Nose Aesthetic

 

Nose Aesthetic (Rhinoplasty) Operation

Nose aesthetic (rhinoplasty) operation is a surgical procedure to fix a nasal deformity, so that the nasal structure and image of the patient will be in harmony with the general structure of the face. Every patient’s face and nose structure is private and personal to every patient himself/herself so there’s no such thing that one image will apply to everyone. Rhinoplasty operation does not fix breathing/respiratory problems. If the patient is suffering from such a problem, a septoplasty procedure can be performed in addition to the rhinoplasty operation.

Of all the patients whom I decide to do rhinoplasty operation, general request is that after the operation, no one could understand that they did a rhinoplasty operation. General public opinion is that the nose is the most important part of a facial beauty. An ideal nasal structure with optimal shape also makes the face look beautiful as well. Various nose aesthetic procedures we do to achieve this, have improved greatly in the recent years and allow us to provide our patients what they need with comfortable and dependable methods. With rhinoplasty operation techniques and appropriate surgery that we choose in accordance with our patients’ requests, we can achieve very satisfactory results.

There are 3 ground rules to pay attention to while doing this. First, common demand among the patients is that after the operation, the nasal structure must look natural and beautiful. Second, as time passes and healing improves, no deformity must occur. And lastly, the most natural function of our nose, breathing, must not be disrupted. Mostly, deviation procedure is also added to the rhinoplasty operation. If these 3 rules are followed, then the outcome would satisfy the patient after the operation. Main topic of the recent medical congresses held in Istanbul is basically these 3 ground rules. In these congresses, discussions and questions among the experts who participate from Istanbul and abroad focus on these rules. Both the patients’ and the experts’ concerns are mainly about these 3 topics.

What does it mean for the nose to look natural after the operation?

Basically, this means that starting from the nostrils, that the nose fits the facial structure and does not show itself very much. Which means fixing the nasal deformity within limits, not lifting the tip of the nose too much that’s not lifted in the first place, not minimizing the nostrils past the intraocular line, in other words, keeping normal and natural. As a result; the patient will have a natural looking nose that’s not identifiable whether it’s undergone surgical procedure or not when he/she is observed from the outside after the rhinoplasty operation.

There are two important criteria to be careful about to prevent any deformity after the healing process:

First, is the breaking of the two nasal bones at the either side with a procedure called osteotomy. Second, as the shape of the tip of the nose is formed, the stitches must be done very carefully and symmetrically. Osteotomy procedure causes too much swelling and purple spots around the nose, eyes and relevant tissue. I do osteotomy procedure always with the “tunnel” technique and observe lot lesser swelling and purple spots after the operation. In other words, being very careful and delicate when working on this anatomic part makes us sure not to face any deformity or unfavorable situation in the future.

Breathing is the most important of those. As an ENT specialist, my main concern at all times is that the patient does not experience any breathing&respiratory problems after the operation and nasal obstruction must be solved if the patient is suffering from it. That is why surgeons usually avoid nasal cavity during rhinoplasty operation to prevent nasal collapse. If there is a septum deviation or anything else that prevents breathing, there will be breathing problems, even the shape of the nose looks beautiful. Surgical technique to make this happen is obvious. It can be done with careful surgical interventions that will be applied to the septum cartilage. Minimizing the concha with necessary procedures in addition to that will provide the desired results.

Expectations before the operation and meeting

What my patients expect: Rhinoplasty operation is a surgical procedure during which the nose is shaped as needed. I almost note my patients’ expectations when I decide to do rhinoplasty operation. Most common request from the patients is that no one could understand that they did a rhinoplasty operation. Second, if they’re suffering from a breathing problem, is that this problem gets fixed. The general facial shape of Istanbul population is the general facial shape of Turkey. The fact that we don’t have a genetic structure with oversized, large nasal bone is our geographical luck. When we divide the face to 3 equal parts, our nose which is in the middle part gives our face the entire expression. Therefore, all the changes we do to this part are extremely important since they impact the facial expression directly. One of the best comments from my patients is that “No one understood that I did rhinoplasty” and “They only said that there is a change in your expression”

Judging from my years of experience, I must say that I stand against the photoshop application. The tissue has no math in it, and therefore this application can cause over expectations for the patient. Photoshop is a program, after all, and you can easily create the most beautiful nose ever but that’s not the case for the tissue. Also, the cartilage and bone structure of the patient may not allow the changes that can be done with photoshop. This is why I think photoshop is just another method to convince the patient for surgery. Instead of that, the best way is to talk with the patient in detail, and to tell the patient what can be done for his/her nose and what may happen in front of the mirror. Another method is to show the patient the previous patients’ before&after photos with similar nasal structure, which will be the best explanation for the patient.

