Strongly lifted columella after rhinoplasty. Specific complications in the area of the tip of the nose. Complications that are likely to be encountered

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General information

Before deciding on the cost of the operation, you first need to understand: What is rhinoplasty and why does it sometimes cost more than plastic surgery on other parts of the face and body?
Rhinoplasty is a surgical intervention plastic surgery to correct the shape or size of the nose. Such interventions were known to people several centuries before our era and were performed by doctors in ancient India. During the Middle Ages, the method developed and even a number of treatises were created on giving the nose the necessary shape. However, rhinoplasty became most widespread in the twentieth century.

Kinds

Although medicine is advancing, the essence of this operation has not changed much since the days of ancient India. The patient is given anesthesia, the skin is removed from the nose, the frame is changed, the skin is put back on and sutured in the necessary places.

All ways to correct the shape and size of the nose are divided into two types:

open,
Closed.

public method
This method is used if it is necessary to work with cartilage or bones. The operation is performed only under general anesthesia. The duration of the operation is up to 2 hours.
During this operation, a skin incision is made along the bridge of the nose at the level of the nostrils. With this method of incision, the skin is removed over a large area and the doctor performs all manipulations under visual control.
Sometimes the skin is incised at the columella ( nostril separator). In some cases, this method can achieve good results. As for the scar, it is so thin that it is difficult to notice. Recovery after this type of surgery takes longer, and the swelling goes down more slowly.

private method
In this method, tissues are cut inside the nasal cavity. Therefore, all manipulations are carried out by touch.

Both methods have the right to life and it is impossible to single out any of them as more effective or safer. But after closed operations, the tissues heal faster, their swelling is less.

The complexity of an operation of any kind is determined by which tissues are involved in the procedure: someone needs to change the shape of the back of the nose - this is work with bone, and someone just needs to change the shape of the tip or nostrils - this is work with cartilage tissue.
In any case, nose correction surgery is a rather complicated intervention.

Indications, contraindications and at what age is it better to do it?

Most operations are performed at the request of patients. But in some cases there are medical indications: for example, if structural defects or injuries interfere with normal nasal breathing. In addition, there are congenital deformities that interfere with normal socialization, for example, a wolf's mouth or a cleft lip.

Contraindications for rhinoplasty

Inflammatory processes of the skin of the face and nose,
Inflammatory diseases of the sinuses,
Infections dangerous to other people ( hepatitis C, HIV),
Severe liver disease
Severe heart disease
Mental disorders.

The most optimal age for rhinoplasty is from 18 to 40 years. Sometimes operations are performed on young patients, if, according to the doctor, his appearance is already sufficiently formed, and no changes should be expected.
As for the upper threshold, after 40 years the skin becomes more flabby, the metabolism in the tissues slows down, the patient's rehabilitation is delayed and is more difficult. And the result may not be what you expected. Therefore, in most cases, a competent doctor will advise against having an operation to change the shape of the nose for a patient over 40 years old, although cases are different.

Examination before surgery

Before the first visit to the doctor, you should carefully formulate in your mind or in writing: what exactly you don’t like about the shape of the nose and what you would like to get as a result of the operation. The doctor usually helps the patient formulate his grievances. However, this help must be very correct, so that the patient does not under any circumstances establish the idea of his own ugliness or imperfection. At the first appointment, a study of the general state of health of the client is carried out. Some tests are scheduled. Often, rhinomanometry or tomography is used as an additional examination.
At the first examination, the doctor explains to the patient what the risks of the operation may be, complications and what the final result is likely to be.
If there are no contraindications to the operation, the preoperative period begins: the time between the examination and the operation. At this time, the client passes all the necessary tests, draws up an agreement with the clinic, and the terms of the operation are set.

Preparing for the operation

The day before the operation, you should take a shower and rinse the nasal cavity with warm water. Hair in the nasal cavity is trimmed. On the day when the operation is scheduled, you should refuse water and food.

Rhinoplasty of the nostrils

In some people, the nostrils are formed too wide or with very long wings. In such cases, surgery can change the shape of the nose. Such operations are performed both under local and general anesthesia. The duration of the procedure may exceed 2 hours.

To reduce the volume or length of the wings of the nose, excess tissue is removed from the outside with a very long wing. If it is necessary to reduce the width of the wings, the tissue in the nasal passage area is removed. Sometimes the fabric is removed from both areas at once.
After removing excess tissue, the doctor tightens the wounds with a special suture material of increased fineness. The suture material is removed five days after the operation. But in order to completely pass the traces of the seams, you need at least 6 weeks. During this period, you should protect the body from stress, and the nose from ultraviolet radiation.

Sometimes it is necessary to add cartilage tissue to the wings of the nose. This happens after injury or unsuccessful plastic surgery. To do this, pieces of cartilage are taken from the patient's ears or nasal septum.

Alignment of the septum (septorhinoplasty)

Due to the occurrence of all curvature of the septum are divided into the following groups:

physiological,
traumatic,
Compensatory.

