Poliklinika Sinteza

Nose Surgery – Rhinoplasty Without Tampons

Aesthetic nose surgery, or rhinoplasty, is one of the surgical procedures that most directly impacts the patient’s personality, making it one of the most responsible aesthetic surgeries. A beautiful nose contributes to facial harmony. A deformed nose becomes a prominent feature that draws attention away from other details on the face that we typically want to highlight.

According to modern research, when meeting an unfamiliar person, the first and most attention-grabbing features are the eyes and the middle third of the face, followed by the lips and teeth. If, for any reason, the nose is too dominant, facial harmony is disrupted, and our focus shifts from the eyes to the nose. The aim of aesthetic nose correction is to divert attention away from the nose, restore facial harmony, and redirect focus back to the eyes.

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About Aesthetic Nose Surgery or Rhinoplasty

Aesthetic nose surgery, or rhinoplasty, is a complex procedure requiring a surgical approach. It is performed under general anesthesia. During the surgery, the otolaryngologist approaches the nose through internal or external incisions, depending on the patient’s needs. Various techniques can be employed, such as removing or shaping nasal cartilage and bony tissue, straightening septum deviations, or adding implants to achieve the desired shape. Most aesthetic nose surgeries performed by Professor Mislav Gjurić are done without visible external incisions on the facial skin, using an internal or endonasal approach (closed technique).

  • Closed nose surgery or endonasal rhinoplasty requires precision, superior surgical technique, and experience. This approach successfully addresses even the most complex nasal deformities.
  • Open nose surgery or external approach differs from the closed method as Dr. Gjurić uses a small skin incision below the tip of the nose, allowing for correction under direct visual control. The scar usually heals very well and becomes almost invisible over time. Open rhinoplasty is particularly used for challenging nasal tip corrections, where new possibilities for cartilage shaping are available. Additionally, open nasal correction is often used in reoperations, revisions, or secondary rhinoplasty.

The success of nose surgery is significantly influenced by the patient’s skin and subcutaneous tissue structure. Thick and fatty skin can, on the one hand, effectively cover minor irregularities that may occur but can, on the other hand, hinder precise shaping when reducing and narrowing the nose. Conversely, thin skin requires special care and precise surgical technique from a skilled surgeon with extensive experience.

Candidates for Nose Correction

There are several reasons why people choose to undergo nose correction or rhinoplasty. Candidates for this type of surgery may have the following issues:

Aesthetic Reasons: Individuals dissatisfied with the appearance of their nose may be candidates for rhinoplasty. This can include changes in nose size, tip shape, position or size of nostrils, angles between the nose and upper lip, or reducing nose curvature. Aesthetic rhinoplasty can help achieve facial symmetry and a balanced look.

Most aesthetic corrections include:

  • Nasal Dorsal Deformity:

The most common reasons for nose correction are a dorsal hump or crooked nose, which may result from injury or congenital conditions. After an injury or previous rhinoplasties, a saddle nose may develop due to a lack of supporting bony-cartilaginous structures. Correcting a saddle nose is very demanding and often requires the use of cartilage and other grafts.

  • Tip Deformity:

Wide, thickened, or drooping nasal tips are common corrections. Additionally, shape corrections of the nostrils and nasal wings are usual. These are very sensitive procedures that require significant experience and knowledge. The choice of technique varies from case to case and involves reshaping the nasal cartilages, positioning them correctly, and securing them.

Functional Problems: Rhinoplasty can also address functional nasal issues that impair normal breathing. This can include correcting septal deviations (septoplasty), reducing or removing nasal polyps, increasing or decreasing the size of nasal passages, or other issues that cause breathing difficulties.

Injuries: Individuals who have sustained nasal trauma, such as nasal fractures or cartilage dislocations, may be candidates for rhinoplasty to correct deformities and restore nasal functionality.

Each patient should consult with a rhinoplasty surgeon who will assess their condition, discuss the goals of the surgery, and provide all necessary information about the procedure, risks, and expectations.

Difficulty Breathing After Rhinoplasty: Some patients may develop breathing difficulties after rhinoplasty, despite a successful aesthetic result. While internal nasal examinations generally show good patency, rhinomanometry can reveal nasal valve insufficiency.

This refers to damage to the delicate mechanism responsible for normal airflow during inhalation and exhalation, resulting from surgical trauma or deformity. Treating this condition is challenging and unpredictable, so it’s best to prevent it with proper surgical technique. Good nasal breathing is crucial for high-performing athletes, so nasal septum surgery is a common procedure for individuals engaged in physical exertion.