Night of the operation:

It is enough to stay one night in the hospital after the operation. During the first night, our patient is quite comfortable thanks to the effects of anesthesia. Sleeping in their rooms and applying ice compression on their cheekbones is enough for the first night. Facial masks and other applications which are recommended in other clinics&hospitals just increase the total cost and of not much use and therefore not necessary. During the operation, if the nasal bone is broken with channel technique as I’ve stated in my previous articles, then not much swelling and bruising occurs on the face, eyes and under-eye bags.

Discharge:

The patients can be discharged 1 day after the operation and I advise them to rest at home and continue their oral medication. Generally, my patients can start to act freely and handle daily tasks after the second day. The swelling on the eyes and under-eye bags increase on the second and third days and start to decrease at the end of the third day. We remove the silicon air pads we placed inside the nose usually on the fifth day. After that, I advise my patients to start using a physiologic nasal spray to wash inside their noses. On the 7th day, I remove the plaster and stitches. After that, my patients can return to their work as well as their daily routines.

Will It Be Obvious that I Underwent an Operation?

Image after the operation and expectations: Of all the patients whom I decide to do rhinoplasty operation, general request is that after the operation, no one could understand that they did a rhinoplasty operation. General public opinion is that the nose is the most important part of a facial beauty. An ideal nasal structure with optimal shape also makes the face look beautiful as well. Various nose aesthetic procedures we do to achieve this, have improved greatly in the recent years and allow us to provide our patients what they need with comfortable and dependable methods. With rhinoplasty operation techniques and appropriate surgery, we choose in accordance with our patients’ requests, we can achieve very satisfactory results.

There are 3 ground rules to pay attention to while doing this. First, common demand among the patients is that after the operation, the nasal structure must look natural and beautiful. Second, as time passes and healing improves, no deformity must occur. And lastly, the most natural function of our nose, breathing, must not be disrupted. Mostly, deviation procedure is also added to the rhinoplasty operation. If these 3 rules are followed, then the outcome would satisfy the patient after the operation. Main topic of the recent medical congresses held in Istanbul is basically these 3 ground rules. In these congresses, discussions and questions among the experts who participate from Istanbul and abroad focus on these rules. Both the patients’ and the experts’ concerns are mainly about these 3 topics:

  • What does it mean for the nose to look natural after the operation?Basically, this means that starting from the nostrils, that the nose fits the facial structure and does not show itself very much. Which means fixing the nasal deformity within limits, not lifting the tip of the nose too much that’s not lifted in the first place, not minimizing the nostrils past the intraocular line, in other words, keeping normal and natural. As a result; the patient will have a natural looking nose that’s not identifiable whether it’s undergone surgical procedure or not when he/she is observed from the outside after the rhinoplasty operation.
  • There are two important criteria to be careful about to prevent any deformity after the healing process:First, is the breaking of the two nasal bones at the either side with a procedure called osteotomy. Second, as the shape of the tip of the nose is formed, the stitches must be done very carefully and symmetrically. Osteotomy procedure causes too much swelling and purple spots around the nose, eyes and relevant tissue. I do osteotomy procedure always with the “tunnel” technique and observe lot lesser swelling and purple spots after the operation. In other words, being very careful and delicate when working on this anatomic part makes us sure not to face any deformity or unfavorable situation in the future.
  • Breathing is the most important of those. As an ENT specialist, my main concern at all times is that the patient does not experience any breathing&respiratory problems after the operation and nasal obstruction must be solved if the patient is suffering from it. That is why surgeons usually avoid nasal cavity during rhinoplasty operation to prevent nasal collapse. If there is a septum deviation or anything else that prevents breathing, there will be breathing problems, even the shape of the nose looks beautiful. Surgical technique to make this happen is obvious. It can be done with careful surgical interventions that will be applied to the septum cartilage. Minimizing the concha with necessary procedures in addition to that will provide the desired results.