Physiological curvature occurs because the nasal septum includes different tissues, which sometimes develop at different rates. And then the shape of the septum can be broken, growths can form on it, or it moves to the side. This disorder usually occurs during adolescence.

traumatic violation develops against the background of bruises and fractures. Even a newborn baby can have such a form of curvature obtained during childbirth. In the future, the development of the partition will go the wrong way.

compensatory a curvature of the septum develops if the shape of the turbinates is broken and in order for the nose to perform its function, the septum begins to bulge.
In some cases, the curvature interferes with normal breathing, and sometimes it does not interfere. It can be detected only when examining the patient with special devices.

Cases in which it is necessary to check the condition of the partition:

Snoring in sleep
Difficulty breathing through the nose
Dryness of the nasal mucosa,
allergic manifestations,
Inflammatory processes of the paranasal sinuses in a chronic form,
Obvious deformity of the nose.

Removal of the nasal mucosa (conchotomy)

Indications for surgery:

Violation of nasal breathing with hypertrophy of the nasal mucosa.

Often this procedure is carried out simultaneously with the operation to change the shape or size of the nose.
The procedure is performed only under general anesthesia and is carried out by various methods: cutting nasal loop, electrocoagulation and laser destruction.

Removal of the nasal mucosa with a cutting nasal loop is a rather traumatic procedure, during which profuse bleeding is likely. In this regard, the patient recovers after it for quite a long time. It is mandatory to prescribe antibiotics to prevent infection of the wound surface. After the operation, adhesions and scars are often formed. Such a procedure today is done only by special prescription of a doctor.

Laser conchotomy - this procedure is humane in relation to the patient's body. Anesthesia is local. The patient does not need to stay in the hospital after it. Since there is no open wound surface after the laser procedure, the recovery of the mucosa is quite fast, and severe inflammation is also rare.

Electrocoagulation - This is an effect on the nasal mucosa with an electric current. This method is used in cases where hypertrophy of mucosal tissues is not strong. The course of the operation is similar to laser coagulation. The operation is performed under general anesthesia, but its duration is not great. Recovery takes place in a short time.

columella correction

The columella is the lower part of the bridge between the nostrils. The appearance of the nose is often spoiled precisely because of the irregular shape of the columella. In order for the nose to be beautifully shaped, the wings of the nose must be higher than the columella. If it is too short, crooked or too long, the shape of the nose can be greatly improved by changing the columella.
In order to increase the columella, a section of cartilage tissue is engrafted. And in order to reduce the lower parts of the wings of the nose are excised. Sometimes a columella correction is done in conjunction with a nose tip correction.
The intervention is performed under general anesthesia, its duration is from 30 to 40 minutes. After the operation, the patient will have to stay in the hospital for 5 days. For 4-8 weeks, swelling of the tissues can be observed, which is not so noticeable two weeks after the operation.
After the intervention, the patient should refrain from physical overexertion, hot food and drink, and hot baths. Sleeping on your side is also not recommended.

Correction of the shape of the nose

During the operation to change too wide nostrils, the skin is cut in the lower part of the nostrils, its excess is removed. The dissected tissues are pulled together with sutures, which are held for 5 to 7 days. Such an intervention always leaves behind almost imperceptible scars.
In the event that the nose is flattened, in addition to reducing the width of the nostrils, augmentation rhinoplasty is also performed - raising the bridge of the nose. A similar operation is performed to enlarge a too small and short nose. It's called "grafting". As a frame for the nose, cartilage and bones taken from other parts of the patient's body are used. Most often, bones are taken from the rib, skull or elbow, and cartilage from the ear.
In rare cases, synthetic materials are used, but they can take root worse. Such operations are considered to be almost the most difficult of all plastic ones, so you should trust your face only to surgeons of a high category.

Rhinoplasty

During the operation, the shape of the tip of the nose is improved. The operation is often performed in a closed way, the intervention affects both the cartilage and soft tissues of the nose, and often the columella. Cartilage is excised or excess is removed from one place and engrafted to another place. Most often, during the operation, the place above the tip of the nose is made thinner, while the tip of the nose is made more protruding. Sometimes, on the contrary, it is necessary to reduce the length of the tip of the nose, but such requests are less common. Often, at the same time, the shape of the nostrils, columella, and also the contour of the nose are changed.
In the event that only the tip of the nose changes during the operation, it is not difficult and the recovery after it is quite fast.

Non-surgical rhinoplasty

Non-surgical technology is good for those who want to change the shape of the nose, but are terribly afraid of surgery. This method is also suitable for those who, for health reasons, the operation is not recommended.
The non-surgical technique is most indicated for those who, in general, have an acceptable shape and length of the nose, but there are minor flaws: for example, asymmetry or a too sharp tip of the nose, depressions on the wings of the nose.

This is a very convenient method to correct some inaccuracies after surgery. But in some cases, after the operation, it is forbidden to use the injection method.

Non-surgical technology allows:

Fill in the holes
Slightly change the shape of the tip of the nose,
Eliminate the hump on the bridge of the nose and smooth out sharp corners,
Make the nose symmetrical.

Technology advantages:

The duration of this procedure is not more than half an hour,
No pain
No bruising or swelling
The result will be visible in 2-3 days.

