Rhinoplasty Patient Information
What is Rhinoplasty?
Rhinoplasty, also called as the nose job, is the art of reshaping and restructuring the nose. The main aims are to improve the nose both aesthetically and functionally.
What is VIP Rhinoplasty?
This is a term that Prof. Apaydin likes to mean the followings:
- A detailed consultation for each patient regarding the nose
- Professional photography for each patient
- Imaging for probable postoperative result (nose design). Prof. Apaydin likes to prepare profile templates for most of his patients to use as a guide during surgery.
- Most importantly spending enough time in the operating room for each individual patient with an effort to solve all possible postoperative problems. Approximately it takes 3 hours for Prof. Apaydin to finish primary surgery. For revision surgeries this time can be 4-6 hours.
- Attentive care for each patient after surgery
- Long term follow-up. Prof. Apaydin likes to see his patients after surgery as long as possible. He has patients that he has been following for 15 to 20 years.
Anatomy of the nose:
The nose is found in the middle of the nose both from the vertical and horizontal aspect, which makes it as the center of attraction. It is composed of skin, subcutaneous tissue, muscles, osseocartilaginous framework and inner structures, namely mucosa and turbinates. The skin thickness is of utmost importance for the outcome in rhinoplasty. Since the osseocartilaginous framework is changed during the operation, thin skin can show all the changes underneath whereas thick skin can hinder them. Therefore the moderate thickness is the best for a better result.
What is the goal of Rhinoplasty?
The major goal of this operation is to give you a natural looking nose which is in harmony with your face. It is aimed to make a better looking nose. Every effort is taken to get the best result, but expecting a very excellent result after each operation is beyond the reality. The outcome of the operation is not solely dependant on surgeon’s abilities and experience, but also on the patient’s age, health status, skin type, bony structure, wound healing, smoking and relevant anatomy.
At what age can it be done?
Rhinoplasty is usually requested at younger age groups, usually between 18 and 35. But it can also be applied succesfully during the 5th and 6th decades as well. In certain situations where nasal obstruction is severe, the operation can be done at an earlier age.
Is it a difficult operation?
Rhinoplasty is undoubtedly the most difficult operation of facial plastic surgery. The challenge is the unique characteristics of each face and the difficulty in tailoring the shape according to each individual face while preserving or restoring the nasal function. The ultimate success comes from good patient-surgeon interaction.
Does rhinoplasty affect my breathing through the nose?
The nasal septum divides the nose into two nearly equal compartments and it is one of the most important supporting structures of the nasal pyramid. Deviation of the nasal septum can be due to genetic inheritance or trauma. Besides, the turbinates originating from the lateral nasal wall can be enlarged due to many reasons. The mucosa covering inside of the nose can also be inflamed and congested due to many factors such as allergy, smoking, etc. All these factors causing nasal obstruction must be examined and shared with the patient. Moreover, all the obstructive causes must be eliminated during rhinoplasty since the airway passage is usually narrowed 10-20 % in the majority of rhinoplasty patients. Under normal circumstances, this narrowing do not cause any nasal obstruction.
Are photographs taken before surgery?
Photographs are a must before rhinoplasty. The standard approach is to take 6 shots for each case: frontal, two obliques, two laterals and basal. Additional pictures can be taken when the surgeon thinks it is needed. The patient is usually photographed 6 months after the surgery again and also on a yearly basis.
Can I see what my nose will look like after surgery?
Every surgeon has a different way to define the predicted result. Some use mirrors, some use hand-made drawings, some like to draw on life-size pictures and many prefer using computer programs for warping pictures. The computers can act as a nice tool where the surgeon can reflect the results of his facial analysis on the patient’s original picture and where the patient can reflect her/his demands. So the computer can act as a tool of compromise between the patient and the doctor. However, we should always remind our patients that the warped images can only be used as a rough estimate just to give an idea about the final operative plan. It can never be guaranteed to have the exact result drawn on the computer.
Am I going to have scars on my face after rhinoplasty?
There are two main approaches to rhinoplasty: endonasal and external. With the endonasal approach all incisions are done though the nose, so no scar is visible on the skin of the nose. However, in recent years external rhinoplasty approach became very popular due to some additional advantages. In this technique, en external inverted “V” incision is usually done at the narrowest part between the nostrils. With proper technique, no prominent scar is seen on these cases. That is why 90 % of the surgeons in USA now prefers this technique more. On the other hand, very experienced surgeons in Europe still getting very good results with endonasal approach. So we can say that the choice of approach is surgeon-dependent and do not cause any trouble on the patient side. Prof. Apaydın have been using both approaches almost for 20 years successfully and in recent years he uses external approach in 60 % and endonasal approach 40 % of his operations.