What other operations can I do along with rhinoplasty?

In recent years, additional nasal procedures are being done at the same time with the rhinoplasty operation. Meaning of nose aesthetic is to change the visual of the nose so that it will look aesthetically better. It can be done by plastic surgeons as well as ENT experts. However, since the respiratory system and nasal airways are also concerned anatomically, nasal cavity might be included in the surgical intervention. In addition to changing the aesthetic visual of the nose, the nasal interior might also be included if the scope of the operation necessitates. Therefore, ENT specialists who have better knowledge about the anatomy of nasal interior, can include nasal deviation procedure and perform septorhinoplasty as well.

Who should do nose aesthetic operation?

In cities like Istanbul, where population is dense, aesthetic operations such as this are quite common. Istanbul being accepted as a medical center over the years, and visual&image gaining even more importance among the population as the information age progressesare two of the most important reasons of this. Range of experts who do these operations also increased. Previously, only relevant experts were doing aesthetic operations but now, as the range of specialization increased even further, experts of every medical discipline do aesthetic procedures which interest their own field. Rhinoplasty is a discipline of its own now. Our nose is not only a part of our image on our face, but also a part of our respiratory system. Therefore, any procedure done on it will also impact various respiratory functions, which increases the importance. If the procedure will only be done to change the visual, then it must not disrupt breathing functions in any way. Or, if there is a deformity such as deviation which must be corrected, then this procedure should also be added to the rhinoplasty operation and carried out as a single operation called septorhinoplasty. As a result, in cities like Istanbul, not only aesthetic surgeons but also ENT experts also started doing rhinoplasty operation. In some centers, these operations are done by surgeons from both fields at the same time.

Deciding to do nose aesthetic is a difficult process.

Many questions come up to the patients’ minds if rhinoplasty operation is added to the nose operation. First and foremost among those is what to do before the operation. I usually tell my patients not to be afraid of pain, swelling and purple spots after the operation. In our surgical technique, swelling and purple spots occurrence on face and under eye bags is minimal. I advise them to come to Istanbul 1 day prior to the operation if they’re coming from abroad, rest well and not to use alcohol or smoke. We also advise them to stop anti-coagulants 3 weeks prior to the operation. If they’re regularly using medication, we advise them to use them until the morning of the day of the operation. Biggest fear of the patients is the discomfort caused by the buffer we place inside the nasal passage after the operation and the swelling and purple spots of the face. Various materials produced in the last years greatly reduced the discomfort caused by the buffers. After the rhinoplasty operation, we place silicone air pads inside the nose to form a shape and create a mold. These can stay inside up to a week and thanks to its structure, aid the breathing as well. This method is also presented as a nose operation without buffers. Actually, a nose operation without buffers cannot be done. But instead, materials that cause minimal discomfort should be used. Silicone air pads are an example to such materials. It’s an easily found material in cities like Istanbul and a common item for all hospitals. Another fear is swelling of and purple spots on the under-eye bags. If an ENT expert is doing the rhinoplasty operation, then he/she can minimize this problem thanks to his/her knowledge about the anatomy of the relevant tissue. If the procedure is done by separating the membrane called periosteum, which covers the surface of the bone, then the swelling will be minimal and will disappear immediately within 1-2 days. If we pay attention to these details, then we can eliminate our patients’ fears regarding the operation.

One of the most frequently asked questions by my patients during nose aesthetic operation meetings: Will my nose bone be broken?