Preparation for Aesthetic Nose Surgery

Preparing for aesthetic nose surgery (rhinoplasty) involves several important steps to ensure a successful and safe procedure. Here are some general guidelines for preparation:

Consultation with the Doctor: The first step is to schedule a consultation with otolaryngologist Professor Mislav Gjurić, who will assess your desires and goals and provide detailed information about the procedure. During the consultation, you will discuss your expectations, review your medical history, evaluate your nasal anatomy, and talk about potential risks and complications.

Many patients often cannot precisely describe what bothers them about their nose, so the main task is to clarify the basis of the deformity and the actual possibilities for correction. Many patients often cannot precisely describe what bothers them about their nose, so the main task is to clarify the basis of the deformity and the actual possibilities for correction.

Computerized Nose Simulation After Surgery: This significantly helps patients better understand how changes in nose shape will affect their overall facial appearance.

At our clinic, we offer a 3D simulation of your nasal correction results using the innovative VECTRA® H2 device. This device allows us to create realistic projections tailored to each individual’s physiology and accurately display the outcome of the surgery. The imaging is done precisely from various angles, helping us align your expectations with what can be achieved, thus preventing any misunderstandings regarding the final appearance of your nose.

Medical History and Examination: The doctor will review your medical history, including previous surgeries, allergies, medication use, and any health issues that may impact the surgery or recovery. You may also be advised to undergo certain tests or laboratory examinations. Aesthetic nose surgery (rhinoplasty) is performed under general anesthesia, which requires a pre-anesthesia examination, laboratory tests, ECG, and spirometry. The final decision and recommendation from the doctor will be based on measurements of nasal airflow (rhinomanometry), photo documentation, and computerized nose simulation.

Discontinuation of Certain Medications and Supplements: Before the surgery, the doctor may advise you to stop taking certain medications and supplements that could increase the risk of bleeding or complications during the surgery. This may include aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and some herbal or dietary supplements.

Stop Smoking: If you smoke, you will be advised to quit smoking at least a few weeks before the surgery. Smoking can negatively affect recovery and healing, so it’s important to avoid smoking before and after the surgery.

Organize Support During Recovery: Plan time for recovery and arrange support for this period. You will need someone’s assistance in the first days after the surgery, as well as in the following weeks until you fully recover.

Recovery After Nose Correction

Nose correction concludes with the application of a protective plaster, cast, or plastic material designed to maintain the shape and position of the nose for the first 7-10 days, until healing. We are proud to rarely use nasal tampons, which facilitates and speeds up recovery after nose surgery.

Recovery after nose correction (rhinoplasty) can vary depending on the complexity of the procedure and individual patient characteristics. Here are some general guidelines on what to expect during the recovery period:

Rest and Recovery: You will need several days of rest after the surgery. It is recommended to avoid physical labor and activities that could increase the risk of nasal injury. This includes heavy exercise, jumping, running, or contact sports. Plan time off work or school to rest and follow the doctor’s instructions.

Swelling of the Nose and Face: This varies individually and depends on the severity of the surgery and the patient’s tissue response. Most swelling subsides within two weeks, and recovery can be accelerated with anti-inflammatory medications, facial creams, and nasal drops.

Pain and Discomfort: You may experience mild pain and discomfort in and around the nose during the first few days after the surgery. Your surgeon will prescribe appropriate pain medication to alleviate this. It’s important to follow the medication instructions and avoid taking non-prescribed drugs.

Nasal Hygiene: The doctor will provide instructions on nasal hygiene during recovery. You may be advised to use saline solutions or nasal sprays to keep the nasal passages clean and moist.

Follow-Up Appointments: Regular follow-up visits with your surgeon will be necessary during the recovery period to monitor the progress.

Returning to Daily Activities: This is possible after two weeks and depends on individual circumstances. Greater physical activity should be avoided for the next two months. Patients from outside Zagreb can travel home the day after the surgery, with the next check-up scheduled after 7-10 days.

It is important to understand that the healing process after aesthetic rhinoplasty takes at least 6 months to a year for the nose to achieve its final appearance.

Precautions

After nose correction (rhinoplasty), it is important to take certain precautions to ensure a successful recovery and minimize the risk of complications. Here are some:

Follow the doctor’s instructions: Follow all the instructions given to you by the doctor. This includes instructions on changing bandages, taking medications, nasal hygiene, and any other specific instructions for your case.

Keep your nose dry: During recovery, it is important to avoid exposing your nose to water or moisture to prevent infection. It is recommended that you avoid swimming, showering, or submerging your nose in water until you receive approval from your doctor.

Avoid physical exertion: During the first few weeks after surgery, avoid physical exertion, heavy exercise, or activities that could increase the risk of nose injury. Limit physical exertion and be careful not to hit or put pressure on your nose.

