Septorhinoplasty is a operation that is increasingly in demand, in which both functional and aesthetic improvement of the nose is desired. We will provide you with information related to this operation below.
Some previous concepts
Septoplasty is considered to be a nose surgery aimed at improving the nasal respiratory function. The operation is basically performed on the nasal septum.
Rhinoplasty is considered to be a nose operation aimed at improving the aesthetic appearance of the nose. It does not necessarily imply an improvement in breathing.
Septorhinoplasty (or also rhinoseptoplasty) is considered to be that nose operation whose objective is to improve both aesthetics and function, in other words, to improve both breathing and the appearance of the nose. It aims to harmonize the shape of the nose with the rest of the face. Except for very specific cases, the vast majority of nasal problems require both a functional and an aesthetic approach. So much so that in most cases it is not possible to obtain a good aesthetic result if the functional part is not improved and vice versa. This is why it is important that the surgeon who performs the septorhinoplasty handles both the aesthetic and functional aspects well. For this reason, otolaryngologists with training in nasal aesthetics are usually great professionals in the management of septorhinoplasties.
Brief history of septorhinoplasty
Septorhinoplasty is most probably one of the most difficult cosmetic procedures in cosmetic surgery. It involves working with an appendix that is located in the centre of our face, marking the symmetry between one half of the face and the other and in which any small imperfection is clearly perceptible.
Nose surgery was practiced in Egypt as early as 3000 BC. In the Ebers papyrus, 1500 years before our era, mentions of nasal surgery already appear.
It was in India that the development of what is now known as septorhinoplasty may have begun. There, theft and female adultery were punished with the amputation of the nose and so it was not surprising that Hindu surgeons became skilled when it came to performing nasal repair surgery. Today, some of these ancient techniques, such as the Indian flap, have been preserved, albeit with modifications or improvements.
The first septorhinoplasty
Throughout these thousands of years, there have been several schools like the Italian one (with the Branca family or Gaspar Tagliocozzi) or the German one (with Dr. Carl Ferdinand Von Graefe, who first coined the term rhinoplasty around 1800). But we can really say that the father of septorhinoplasty, as we know today, was Jacques Joseph. This German plastic surgeon implemented one of the most widely used techniques today in 1898: trestle reduction. Later on, he developed other techniques such as osteotomies, which are also used today.
During the last 120 years the technique has not changed much from the one established by Jacques Joseph, but the methods and targets pursued have. Thus during the 50’s and 60’s the tendency was to over-correct nasal defects, leading to exaggerated ridge resections and over-rotated tips. This resulted in an unnatural and stigmatized appearance of having been operated on, while at the same time causing significant respiratory dysfunction. In the 80’s, the concept of structural rhinoplasty emerged, particularly from otolaryngologists, who encountered cases that were difficult to solve. They dealt with cases in which the support structures of the nose had not been respected in previous operations. This tendency has led to the achievement of better results: a more natural appearance with fewer functional problems.
Description of some terms
Since 5000 years ago until today, many aspects of the technique in nasal surgery have been perfected and terms such as secondary septorhinoplasty, ultrasonic or rhinomodeling have been coined.
Primary septorhinoplasty: is the one that is performed on a nose that has not undergone any type of previous operation (surgical or non-surgical). An example of non-surgical operation would be the infiltration of filling substances, which may have modified the patient’s natural structures.
Secondary septorhinoplasty: is the one that is performed on a nose that has previously undergone some kind of modification
Ultrasonic Septorhinoplasty: This is a modern procedure in which the work on the bony part of the nose is done without damaging the soft tissues. This means less swelling and bruising. In contrast, it is a somewhat more expensive procedure. There is no difference in the final results compared to classic septorhinoplasty.
Rhinomodelling: this procedure makes it possible to modify small nasal defects without the need for any surgical operation. It is performed through a simple procedure in the hospital that lasts a few minutes, injecting filling substances (mainly hyaluronic acid). Good results are obtained, but the disadvantage is that the treatment is temporary and lasts for around 9 months. It requires repeated injections to maintain the effect.
What do I do first, septoplasty or rhinoplasty?
As it can be deduced from the previous paragraphs, it is not easy to obtain a good aesthetic result if the functional problems are not also corrected, but at what point should each operation be performed? It is ideal to do all of them at the same time, in the same act. Many times to make aesthetic adjustments we need cartilage or bone grafts. The most used and best for their compatibility are our own cartilages or bones, which can not generate any rejection. Among the most used grafts are the septal cartilage itself, the ear cartilage or the costal cartilage. And the most used of all is the septal cartilage. In a septorhinoplasty, both the nasal functional problem can be corrected and the septal cartilage that has been removed can be applied somewhere else at the same time. Therefore, if you have thought about having surgery on your nose and you have both aesthetic and functional problems, the best thing would be to do it in one single operation.
How long does it last, do I need to be admitted, what anesthesia is used?
Septorhinoplasty, is an operation that lasts for about 2 hours, depending on the difficulty. All noses are not the same. This operation is performed using general anesthesia. In cases of rhinomodelling or small touch up operations, they could be done with local anaesthetic, even in the consultation room.
Once the operation is done, it is customary to stay in the hospital for a day for better pain control, although most patients can go home the same day with medication. Once the operation is over, the patient is given a nasal packing and an external splint that holds the work done. The plugs are usually removed after 48 hours, while the splint is removed between 7 and 10 days after the surgery, from which date the patient can go about his or her life with complete normality.
After the removal of the splint, the work done and the change experienced can be appreciated. There is still swelling in the tissues that will gradually disappear over the weeks. After a month, the nose will have an almost definitive appearance, since the swelling will have almost completely gone down. It must be taken into account that the nose can continue to suffer changes, generally small, for months, even a year, due to the action of the healing process.
Who do I go to to correct my problem?
- Look for a trusted and experienced otolaryngologist in nasal surgery. As we explained at the beginning, septorhinoplasty is one of the most complex aesthetic surgeries there is.
- You should consider both your aesthetic and respiratory needs.
- The good result of the surgery starts during the examination. Making an adequate diagnosis of the problems to be solved will be a guarantee of success once the process is finished.
- It is important that the whole process of the surgery is explained to you well, as not all surgeries are the same. There are simple ones, but there are also very complex ones. Being informed about all the aspects of your surgery will make you have realistic goals of what can and cannot be achieved. This can prevent future disappointments regarding the results obtained.
- Once you have chosen the doctor you want to use for your surgery, trust him or her. Everyone wants the best for their patients and will do everything in their power to ensure that this is the case.
If you want more information…
Information about Rhinoplasty (Medline)
Rhinoplasties must contemplate functionality and aesthetics (SEORL)