Technology cons:

The effect lasts from 6 months to 3 years depending on the drug used,
There is a possibility of "migration" of the gel. This happens if the procedure was performed by a not too professional doctor.

Injection rhinoplasty (using fillers)

This technique is used when the general shape of the nose is quite acceptable, but there are small drawbacks: for example, asymmetry, too sharp angles or too sharp tip of the nose. In such cases, filler injections are used. After such an operation, the patient recovers quickly, and the price of procedures is much lower.

As fillers use:

temporary substances,
intermediate substances.

Hyaluronic acid is primarily a temporary substance. It is infused intradermally. Before the injection, the skin is treated with an anesthetic. Such an injection will help to change the shape of the nose for quite a long time.

The intermediate substances include the fat of the patient himself. It is taken from the knees, abdomen or thighs. The removal is carried out under general anesthesia. Before introducing fat into the nose, it is filtered and passed through a centrifuge. This procedure has disadvantages - since fat can be absorbed into the tissues, in five cases out of ten it is necessary to do repeated procedures.

Contour plastic

Contour plastic is a jewelry procedure during which the contour of the nose is slightly changed. "Pockets" are made under the skin of the nose into which implants or grafts are inserted.
Today, this technique is not used very often, since it is much easier to use the biogel injections described above.

Laser rhinoplasty

In laser rhinoplasty, the laser is used as a scalpel. This technology allows you to reduce blood loss, accelerate healing after surgery. In addition, the laser is easier to work with cartilage. Heated by the laser, the cartilage becomes less rigid and more pliable.

The laser dissects tissue, seals blood vessels and eliminates pathogens. Under the influence of the laser, the recovery processes in the tissues are accelerated. With the help of a special laser device, you can correct the nasal septum.

There are techniques that make it possible to simultaneously eliminate aesthetic defects and improve the function of the nose.
The course of operations using a laser is usually the same as in classical surgery. The operation can also be closed or open. Incisions are usually made along the bridge of the nose and at the bottom of the nostrils.

Very often, during the operation, a laser is combined with a conventional surgical scalpel. Such interventions are most preferable, since not in all cases the laser can do the delicate work that is subject to the old proven methods. But, if the skin is dissected by a laser, it heals without scars and scars. The incision is very thin, the blood does not flow, and the cells are already ready for recovery.

Thus, laser technologies are successfully used in plastic surgery, including nose correction operations in combination with conventional surgical methods.

Reconstructive rhinoplasty

Reconstructive rhinoplasty is the correction of the shape of the nose after an injury or congenital malformation. Such operations require more skill from the doctor than primary ones. After all, it is impossible to predict in advance what condition the nose frame is in.

Often, during reconstructive operations, cartilage from the ribs, ears, or nasal septum is used to restore the framework. Tissue sections are removed from the patient's body, while tissue sampling does not harm the general condition and appearance.
Reconstructive surgery is necessary to restore normal appearance in case of cleft palate or lip. Sometimes a number of surgeries are needed.
Reconstructive surgeries are also performed after injuries that have led to damage to the bone or cartilage. In severe cases, patients who have completely lost their noses end up on the table of surgeons.

During operations, microsurgical technology is used, which makes it possible to give the patient's face a healthy look.
One of the most common nose deformities that a reconstructive surgeon has to deal with is the saddle or boxer nose. Both a severe bruise along the bridge of the nose and an infectious disease of the nasal cavity can lead to such a lesion. With this type of deformation, the cartilage that forms the septum can be completely destroyed, and the doctor completely restores the cartilaginous septum and the framework of the nose.

The duration of such an operation can be up to six hours. The patient receives general anesthesia. Outside, the skin is dissected only in the region of the columella, the remaining incisions are made inside the nasal cavity. Therefore, postoperative scars are almost invisible. The operation affects all types of nasal tissues: soft, bone and cartilage.
After the operation, to fix the new shape of the nose, tampons are inserted into the nostrils, which are kept for three to six days. The plaster bandage is removed after five to twelve days, depending on the complexity of the operation. But a day after the intervention, the patient is allowed to go home. And in a week he will come to remove the stitches.
Patients are not recommended to wear glasses for 8 weeks, and exercise for 2 weeks. After three weeks, the shape of the nose approaches the final version and further changes are visually almost invisible. However, the traces of the operation completely heal only after six to twelve months.

The patient should be observed by a doctor for a sufficiently long period.

Rehabilitation in the postoperative period

After the operation is over, you must carefully follow the advice of doctors. Otherwise, the healing of the nose will not go at all as planned by the doctor.

The most important tips to help prevent swelling:

In the first few days after the operation, refrain from tilting your head down,
Don't sleep on your stomach
Eat soft food, not hot
For the fastest elimination of bruises and edema, lotions should be made with an aqueous solution of furacilin,
Rinse the nasal cavity with any special solutions ( sold in a pharmacy), injecting into each nostril 2 injections seven times a day, then gently blow out the nose,
Antibiotic to prevent wound infection Zinnat 250 mg twice a day for five days,
To prevent the development of a fungal infection Fluconazole 150 mg take one capsule orally on the 3rd day of treatment Zinnat,
Entrances to the nostrils should be cleaned daily with a cotton swab and hydrogen peroxide 3%,
Two days after the intervention, you are allowed to take a shower,
When swimming, keep the nose area from getting wet,
It is allowed to apply cosmetics 14 days after the intervention.