Sleep in an elevated position: During the first few weeks after surgery, it is recommended to sleep with your head elevated to reduce swelling in the nose. Use pillows or headrest cushions to elevate your upper body while sleeping.

Avoid smoking and alcohol: Smoking can hinder the healing process and increase the risk of complications. It is recommended that you avoid smoking and consuming alcohol during the recovery period.

Sun protection: During the first few months after surgery, avoid exposing your nose to direct sunlight. Sunlight can cause permanent scars or skin pigmentation. If you go out in the sun, wear a wide-brimmed hat or use sunscreen (SPF).

Regular check-ups: Regularly visit your surgeon during the recovery period for check-ups and to monitor the healing progress of your nose. If you notice any unusual symptoms, such as severe pain, bleeding, or infection, contact your doctor immediately.

Cost of Nose Correction

You can check the current price list of the Sinteza Polyclinic for more information on the cost of the procedure, contact us by phone at +385 1 5005 970 or via email at info@sinteza.hr for more information. For direct appointment reservations, click on the link.

FAQ

What functional disorders of the nose can occur after primary rhinoplasty?

The most common functional disorder after rhinoplasty is difficulty breathing through the nose. This can occur either due to unrecognized narrowing of the nasal passages that existed prior to the surgery or due to airflow disturbances through the nose as a consequence of an inadequately performed procedure—rhinoplasty.

Otolaryngologists, unlike plastic surgeons or so-called aesthetic surgeons, are trained to recognize and treat not only aesthetic but also functional problems of the nose. If necessary, surgery on the nasal septum (septoplasty) and procedures on the nasal turbinates (turbinate surgery, laser) are performed simultaneously with rhinoplasty—the aesthetic procedure. Breathing difficulties after rhinoplasty are most often a result of excessive removal of cartilage in the area of the nasal tip or the cartilaginous dorsum of the nose at the entrance to the nasal cavity. These disorders can be corrected with a subsequent surgical procedure.

What are the advantages and disadvantages of open rhinoplasty compared to the closed method?

The advantages of open rhinoplasty include good visibility of the anatomical structures of the nose throughout the entire procedure, which allows less skilled surgeons to master the surgical technique more quickly. The open technique allows for precise correction, especially of the nasal tip, using methods of grafting and suturing the nasal cartilages.

On the other hand, it negatively affects the supporting structures of the nose in terms of their weakening, as some normal structures are sacrificed during access, which can be preserved with the closed approach through the nose. Therefore, extensive and precise reconstruction is necessary at the end of the surgery.

Additionally, with the open approach, there is an incision in the skin below the nasal tip, in the columella, which can be aesthetically unacceptable. Swelling of the nasal tip after surgery with the open approach lasts longer than after closed rhinoplasty.

What are the advantages and disadvantages of closed rhinoplasty compared to the open method?

The advantage of the closed approach in rhinoplasty is the preservation of all normal structures of the nose and the focus on the targeted correction of only those parts of the nose that need to be corrected.

In closed rhinoplasty, there are no external incisions on the skin, and therefore no external scars. Visibility during the surgery is somewhat reduced, which is why closed rhinoplasty is performed in most cases by surgeons—otolaryngologists—who are trained in functional and aesthetic nasal surgery. Sometimes, it is very difficult to perform extensive reconstructions of various parts of the nose using the closed approach, and in those cases, the external approach is preferred.

What are the contraindications for rhinoplasty? Are there any diseases or conditions that make it impossible to perform rhinoplasty?

Rhinoplasty, unlike septorhinoplasty, is by definition an aesthetic procedure that, like other aesthetic procedures, is performed at the request and desire of the patient.

In contact with the patient before the surgery, it is necessary to exclude candidates who have unrealistic expectations of the procedure or even suffer from body dysmorphic disorder. Indications for performing rhinoplasty before puberty are very strictly defined. In other cases, the contraindications are the same as for all other surgical procedures.

Why is reoperation using the open rhinoplasty method more demanding and riskier?

Every secondary (or revision) rhinoplasty is more demanding and riskier due to the changes in the tissue caused by the previous surgery—in terms of scarring, tissue atrophy, lack of cartilaginous or bony structures, etc. For this reason, an open approach is often used in secondary rhinoplasty, as it allows for the best possible visibility and control over the structures that need to be corrected. However, there are limits; if the nose has been operated on multiple times with an external approach, the skin and scar in the columella can become so atrophic that any further procedure is accompanied by increasing risk.

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Prof. dr. sc. Mislav Gjurić, dr. med.

Specijalist otorinolaringologije, subspec. plastične kirurgije glave i vrata

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