Rhinoplasty

rhinoplasty- nose job

1. RHINOPLASTY Mrs. REVATHY.A

2. INTRODUCTION Rhinoplasty is a frequent operation that only few surgeons are considered to truly master the wide scope of technical nuances. John Orlando Roe entered history as the father of aesthetic rhinoplasty after having reported a “simple operation” in 1887.

3. DEFINITION Rhinoplasty   commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the  nose.   There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. 

4. Indications Indications for open rhinoplasty include the following: Nasal tip modification Internal nasal valve dysfunction Thick nasal skin Repair of  septal perforations

5. Posttraumatic nasal deformity with a deviated septum or dorsum Cleft lip and palate nasal deformity Nasal tumor excision Secondary rhinoplasty

6. CONTRAINDICATIONS Intranasal substance abuse ( eg , cocaine) Psychological or psychiatric instability Comorbid medical conditions that preclude surgical clearance Preoperative diagnosis of nasal dysfunction (with or without aesthetic deformity) that may be better treated with a closed approach ( ie , septoplasty for airway obstruction) or medical management

7. Patient refusal of external scar Very thick nasal skin in which postoperative edema can be permanent

8. PREPARATION Avoid aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and other non-steroidal anti-inflammatory medications . Refrain from smoking two weeks before and two weeks after surgery. Avoid sun damage two weeks before surgery . NPO Consent Post operative teaching- nasal dressing

9. PROCEDURE Rhinoplasty surgery  includes the following steps : Step 1 – Anesthesia intravenous sedation or general anesthesia. 

10. Step 2 – The incision Rhinoplasty is performed either using a closed procedure , where incisions are hidden inside the nose, or an open procedure , where an incision is made across the columella , the narrow strip of tissue that separates the nostrils. Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose .

11. Step 3 – Reshaping the nose structure An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts. Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.

12. Step 4 – Correcting a deviated septum If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing . Step 5 – Closing the incision Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.

13. POST OPERATIVE MANAGEMENT Provide head elevation (30degree) Administer analgesics, steroids and antibiotics Avoid strenuous activities such as aerobics and jogging. Take baths instead of showers. Not blow the nose . Eat high-fiber foods, such as fruits and vegetables. Avoid extreme facial expressions, such as smiling or laughing. Brush teeth gently to limit movement of upper lip. Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over the head .

14. RISKS Anesthesia risks Infection Poor wound healing or scarring Change in skin sensation (numbness or pain) Nasal septal perforation (a hole in the nasal septum) is rare. Difficulty breathing Unsatisfactory nasal appearance Skin discoloration and swelling Possibility of revisional surgery