Forbidden:

7 days after the intervention, exercise, carry children in your arms and lift other heavy objects,
14 days after the intervention visit the pool and sauna,
Wear glasses and sunbathe for 30 days after the intervention.

Recovery is happening at about the following pace:

Edema is reduced by about two-thirds after 4 weeks,
After 12 months, swelling subsides completely,
In some patients, edema subsides asymmetrically,
After 14 days, bruises completely disappear,
7 days after the intervention, nasal breathing may worsen, as caked crusts of blood appear in the nose.

Edema, callus and other complications

According to medical statistics, complications after rhinoplasty are observed on average in 12% of cases. In three cases out of ten, you have to do an additional operation. In order to reduce the likelihood of complications, a thorough examination is carried out before the intervention, and during the operation, the surgical impact is minimized. Complications may appear immediately after the operation, and may be detected after some time.

Complications can be of two types:

functional,
Aesthetic.

However, in most cases, both types of complications are observed.
Aesthetic: drooping of the tip of the nose, too raised tip of the nose, drooping of the bridge of the nose, beak-shaped nose, curvature of the bridge of the nose. Very often there is asymmetry of the nose after operations. If the asymmetry is caused by the fact that the doctor “did not get” a little tissue, then it is not at all difficult to solve such a problem. But if, on the contrary, more than necessary was withdrawn, you will have to do a tissue transplant. Some time after the operation, you may find that the skin on the nose is too thin or its color is different from the color of the skin of the face.

Functional complications: septal perforation, ethmoid avulsion, and cerebrospinal fluid leakage ( older people are more disposed), abscess, toxic shock, hematoma, respiratory impairment, tissue inflammation.
Ideally, after surgery, respiratory function should remain at the same level or even improve. If breathing worsens, the doctor must find the cause and eliminate it.
Too much exposure to the nasal mucosa can provoke the development of atrophic rhinitis.
Too much narrowing of the bony structure of the nose can lead to poor nasal valve function and nasal obstruction.
Too much trimming of the lateral legs sometimes impairs the operation of the nasal valve.

Bone callus after plastic surgery appears infrequently. However, it nullifies the entire result of the operation. A corn appears if the body is very actively taken to restore pieces of tissue removed during the intervention. In this case, the restored tissue is often larger in volume than the removed one. Most often, callus develops when the hump on the bridge of the nose is removed and in those who have completely changed the shape of the nose.

Causes of callus appearance:
1. individual response of the body. This is one of the main reasons. In some people, the body has a high degree of self-healing.
2. Physician experience. This is a big part of the operation's success. A doctor with extensive experience has enough secrets and practices to prevent the growth of calluses. If the operation was performed by a doctor with experience in plastic surgery, swelling and bruising are common complications and nothing more.

Scars after rhinoplasty

The presence of scars after the operation depends primarily on what type of operation will be chosen: open or closed. With the second type of intervention, no scars can appear on the outside, in principle, since all incisions are made inside the nasal cavity. If the operation is not performed by a very qualified doctor, then such scars can interfere with breathing, but they will not be noticeable in any case.
With open surgery, thin scars, upon closer examination, can be detected for several years. Then they disappear completely. But here everything again depends on the skill of the surgeon.

Revision rhinoplasty

A second operation is appointed if after the first one there are any defects or if the first operation was not carried out successfully enough. With complex rhinoplasty, it is often difficult to foresee whether one operation will be enough. Between the first and second, as well as all subsequent operations, at least six months should pass, it is better to wait a year.

According to medical statistics, most unplanned reoperations occur due to insufficient professionalism of doctors. If the second operation is done by a good doctor, then he will be able to completely correct all the mistakes of a colleague. However, in particularly difficult cases, you have to do several operations. In such a case, a specialist with extensive experience and well-conducted tissue grafting is needed.
Sometimes the first operation was done correctly, but the results did not satisfy the patient. In this case, the repeated operation is easier to do, its duration is shorter.

Issue price

The total price for rhinoplasty includes the cost of work, medications, anesthesia, as well as the cost of the patient's stay in the hospital. The price depends primarily on the complexity of the operation, as well as on how much work the doctor will have to do and on what method the operation will be performed.

For example, the cheapest operation is the correction of the nostrils. This operation is simple, and therefore the price for it is low, from 20,000 rubles, but can rise up to 40,000 depending on the amount of work. Also, they will not charge very much for the correction of the bridge of the nose after a fracture - in some clinics, only 30,000 rubles. For the correction of the tip of the nose, they charge from 50,000 to 80,000 rubles. Although this operation is not very voluminous, but the work needs to be done by jewelry, therefore the price is higher.

The most expensive operations are those that cover not only the soft tissues of the nose, but also the bone structures. Such operations can cost 90,000 rubles or more. A full rhinoplasty today costs from 120,000 rubles. Although, you can find clinics where promotions are held, and a complete alteration of the nose will cost 100,000 rubles.