What should I avoid before the operation?
One of the most important things before surgery is to avoid Aspirin containing drugs which are used against pain and upper respiratory tract infections. You can use paracetamol or acetaminophen as pain killlers. Please stop using cigarette smoking since nicotine can disturb healthy blood circulation which can impede wound healing. Please make the usual preoperative checkup such as blood tests, ECG and chest radiogram. Please do not drink alcoholic drinks a few days before and a few weeks after the surgery since it may cause congestion and additional bleeding inside the nose.
What to do on the day of surgery?
On the day of surgery please take a taxi from the hotel to private hospital. The details of the private hospital will be given to you by the nurse practicioner. Please contact the reception desk to start hospital admittance. Your name has already been given to them. The lady in charge in the front desk will help you with the formalities. If not done previously, your blood tests will be done and you will be seen by the anesthesiologist. Afterwards you will be taken to your room. Prof. Apaydin will see you in your room. From there you will be taken into the operating room.
How is the operation done?
The rhinoplasty can be done either under local and sedation anethesia or general anesthesia where the majority of the doctors prefer the latter to make their patients more comfortable and to concentrate better. The operation can last from 1 hour to 6 hours depending on the severity of the deformities. As mentioned before there are mainly two basic approaches: endonasal or external. The surgeon can choose either of them depending on the deformity after explaining them in detail to the patient. The skin envelope on the cartilage and bony framework is elevated. If there is a hump (which is usually the case) it is resected and the profile alignment is attained. The septal work is later done to straighten the deviation. The open roof created after removal of the hump is closed by breaking the bone from lateral sidewalls. The incisions are then closed by sutures. Nasal packing or splints are then usually inserted into the nose. In case of limited or no septal work, no packing or splints are necessary. A cast is put over the nose to hold the fractured fragments in place.
Can I have additional surgeries during rhinoplasty?
The rhinoplasty procedure is done under general anesthesia. Other facial contouring procedures may be performed at the time of your rhinoplasty surgery, such as injectable fillers, botulinum toxin injections, blepharoplasty, foread lift, facelift. Obviously the operation time will increase, but you will be able to hit two birds with one stone.
The first week after surgery:
You will have a cast over the nose for the first 5-10 days (usually 7 days), which must be kept dry. Swelling and bruising around the eyes and cheeks is different for each patient, but normal after rhinoplasty surgery and they are more marked within the first three days. They usually disappear in 7-10 days. Prof. Apaydin usually uses absorbable sutures which will not be removed. On rare instances, he uses non-absorbable sutures which is removed 5-10 days after surgery. When the cast is removed, the nose will be a little bit swollen. After cast removal, an additional taping on the nose is kept for one more week in most of the cases.
How long should I stay in Izmir?
Prof. Apaydin has been operating a lot of patients coming from different cities and countries. They usually go into consultation and are operated the next day. After the operation they are asked to spend 7 days in or around Izmir. There are many attractions in and aound Izmir. Because this operation does not make you immobile, you will feel free to go around after a few days after operation. Most of the patients stay 8-10 days for rhinoplasty in Izmir.
Things to do after surgery
- Sleep with head of the bed elevated or use two to three pillows. Do not move your head to sides more than 45 degrees. If you do more, the fractured fragments of the nose can move and end up with unwanted distortion of the nose. Please keep up with this rule for at least three weeks until told otherwise.
- Keep your head elevated while leaning on the floor to prevent nose bleeding.
- Do not consume very hot drinks since the vapor can increase nasal congestion and bleeding.
- Do not blow nose until instructed. Wipe or dab nose gently with Kleenex if necessary. You can clean the secretions and crusts in the nose gently by wiping with hydrogen peroxide and Bacitracin ointment.
- You will have a gauze drip pad placed beneath your nose. Change this as needed for the first two days following surgery.
- Use cold gel sor ice packs over the nose, around the eyes and cheeks. Do not place ice packs directly on your skin.
- The nasal cast will remain in place for approximately one week and will be removed by the doctor. Please do not disturb it and keep it dry.
- Brush teeth gently with a soft toothbrush only. Avoid manipulation of upper lip to keep nose at rest.
- Avoid foods that require prolonged chewing. Please use less salt for at least one month after surgery.
- Rest at least one week. Avoid athletic and sexual activities for two weeks.
