Although
there has lately been, in some social circles, a craze for so called
"open" surgery we, personally, belong to a school of thought
where it is believed that, with a good knowledge of anatomy, but
especially of the role played by the forming and supporting structures
of the nose as well as of the bony, cartilaginous , ligamentary, fatty
and mucus membranes structures and of the relation between one another,
nasal surgery can be performed through the nostrils without any
drawbacks, but especially without incurring any risk.
Numerous are the
esthetical reasons for which rhinoplasty may be considered : be it a
distorted or displaced glabella, an excessive nasal pyramid which stands
out against the rest of the nose, an excessively eminent lump, an
exagerately massive, bifid, ball shaped or prickly nasal point,
excessively large, flat, or on the contrary, too pursed (pinched)
nasal wings, everything can be corrected either separately or as a
group. The nose is an important facial element for a person. To correct
one person's deformity in a certain way is not suitable for another
person's deformity. That is to say that there is not one type of nose
which suits all faces and this is where the surgeon's genious and
artistic talent come in. The nose cannot be considered as a completely
autonomous unit without taking into account its surrounding features. A
certain shape of nose may be agreable or suitable for a person, but it
will not be the case for another one. Discernment and subtleties with
which nasal corrections must be contemplated are as important to a
plastic surgeon as general architectural environment or urbanistic
planning is to the architect when contemplating what shape and form an
edifice of his creation will take. Therefore, the plastic surgeon should
be able to advise his patient against an operation if he finds that this
operation is not the solution to the problem. Should the case arise, he
sould as well be able to suggest a complementary correction to
rhinoplasty such as adding to the rim of a lip, moving the chin forward
or backward, correcting asymetrical jaws and so on.
THE CONSULTATION
must allow the client to explain the problem for which he sought a
consultation and allow the surgeon to explain to him the way he
contemplates doing the correction.
THE OPERATION
will be done under local or general anaesthesia. It is not recommended
that a nervous or impationt person be operated under local anaesthesia,
and in such a case general anaesthesia is given, thus avoiding useless
stress and discomfort.
THE POSTOPERATION PROCEDURES are relatively simple. We, personally,
neither insert vaseline coated packs in the nose for the first few days
following surgery nor do we use a plaster cast in order to stabilize the
tissues in the desired position, but rather apply a small Thermobile
plastic splint for a week ; this allows the patient to socialize more on
account of the splint's small size (the splint covers partially the
nose) and because of its discreteness (the colour being the same as that
of the facial skin).
Rhinoplasty 4
POSTOPERATIVE VISITS
generally take place a week, a month, three months and six months after
the operation. Afterwards the patient is seen once a year for a few
years when possible.
POSTOPERATIVE SEQUELS
are simple. Following the oedema of the first week comes a period
of swelling which will slowly be resorbed in usually six months,
although it may take longer. Even if imperfect results are not frequent
in very experienced hands it is well known that some corrections could
have to be done once swelling is over. These imperfections could be the
result of a multitude of factors among which the fact that the
sculpture of the nose is performed on living tissues which react
differently from one patient to another.
A good and honest practice is not to ignore these imperfections or try
to avoid facing them. Our policy is to make our best to
correct subsequent deformities once the swelling has disappeared that is
to say about one year after the procedure without charging
surgeons fees. We believe in this very appropriate
"adage": a good surgeon is not the one who never has
imperfect results - this does not exist - but the one who has the will
and
the skill to correct them.
RELATED PROBLEMS
: it sometimes happens that the surgeon has to correct a respiratory
problem at the same time that rhinoplasty is done. The problem may be
due to one of the three following conditions :
- a septal deviation (deviation of the nasal partition),
- hyperthophy of the turbinated bones, especially the lower ones,
- one's own pinched or pursed nostrils (the valve abnormality).
All above mentioned abnormalities are corrected while rhinoplasty is
performed