For computer modeling of the nose, they take about 2,000 rubles.
A day in the hospital will cost approximately 3,500 rubles. Moreover, in some clinics, the cost of dressings is not included in the total cost of the service.
For each dressing you will have to pay a couple of hundred rubles.
You should be especially careful if a good clinic offers services cheaper than its colleagues. Most often, a lot of necessary and rather expensive services will be added to the initial price, for example, they can charge a separate fee for anesthesia during surgery.

Free rhinoplasty

Free cheese only happens in a mousetrap! We all have long been accustomed to this statement and consider all free offers only tricks of scammers. But this is not always true. Even in the modern world, such an expensive and elite service as rhinoplasty can be done for free, and even in a good clinic.
Not everyone knows that some clinics hold promotions: free plastic surgery. Moreover, they are not made by students - trainees, but by experienced and eminent surgeons.
Such promotions are announced in advance on the websites of clinics or on thematic websites. All interested send their data. Usually a photo and a few lines about yourself are required. On some sites, contestants receive points for the number of contestants involved in the process. And on other sites, a blog contest is held between the participants. The winner gets a free rhinoplasty.

A certain number of applicants are selected and invited to the clinic for casting. And here the doctor chooses the one most needy candidate.
As incentive prizes, another two or three participants may be offered an operation for half the cost.
Very often, such promotions are held in the summer, as the influx of clients to aesthetic surgery clinics subsides at this time.

Immediately, let's define what a columella is. Columella, or, as it is also called, the column of the nose, is a fold located between the nostrils. It is formed by the skin component and the legs of the large alar cartilages. The aesthetic appearance of the nose, the contours of its nostrils and their symmetry depend on the columella. According to modern canons of beauty, it is generally accepted that it should be slightly below the level of the nostrils.

In addition to the aesthetic function, an anatomical load is also assigned to the columella - it must maintain the tip of the nose in an elevated state and form an adequate lumen of the nostrils, ensuring unhindered entry of air into the nasal cavity.

When is columella plastic surgery performed:

Too upturned tip of the nose due to high columella.
Descent of the tip of the nose.
Too sharp or too obtuse nasolabial angle.
"Dangling columella" is an anatomical feature when the columella is lowered too low compared to the level of the nostrils.

The columella is enlarged by transplantation of the patient's own tissues or biocompatible transplants. With a decrease, on the contrary, its partial excision is required. However, changes in the appearance of the columella do not always imply surgical work with it; most often, complex plastic surgery of the tip of the nose, including its wings, is required. Let's look at the operations in a little more detail.

You can enlarge the nose column in one of the following ways:

Install cartilage grafts.
Suture the medial crura of the alar cartilages.
Introduce fillers or the patient's own adipose tissue into the columella area.

If the patient has a smoothed nasolabial angle, a partial excision of the columella or resection of the edge of the quadrangular cartilage is performed.

With a pointed nasolabial angle, an increase in the nasal septum is performed using biocompatible expanding grafts or suturing is used on paired alar cartilages.

The operation on the columella is performed under anesthesia or with the use of local anesthesia, depending on the volume of intervention, the duration of which is 20-40 minutes. Long-term hospitalization is not required.

Contraindications for columella plastic surgery

Contraindications are standard, as for most plastic surgeries:

Chronic diseases in the stage of decompensation.
Violation of the blood coagulation system.
The presence of skin diseases in the area of intervention.
Acute respiratory diseases.

Postoperative period

Recovery after columella plastic surgery is much easier than with rhinoplasty, because. in the case of this operation, the bone structures of the nose are not affected. Difficulties in nasal breathing are not observed. For the first 1.5-2 months, swelling and pastosity of the operated tissues are possible, but visually this is noticeable only in the first weeks.

There are also no special restrictions in the postoperative period. Recommend reasonable abstinence from excessive physical exertion, exclusion of the action of thermal procedures - baths, saunas, hot baths. You also need to protect the nose from physical injury, in particular,
In order not to accidentally damage the tip of the nose during sleep, it is better to sleep on your back.

The nose is the most pronounced part of the face, thanks to which the face can change beyond recognition. The part of the skin located between the nostrils is called the columella and greatly influences the appearance of the nose. Also, this small part of the nose is very important for the breathing process to be normal, and for this, it performs important functional tasks. At rhinoplasty the columella is often corrected to remove an aesthetic flaw and create a harmonious nose.

Columella - what is it?

Between the human nostrils there is a unique part of the skin, which is called the columella. Anatomically, the columella of the nose consists of the medial crura of the alar cartilages, however, these cannot be seen. There is another name for this anatomical term: column or column of the nose.

The huge role of columella lies in the perception of a person's nose as something normal, not interfering with existence. These qualities are inherent in a beautiful columella:

width - no more than five to seven mm;
in women the angle between nose and lip is about one hundred degrees, in men ninety-five;
there should be no sagging of the column;
the location of the columella cannot be higher than the wings of the nose, when viewed from the front.
symmetry of the nostrils.