One of the most frequently asked questions by my patients during nose aesthetic operation meetings: Will my nose bone be broken? This procedure sounds as the most frightening part, so I want to explain it in detail to decrease our patients’ fear about it. ENT experts know that whether it’s a rhinoplasty operation or a simple deviation procedure, the nose bone is certainly broken.  In deviation operations, middle segment is formed by bone and cartilage fragments. To fix septum deviation; this segment is removed from the mucosa above them, the deformed lower bone fragment is broken and removed. That is why patients sometimes feel a pain on their upper front-line teeth. As rhinoplasty experts, we do another additional procedure. This additional procedure is done to prevent the formation of a flat line that looks like a plateau in the absence of the removed bone and cartilage fragment. In order to do this, the bone which forms the frame of the nasal structure is broken at both sides, including the intraocular side up to forehead. This is the most important intervention of the rhinoplasty procedure. Because this is how we can give the nose its exact shape. During these operations which I also do in other places other than Istanbul, I show extra care because this fracture procedure causes bleeding and purple spots on the patient’s face and around the eyes. If I’m doing the rhinoplasty operation outside Istanbul, I will be leaving the patient in the care of a colleague, so I don’t want the face of my patient’s eyes and face to swell too much. That is why I do the fracture procedure with canal technique. This procedure separates the bone and the membrane on top of it. So, the membrane is damaged during the procedure. Which means 3-4 hours of ice compression after the operation improves the healing process greatly and swelling occurs minimally in the days after. As a result, bone fracture is a must, basis element of the nose operations. That is why it must be done by a qualified expert with knowledge and experience and in compliance with the anatomy and relevant tissue.

Photography before nose aesthetic operation

There are many questions regarding the shaping applications on photos before rhinoplasty. What are the advantages and disadvantages of doing this? Since this is a popular question among the patients during the pre-operative period so I want to answer that based on my experience. Plainly put, I am most certainly against pre-operative photography and editing those photos to get an image of post-operative results with applications such as photoshop. I want to mention each of the topics which seem as an advantage but in truth, is a disadvantage.

First, the tissue has no math in it. Even if exactly the required procedures are done to achieve the image obtained through photoshop, the results might be the same. It can even be the opposite. This result might be liked by the patient, but he/she might not like it as well. Since applications such as photoshop increase the expectations of the patient, we might face unfavorable situations.

Second, if the patient and the expert agree on an image produced by digital means, this might force the expert to ignore the physiologic characteristics of the nose to achieve the desired image. Especially an image which might not fit the nasal structure of the patient that changes the angles of the nostrils and narrow the nasal passage might cause chronic respiratory and permanent breathing problems. Therefore, even if the desired image is achieved, unwanted results might cause long-term problems for the patient.

Thirdly, these applications do not take theform, or the shape of the nasal tissue and the cartilageinside into consideration and focus solely on the profile image. Which means we can only see the true shape of the nasal cartilage during the actual surgery. But on the outside, we can only see the skin. The shape of the cartilage and the bone we see during the operation directly effect the course of the operation. As a result, the absence of these factors can cause deceiving results.

Actually, programs such as these are easy to use and reach and a bonus during the meeting with the patient. They assist the patient to agree to the operation and get ready psychologically. They also increase the popularity of the doctor, but these applications and programs must be used without exaggeration and not increase the expectations of the patient. I don’t use such programs during my meetings with my patients, but I fully use the pre-operative photos that show the structure of the nose and the face from the start to the finish of the operation. As I’m doing the operation, I closely monitor the photos taken from the front and the profile and pay special attention to the details I discussed with the patient. This helps me more than anything. By doing that, I can achieve results in accordance with the patient’s expectations and a natural looking nose that can’t be understood if it’s undergone aesthetic procedure.

Secondary (Revisional) Rhinoplasty

Greatest fear of my patients who undergo nose aesthetic rhinoplasty, is a secondary rhinoplasty operation. Sometimes, even when all the necessary procedures are applied so that a secondary procedure will not be required, a revision might be necessary. Main reason of this is rather than an insufficient intervention during the operation, different responses from the tissues during the healing process. Sometimes even though the bone and cartilage combination is done perfectly, you cannot prevent the deformity that forms during the healing period. Some experts use filling material or cortisone to prevent this, but no statistically meaningful results could be obtained from these methods. I, for myself, advise to wait for the natural healing process to be completed and nothing other than massage to be applied before 6 months period. My purpose of doing this is that during the first operation I do not apply any intervention that might disrupt the respiratory physiology of the patient and leave the tissues extracted from the patient such as cartilage in the operational area and do not waste them. Therefore, no foreign material burden is put on the healing tissues during the first 6 months so that we can wait for the physiological healing process to be completed. And if a secondary operation is required, we will have enough original and natural material, the patient’s own tissues, that we can use.