- You may wash your face – carefully avoid the dressing. Take tub baths until the dressings are removed. Do not wash hair for one week unless you have someone do it for you. Do not get nasal dressings wet.
- Avoid excess or prolonged telephone conversations and social activities for at least 10-14 days.
- Avoid smiling, grinning, and excess facial movements for one week.
- Wear clothing that fastens in front or back for 1 wk. Avoid slipover sweaters, T-shirts and turtlenecks.
- Avoid sun or sun lamps for 6 weeks after surgery since heat may cause swelling of the nose.
- Do not swim at least for one month. You may easily confront with some kind of trauma during swimming.
- Your face will be swollen within 3-4 days after surgery. Then the swelling usually subsides within 2-3 weeks. The whole sweling is usually gone within 12 to 18 months.
- You may have bruising around the eyes within 1-2 weeks after surgery. It is usually gone after ten days. If it persists longer, a camouflage with makeup can be done.
- Take only medications prescribed by your doctor.
- Do not wear regular glasses or sunglasses which rest on the bridge of the nose for at least 4 weeks.
- You can wear contact lenses 2-3 days after surgery.
- When the cast comes off, the nasal skin can gently be cleaned with soaps and moisturizers.
- Do not risk anything. If you have a question in mind and you think that it is very important, please call your doctor.
How long does the follow-up after surgery last?
Rhinoplasty is reasonably a predictable operation. However, since the nose is a dynamic organ and the surgeon usually would like to see the nose after wound healing and during its longlasting changes. The surgeon generally sees his patient more often during the first three weeks after surgery, the time needed for early wound healing. Then the routine followup protocol can be to see her/him after 6 weeks, 3 months, 6 months, 1 year and once a year. This followup protocol is important for both the patient and the surgeon since they can evaluate the result of surgery together.
What is revision rhinoplasty?
Revision rhinoplasty is done for patients who have been operated before and would like to have another surgery due to an unwanted situation. In this case the surgery is much more complicated, because the surgery is done in a field of scarred tissues. There may be a need of obtaining cartilage from ear or rib. Ideally, revision rhinoplasties should be done by surgeons having years of experience on these operations. Because revision surgery is really very difficult and more time must be spent in the operating room. Prof. Apaydin has been successfully performing revision rhinoplasties in Izmir and all over the world. He has his own techniques for this kind of difficult cases.
Price of surgery
Prof. Apaydin is a worldwide known surgeon in rhinoplasty. Many patients come to see him and be operated by him from all over the World. There are all inclusive package for primary rhinoplasty (consultation, surgical fee, anesthesia, operating room expenses, 1 day hospital stay). In revision rhinoplasty, in other words, a patient who has been operated before and would like to have another surgery due to an unwanted situation, the surgery is much more complicated, needs years of expertise and takes longer time. That is why the expenses for the revision surgery is much higher.
How to pay?
The payments can be transferred to Prof. Apaydin’s account in advance. You are free to pay in cash or by credit card in the office as well. It is understandabIe that the the price of the surgery is an important factor for the patient. However, it should be kept in mind that if you are after VIP rhinoplasty, it will not be inexpensive.
How to travel Izmir and Why Izmir?
Izmir is one of the biggest and most beautiful cities of Turkey and the Mediterranean reaching a population of almost 5.000.000 inhabitants. It is a typical Mediterranean city with many attractions in and around, which makes it especially very appealing in the summer time. There are many direct flights from Europe and Middle East. Even when you travel over Istanbul, it is usually much easier and quicker to reach your hotel Izmir than to your hotel in Istanbul because of the more relaxed traffic. The people of Izmir have the best quality of life in Turkey. That is very important for the patients as well, because travelling in the city, visiting the private clinic and private hospital are all very easy and not time consuming.
Transportation from/to the Airport
When you arrive Izmir Adnan Menderes Airport by plane, you are 15 km distant from the city center. You can travel downtown by taxi, municipality buses, the suburban line (İZBAN) and Havaş buses. Read more … (http://www.visitizmir.org/en/how-come/-907329/-631467)
Where to stay?
There are many nice 4 and 5 star hotels in Izmir with reasonable prices. The best hotels in downtown area which are also close to our office are as follows:
- Hilton Izmir
- Mövenpick Hotel
Surely there are many other nice hotels which are walking distance or can be reachable after a short drive. On the day of consultation, it is needed to stay in a hotel. On the day of surgery, our patient and one companion usually spend the night in the hospital. Usually the next day our patient is discharged to go to the hotel. If the patient is operated in the early morning, she or he can leave the hospital in the evening as well.