The success of rhinoplasty directly depends on these rules. If you do not take them into account, the image of the nose will be very wrong, as a result, the appointment of a second plastic surgery is possible. In other cases, excellent results can be obtained with a simple operation to improve the nose.

In some cases, people may have problems with the columella of the nose, for the solution of which it is necessary to carry out rhinoplasty of the nose in Moscow. Patients of a plastic surgeon, based on how the ideal columella of the nose should look like in size and shape, most often face the following problems:

sagging of the nasal column;
very high location of the columella;
a very small, or vice versa, large, angle between the nose and the lip.

In certain cases, a person considers that his nose is large, with a curved tip, snub-nosed. To correct the appearance, in general, it does not require heavy and traumatic operations aimed at changing the shape of the back or its tip. A change in the nasal column will also suffice. For this purpose, we recommend paying attention to rhinoplasty of the nose, the price of which will pleasantly surprise you.

Columella correction during rhinoplasty

Maintaining a perfect combination of nose and face is the goal of a plastic surgeon when correcting a certain flaw. This should also be done in the most simple way. With an irregular shape of the columella, the result of working with it will not make the face beautiful, but will reveal other features.

Sometimes when correcting the nasal column, the doctor does a lot of work. It depends on the structure of the nose of a person who has expressed a desire to provide plastic surgery services. In such cases, the tip of the nose can be changed by the doctor, raised higher, and with it the columella of the nose.

It happens that the effect can be achieved with columella plastic surgery. In this situation, the surgeon transfers them higher without touching the column. As a result, it becomes, as it were, lower. The doctor and patient must work closely together in preparation for surgery. The patient should be explained what he would like to see at the end of the operation, and the doctor, knowing all the subtleties of such a process, the structure of the nose, should tell you which methods are best used to achieve the desired result.

The amount of work depends on how much anesthesia is needed during the operations of the surgeon. In cases where the doctor needs to remove unnecessary tissues to raise the nasal column to the intended height, it is enough to use local anesthesia. If you need to do more, general anesthesia is indispensable.

Advantages of anesthesia causes the following:

thanks to medication sleep, the patient is not aware of the excitement, he is physically unable to move, and interfere with the surgeon in his work;
general anesthesia makes it possible to almost not use local anesthetics, and, as a result, the doctor works with those tissues that have not been exposed to various drugs.

The importance of anesthesia in a particular case is discussed with the doctor. After assessing how large and how long the work required, coupled with the degree of soreness, he should advise the patient to use the most appropriate option in a particular case.

Many factors affect the recovery time after columella plasty. In particular, these include:

doctor experience;
how severe the intervention was;
how accurately the instructions of the surgeon were followed.

Two weeks after rhinoplasty in Moscow is optimal rehabilitation period after rhinoplasty . But there is an exception. After two days, you can return to normal life if only columella has been corrected by the doctor.

People of all ages and any gender turn to rhinoplasty, wondering: how much does a rhinoplasty of the nose cost? The reason for this is clear - the nose is that part of the face that adorns a person more than other parts of the face. It is enough to order a rhinoplasty of the nose in Moscow, and an excellent result is guaranteed.

This chapter explains the first stage of rhinoplasty surgery. At this stage, the necessary incisions of the nose are made, allowing you to see its base - bones and cartilage.

Look at the images above. An external incision is made along the dotted line in the form of an inverted V, other incisions are made in the nasal cavity on the mucous membrane. The operation, during which the skin is cut, is called open rhinoplasty. If access is made only from the side of the nasal mucosa - closed rhinoplasty.

The part of the nose where the incision is made is called the columella or column. In the figure, the columella is colored blue. The incision is made in its narrowest part (indicated by red arrows). It is called a "trans-collumer" incision. The columella has the greatest width above and below this place.

The incision is made in the narrowest part of the columella so that the scar remaining after the operation is minimal. Although after complete healing of the wound, it becomes almost invisible.

As a rule, the operation does not begin with an external incision, but with one of the internal ones. With the left hand (the operation in the photographs is performed by a right-handed surgeon), the tip of the nose is turned to the left, thereby fixing the position of the nose itself. It also opens access to the site of the future incision. The images above show the described process. The left figure shows its beginning, the right one shows a ready-made incision, which is called the medial-marginal incision. During this part of the operation, a conventional medical scalpel is used.

Next, the lateral part is performed ("lateral" - remote from the middle, i.e. in this case it is the lateral part) of the marginal incision. The incision is called a marginal incision because it is made along the edge of the nasal cartilage (shown in blue in the top image) that gives the nose tip its shape. After the incision is made, the cartilage can be seen in its entirety.

In the upper left image, a small red line indicates the lateral portion of the incision. A small red strip next to the columella is the medial part of the incision (the incision running along the columella). Next, both parts of the cut are connected.

Pay attention to the work of the surgeon's hands. The left hand fixes the nose in the required position, pulls the cartilage to the side, which is necessary for making accurate cuts, and also performs many other functions. In this case, the left hand holds a retractor that opens access to the right nostril. The finger of the hand presses on the nose, opening up a place for the incision and giving direction to the scalpel, which is held, respectively, by the right hand.

