or crooked and want to this appearance
  • The people with the nose which is attacked by the strongly things such as accident or the extreme sport which this make the peoples suffer from both of unbalance shape and can be related to breathing problem
  • The person with the thick skin on the nose is the better candidate for having nose reshaping compare to the peoples with thin skin. Because if you have a thin skin, the removed hump or hollows nose is difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside.
  • The peoples who have a problem with the breathing problem which caused of the nose are damaged by accident, sport or even the problem since  birth. It’s because of the nose is blocked inside and want to fix this problem
  • The people who need to improve the face appearance, make the face looks more harmony and shape
  • The people who need to restore the flaw parts of the nose
  • The peoples who want to have more self-confident

What are the results the candidate can expect?

  • The result of nose surgery are immediately visible and permanent
  • The goal of Rhinoplasty is to improve the nose aesthetically, creating harmony with the other facial features and also improving the breathing problem.
  • After the surgery, the size of your nose can be smaller, the tip and shape can be correct and the hump can be removed, depending of the volume of the nose you would like to improves. And since the structure of your nose is shaped , this can effect of the changing angle between your nose and the upper lip
  • The nose structure will be improved, creating harmony with the with the other facial features, balanced and proportioned nose.
  • The size of your nose will be smaller
  • The height of your nose bridge will change ( but not too much )
  • The tip and shape of your nose will be corrected
  • The hump will be removed which make the nose and reduce the width which the nose can look straight
  • Because of changing the shaping the structure or your nose, this can effect of the changing angle between your nose and the upper lip
  • Increase your self-confident 
  • Reconstruction the nose shape for the peoples with accident
  • Improving some breathing problems
  • Narrow the opening of the nostrils

Recover/Post-Operative

Length of stay at the hospital and in Thailand

1 night in the hospital, recommends 9 days in Thailand

Pre-operative care

  • Before the surgery can happen, you need to have a consultation with the surgeon and inform them all information about your medical problem, your allergies, medical you are taking and including. If you know that you have problems with your blood pressure, your heart, or your lungs, asks your family doctor to check that these are under control
  • The surgeon will clarify you all detail about the procedure, the complication and risks from the surgery
  • In some cases with very complicated breathing problems need to make an X-Ray scan to see the real cause of the problem
  • You will be asked to stop taking Aspirin, ibuprofen, and products containing aspirin and ibuprofen including anti-inflammatory medication , high dosing any multivitamins/herbal remedies/teas etc. before and surgery for 2 weeks, this may inhibit blood clotting and cause bleeding problems during and after surgery
  • Stop smoking or drinking alcohol before and after the surgery 2 weeks, that’s effect to delay wound healing
  • Try to drink water as soon as you can before the surgery
  • Prepare the thing for the recovery time such as high pillows, cool pack or stock some food in the fried. Because after the surgery, you won’t feel comfortable to do these things

On the surgery date

  • On the surgery date, you should stop eating and drinking 6 hours before the surgery
  • Take a bath and wash your hair wash your hair (because after a surgery, you maybe not comfortable to do it for a few days) but without applying the lotion and cream on the body including no makeup
  • Take out all accessories, such as earring and also remove the nail polish before getting the operation room
  • Wear the loose cloths or comfortable, If possible take the shirt with the button in front
  • Sleep well before the surgery
  • Make a physical checking up to be sure that you have the normal level of your blood pressure or any disease come up which can’t undergo the surgery or not. And including checking your breathing problems combination in case you would like to improve these problems also

Post-operative care

  • After the surgery, the small splint will be placed over your nose to support the new shape of nose and you will be recommended to sleep with the high pillow (in the possible of the head higher than the chest) to reduce the swollen and bruising from the operation. And it’s not only your nose which is swollen and bruising; your face also will be puffy, especially the first day after the surgery. If you still have strong pains, the pain killer medicine is allowed to take it
  • If you still have strong pains, the painkiller pill and antibiotics medication is recommended if the pain is extremely and for preventing to get infection during the healing process and continue taking them until they are all gone
  • But be careful not to take the aspirin or some combination procure may contain aspirin or other non-steroidal anti-inflammatory drugs that increase bleeding.
  • And cool pack, frozen peas is required to apply on your nose. This can reduce the swelling and stop bleeding (especially, the first few days is recommended to keep cool pack on your surgery area all the time) and including vitamin A and C is also can help
  • During this time, its very importance to keep you wound dry and clean. You can clean your face with the wet towel but if you really want to take a shower to wash your face, you can do it with gently and dry it up as soon as possible. Use the Q-tip (cotton bud) with sterile water to clean your nose both inside and outside and change the bandage on both inside and outside your nose as often as possible to prevent growing up of bacteria
  • Don’t worry if there is some bleeding or oozing from the incision, that’s normal and will resolve within 2 days
  • About 7 days after the surgery, you have to come back to see the surgeon again for follow up checking to be sure that the incision go well, no side-effect or complication
  • Just to be informed, during this time, you face will be bruised and don’t get too panic or frightened when you look at yourself in the mirror ( but it doesn’t happen to every patients ), your face maybe get some shades of the purple , green and yellow before the face completely ( around 10 days).
  • Do not blow your nose. If you sneeze, open your mouth to divert the airflow away from the nose or avoid any pressure on your nose. During the recovery time , the incision can be itching , try to not scratch it. Apply the moisturizer, oily lotion on the nose are recommended
  • Avoid extreme activities or strenuous sport at least 3 weeks because of the rising high blood bending over or lifting heavy things and including be careful to the children and pet that can attack your nose and it may move suddenly and also can cause of bleeding inside your nose
  • And if you wear glasses, don’t wear it for the first 3 weeks ,contact lenses are OK immediately after nose surgery. The opposite is true with eyelid
  • The nose skin after Rhinoplasty is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months.
  • The nose may feel a little stiff and numb for up to three months, particularly around the tip. And it’s normal if you feel loss of the smell after the surgery, and including the numbness of the nose. It will almost always temporary and can last 6-12 months

What are the possible risks and complications involved?

The common symptoms

After Rhynoplasty, you can always expect temporary swelling and bruising around the eyes and nose and also lose of the sensation(numbness) and smell in the beginning. But all of this will fade away over the time and can last long 6-12 months

Infection

The risk of infection is very low because normally the surgeon will let you to take the antibiotics medicine to prevent the infection. But however, it’s possible which you an notices from you have a fever after the surgery the redness or the swollen and pains increasing and not fade away over the time as it should be. This you should be back to see your surgeon again

Bleeding

It’s normal if you have a bleeding( also oozing )from your nose after the surgery , this can long last to 4 weeks after the surgery. But if your nose is bleeding uncontrollably, and especially it’s more risky in the peoples with the blood disease such as Von Willebrand(VWD) is a bleeding disorder. It affects your blood’s ability to clot)you should go back to see your surgeon as soon as possible

The breakdown of skin tissue (skin necrosis)

Due to the tissue surround the nose is damaged , this is caused of the thermal instrument what the surgeon uses to close the bleeding vessels after removing the tissue. But because of the wrong operation of the surgeon, the tissues might be damaged. And including the damaging of lacrimal gland. It can even lead to fistula into the nasal cavity.

Skin problems

Even the scars of Nose reshaping are very small. But if you heal them in the wrong way, it’s can become visible scars which you need scar revision again.

Breathing problems

Due to after Rhinoplasty, the nose always becomes narrower, that’s why you have less space inside the nose for breathing. And if you have uncomfortable to breath just go back to see your surgeon again. The surgeon will use steroid sprays first to open the breathing passages. If this does not work, revision rhinoplasty is required