If our patient underwent operation in another center, by another surgeon, they might not want a secondary operation and approach such a procedure with caution. But we encourage them, and conduct a thorough examination, backed up by tomography, to understand the quantity of cartilage we can use. If the cartilage quantity is not enough, I inform our patients that we can use ear cartilage which is closest in formation and the very resilient rib cartilage instead.

My patients’ second fear is that the healing process will be even worse than before. I inform them that since we will take all the necessary precautions, this time the healing period will be whole lot better. They experience this themselves and state that the second time was truly better than their first rhinoplasty experience.

Fracture of the nose bone during nose aesthetic operation

One of the most frequently asked questions by my patients during nose aesthetic operation meetings: Will my nose bone be broken?

This procedure sounds as the most frightening part, so I want to explain it in detail to decrease our patients’ fear about it.

ENT experts know that whether it’s a rhinoplasty operation or a simple deviation procedure, the nose bone is certainly broken.  In deviation operations, middle segment is formed by bone and cartilage fragments. To fix septum deviation; this segment is removed from the mucosa above them, the deformed lower bone fragment is broken and removed. That is why patients sometimes feel a pain on their upper front-line teeth.

As rhinoplasty experts, we do another additional procedure. This additional procedure is done to prevent the formation of a flat line that looks like a plateau in the absence of the removed bone and cartilage fragment. In order to do this, the bone which forms the frame of the nasal structure is broken at both sides, including the intraocular side up to forehead.

This is the most important intervention of the rhinoplasty procedure. Because this is how we can give the nose its exact shape. During these operations which I also do in other places other than Istanbul, I show extra care because this fracture procedure causes bleeding and purple spots on the patient’s face and around the eyes. If I’m doing the rhinoplasty operation outside Istanbul, I will be leaving the patient in the care of a colleague, so I don’t want the face of my patient’s eyes and face to swell too much.

That is why I do the fracture procedure, which is called osteotomy, with “tunnel” or “canal” technique. This procedure separates the bone and the membrane on top of it. So, the membrane is damaged during the procedure. Which means 3-4 hours of ice compression after the operation improves the healing process greatly and swelling occurs minimally in the days after.

As a result, bone fracture is a must, basis element of the nose operations. That is why it must be done by a qualified expert with knowledge and experience and in compliance with the anatomy and relevant tissue. Total cases done by the expert and his/her experience about this procedure is therefore very important.

 

 

 

Dr. Tamer Haliloğlu Kimdir?

Rinoplasti Doktoru Yrd. Doç. Dr. Tamer Haliloğlu, Yunanistan’ın İskeçe kentine bağlı Kösehalli köyünde dünyaya geldi. 1970 yılında ailesi ile birlikte Türkiye’ye yerleşti. İlkokul eğitimine İzmit Fevzi Çakmak İlköğretim Okulu’nda başladı, daha sonra Namık Kemal Orta Okulu’nu ve İzmit Lisesi’ni bitirdi.

İstanbul Üniversitesi Tıp Fakültesi’nden 1987 yılında mezun olan Haliloğlu, hemen sonrasında İ. Ü. İstanbul Tıp Fakültesi Kulak Burun Boğaz Hastalıklar Ana Bilim Dalı’nda Profesör Doktor Behbut Cevanşir’in ekibinde ihtisasa başladı ve 1993 senesinde Kulak Burun Boğaz Hastalıklar ve Baş Boyun Cerrahisi Uzmanı oldu.

16 yıl Alman Hastanesi Kulak Burun Boğaz Departmanı’nda, 8 yıl SSK Okmeydanı Eğitim Hastanesi’nde Başasistan olarak çalıştı ve eş zamanlı olarak İ. Ü. İstanbul Tıp Fakültesi KBB Ana Bilim Dalında üst ihtisas yaptı.

Randevu Alın