We return to the outer cut (indicated by the red line).

The next stage of the operation is to separate the skin of the tip of the nose from the cartilage located under it. Scissors (necessarily with blunt ends) are wound from the inside of the columella (figure above). Then they are gently opened, and the skin is separated from the cartilage. This action must be carried out with the utmost care so as not to damage the tightly connected skin and cartilage.

Pay attention to the image. Do not forget that the part of the nose painted in blue is called the columella, in green - the tip of the nose, and the base is circled with a red triangle.

After we have separated the skin from the cartilage at the tip of the nose, we must do the same on the colummel. To do this, the scissors are inserted into the medial-marginal incision, and gently advanced further until they appear on the other side (see image below).

The main advantage of external rhinoplasty over internal rhinoplasty is that the surgeon gets a better view of the nasal cartilage, which in turn allows the operation to be performed under full visual control.

Also, the use of external rhinoplasty is justified in the case of a repeated operation. As a rule, such a need arises after an unsuccessful previous one.

And so we proceed to the dissection of the columella. It is necessary to start the incision at the top of the inverted V. At the same time, the left hand pulls up the tip of the nose, and the little finger of the right hand shifts the columella down, stretching the skin, which in turn facilitates the incision. From the top, the incision is made to the base sequentially in both directions.

In order to ensure the successful completion of the stage of the operation, it is necessary to slightly push the skin along the edges of the wound. If the columella opens slightly, then the incision was made correctly.

The thickness of the skin of the columella is minimal, so the incision must be made with extreme care so as not to damage the cartilage lying directly under the skin.

Although an external incision results in a scar, in many cases its use is necessary. At the same time, it should be noted that if the operation is performed by a qualified surgeon, then the scar is almost impossible to see. Especially after it has healed (look at the images above, the red line indicates the location of the scar).

Here it is worth touching a little on the topic of unqualified doctors. Although this requires a separate discussion, and not within the scope of this article.

Consider an example. The surgeon who performed the operation (see image) made many incorrect incisions at the base of the nose. In this case, he made the following mistakes: he incorrectly made a trans-columnar incision (indicated in green), which, if done correctly, leaves no traces at all. The next mistake is the wrong incisions made by him to reduce the size and thickness of the skin of the nostrils (indicated in red and blue, respectively).

Therefore, carefully approach the issue of choosing a plastic surgeon. After all, postoperative errors can not always be corrected.

Let's get back to the operation. After dissection of the columella with a scalpel, the skin is cut with scissors to the full thickness. This will expose the tip of the nose and get to the right cartilage.

The skin above the incision site is lifted up with a two-pronged retractor. And the lower part remains in place (in the right figure, the red line indicates the place of the incision).

With the tip of scissors, the soft tissues of the columella are separated from the cartilage. The cartilages located at the tip of the nose are called the inferior lateral cartilages (the right cartilage is colored blue in the figure).

The pink color in the upper figure indicates the surface of the skin adjacent to the cartilages of the tip of the nose.

Thus, access to the lower lateral cartilages was obtained. Further, with the help of scissors, the soft tissues of the tip of the nose are completely separated from them.

We all know that the traditional use of scissors is to place an object between the blades and cut it. Most of the time, the rhinoplasty surgeon uses this instrument in a slightly different way. Most often, he performs sliding movements, rather than cutting. To expose the lower lateral cartilage, the surgeon closes the scissors, places the ends of the scissors on the surface of the cartilage, and then opens the scissors, spreading the tissue with the scissor blades.

Now the cartilage of the tip of the nose is completely open and you can see the cartilage forming the back of the nose (highlighted in pink in the figure, the right lower cartilage is indicated in blue).

In order for the skin separated from the cartilage not to interfere with the further operation, a retractor is used to hold it.

Now the lower and upper cartilages have become available (in the photo, the upper cartilage is indicated in green, and the lower ones are blue and red, respectively).

It should be noted that there is almost no bleeding in the shown pictures. This is explained as follows. The nose, like any other part of the body, has places both with abundant blood supply and areas in which the number of blood vessels is minimal. A qualified surgeon leaves intact places with a large number of blood vessels, which avoids large bleeding and does not interfere with the operation.

Let's clarify some points on anatomy and terminology (see photo above).

The tip of the nose is the part marked in pink in the right photo and circled in red in the left photo.

The bridge of the nose is the part between the tip of the nose and its upper point, located between the eyes. In the image, the bridge of the nose is marked in blue.

Hump - part of the nose, located, as a rule, in the middle of the back of the nose. Often in this place the nose has a bend (in the figure, the hump is indicated by a green arrow).

The upper part of the nose, located closer to the eyes, is formed by the nasal bones, and the lower part is formed by cartilage. In the image, the border of the separation of bones and cartilage is shown as a black wavy line.

The nasal bones are firmly attached to the bones of the skull. The lower part of the nose, formed by cartilage, is much more mobile (therefore, for example, in boxers, the nose is always broken in the lower part).

