RHINOPLASTY: UNDERSTANDING BY AN ENT SURGEON FOR BETTER OUTCOME OF THE PROCEDURE

Rhinoplasty is one the most common nose surgeries done in routine practice. Often, rhinoplasty is considered a public performance. The stage is life after surgery. Some say it is a great theatre—quite often a poem. The face is the most fascinating thing and it has to be handled with great care. The question of whether aesthetic surgery can make people happy or not is controversial and disputed. Each individual has their own definition of happiness. Most candidates for rhinoplasty come to us because they hope to be happier by becoming more attractive. The hope of becoming both happier and more attractive is in fact justified because patients tend to be more self-confident and content following a successful operation. In this sense, a positive result of a rhinoplasty can make people happy.

In our practice, we found that in more than 70% of cases, the presence of septal deviation/nose block coexisted with a deformity of the external nose. We performed a concomitant septoplasty in 80% of our primary and secondary rhinoplasties.?

The human nose has various functions. It is a respiratory and sensory organ and has a special aesthetic importance as a central feature of the face. The functional and aesthetic aspects of the nose are inseparably linked in a morphological sense. It is our experience that functional and aesthetic problems of the nose almost always coincide.

But the concept of functionality does not apply just to the improvement of nasal breathing. It includes the following aspects as well:?

●?????? Peripheral olfactory disturbances

●?????? Recurrent and chronic sinusitis

●?????? Lung infections, asthma

●?????? Middle ear ventilation problems

●?????? Rhino genic headache

●?????? Poor vocal quality

●?????? Nasal ventilation problems due to snoring?

It is my firm belief that the ideal outcome in rhinoplasty can only be achieved with a twofold goal: preserving the physiological functions of the nose and maintaining the appearance of a natural, individual, non-operated nose. To achieve both goals, septal deviation correction, FESS (functional endoscopic sinus surgery), turbinoplasty (conchoplasty), and adenoidectomy are required in the repertoire of a well-trained Rhinoplasty surgeon.?

CASE SELECTION IS THE KEY?

The success of the surgical procedure will begin with case selection. If the patient is clear about his/her nose problems and the clear-cut requirements of the surgical procedure, we can decide whether the patient is a good candidate for rhinoplasty or not. If the expectations of the patient are realistic (for example, crooked nose/saddle nose or nose block correction), they will be happy with the post-operative results. If the patient is having minor, imaginary defects or is motivated by others or copying a celebrity, then he/she is not a good candidate for rhinoplasty. An experienced nose surgeon will assess the psychological status of the patient and whether patient requirements are realistic or unrealistic.?

LEARNING CURVE OF A SURGEON?

Before putting a knife on the nose, a learning surgeon needs positive confidence and guidance from the senior surgeons. Rhinoplasty is a complex 3-dimensional surgery. To master the skills of the rhinoplasty procedure, the gold standard will be a well-structured training program under an experienced rhinoplasty surgeon. To begin with, a learning surgeon must understand the concepts of septoplasty, FESS and other procedures related to the lateral wall of the nose. After post-graduation (any degree MS ENT, MCH PLASTIC SURGERY, MDS OMF SURGERY), surgeons must attend cadaver dissections, participate in hands-on surgical training programs and read monograph books on rhinoplasty.?

OFFICE OF A RHINOPLASTY SURGEON

Nose is jewellery on the face. The office of a rhinoplasty surgeon must look like a beautiful jewellery shop. Ambience and interiors should be attractive to the patient. The surgeon and staff in the hospital must be tidy and good-looking.?

For pre-operative consultation, printed questionnaires and checklists will help to get information from the patient. Standardised rhinoplasty photographs are essential for pre- and post-operative documentation. If the patient is a good case for rhinoplasty, we will share the copies of the FAQ & As (frequently asked questions and answers) and precautions to be followed by the patient/patient attenders.

TAKE HOME MESSAGE?

Rhinoplasty is not an emergency or a lifesaving procedure. It is an elective procedure. Before selecting the surgeon, the patient is advised to understand concepts about the functions of the nose along with the external appearance. Pre-operative preparation is the key to avoiding dissatisfaction/complications and revision rhinoplasty surgeries. Surgeons always assess the psychological status of the patient, the patient’s realistic expectations from the procedure, standardised photographic documentation, a CT scan of the Nose Para nasal sinus and a thorough preoperative anaesthetic check-up.??

Dr. CHIDANAND DEVASAMUDRA

MS ENT, FELLOW IN RHINOPLASTY (SEOUL)

MANAGING DIRECTOR, AKSHAYA RHINODENT HOSPITAL,

SAHAKARANAGAR, BANGALORE