The border separating the nasal bones and cartilage is located at the very top of the hump of the nose (unless, of course, it is noticeable, otherwise this place can be determined by touch).

The photograph does not show the bony part of the bridge of the nose, despite the fact that the skin is pulled up with a retractor (the cartilage that forms the bridge of the nose is colored green).

The right lower lateral cartilage is shown in two colors in the photograph. The lower part of the cartilage, which forms the columella, is indicated in red, and the upper part, which is located above the nostrils, is indicated in yellow. At the junction of these areas (indicated by the blue arrow), the most protruding part of the tip of the nose is formed.

In the photo above, it's easy to tell the two areas apart. At the junction, the cartilage forms a slight bend, which is indicated by a white line.

Also, the blue arrow points to the place of transition of the collumellar part of the cartilage to the lateral part. It is this area that we perceive as the tip of the nose. This transition is called the dome of the lower lateral cartilage. In the figure, the dome is marked in green.

The upper image shows normally located, previously unoperated cartilages. The right nasal cartilage is colored blue. The skin above it is pulled up with a retractor so that a small part of the cartilage of the back of the nose is visible, colored green.

The photo above shows both cartilages from the same patient. This is a rare case when the cartilages are completely symmetrical. They usually vary slightly in size and shape, making it difficult to perform a rhinoplasty operation.

When the cartilages of the tip of the nose are strong enough and the skin covering them is thin, a small visible groove forms between the cartilages (shown in blue in the photo).

It can be easily detected by pressing a fingernail against the tip of the nose (dome).

If the groove between the cartilages is clearly visible, then the tip of the nose is called split.

The picture above shows a typical view of the tip of the nose after it has been opened. The lower right cartilage is bent down with a special metal hook, which allows a good view of the cartilage separation area (the left cartilage is highlighted in blue, the cartilage of the back of the nose is highlighted in green).

It is necessary to pay attention once again to the fact that the shape and size of the cartilages are clearly visible only when they are carefully cleaned of soft tissues.

Look at the top photos. On the left is a previously unoperated patient with normal lower cartilage. On the right is the result of a poorly performed rhinoplasty. In this case, the cartilage is covered with a thick layer of connective tissue, so it is quite difficult to see them. A second operation, which must be performed due to the unsatisfactory results of the previous intervention, will be somewhat difficult because. isolating cartilage without damaging it is not easy in this case.

Here is another patient's nose after a failed rhinoplasty.

Instead of normal cartilage, which I would like to see, in this case there are large growths of scar tissue.

Rhinoplasty It is not for nothing that it is considered one of the most sought-after and most complex plastic surgeries.
The fact is that the structure of the nose by its nature is a lot of complex cartilage and bones, and nose surgery consists in changing each component.
The work is painstaking, long, requiring special skills and abilities.
Also, a surgeon performing rhinoplasty must be an aesthete in this difficult matter, because the harmony of the face after surgery is a very important point.
He must have a certain taste and understanding of what result his manipulations will lead to, because the nose must fit into the overall picture of the face, not be a separate part of the face, and one should not forget about its functionality - the nose must breathe.
Often, rhinoplasty is combined with a correction of the nasal septum, that is, the restoration of proper breathing - this is already called rhinoseptoplasty, but we will talk about this in a separate chapter of our website.

The nose is a complex system, in front of you is the anatomical structure of the external nose.
The shape of the external nose is very reminiscent of a trihedral pyramid, which is located with the base down.

Of the three surfaces of this pyramid, the back part is practically absent, because it faces the nasal cavity (inner part of the nose), and the other two form the side walls of the nose.
The line of connection of the side walls of the nose is the back of the nose.

The cartilages of the nose are the remnants of the nasal capsule and form in pairs the side walls (lateral cartilages), the wings of the nose, the nostrils and the movable part of the nasal septum, as well as the unpaired cartilage of the nasal septum.
The bones and cartilages of the nose, covered with skin, form external nose.

There are two types of rhinoplasty:

open;
closed.

Open rhinoplasty more often used in cases where it is necessary to work directly with the nasal bone or cartilage.
The operation is performed under general anesthesia and takes an average of 3 hours. The incision with this access is located in the region of the columella. During the operation, the surgeon sees all the structures of the nose without any problems, everything is in full view.

Yes, rehabilitation takes a slightly longer process, swelling and bruising are more pronounced than after closed rhinoplasty, but the undoubted and big plus is the predictability of the result.

Closed rhinoplasty the good thing is that the scars are located inside, along the nasal mucosa, the sutures that are inside tend to dissolve and do not need to be removed.
The closed technique is less traumatic, there is no temporary circulatory disturbance from damaged columellar arteries. The closed technique also has its drawbacks: suturing the cartilage vaults is difficult, which makes it difficult to achieve symmetry.

Rhinoplasty is divided into several types:

Rhinoplasty of the nostrils. The purpose of the operation is to reduce the nostrils, change their shape.
Septorhinoplasty. Surgery to correct the nasal septum, restore breathing. Curvature of the septum can be traumatic (obtained as a result of injury), physiological (shifts or growths), compensatory (the shape of shells that prevents normal breathing).
Conchotomy. Surgery for mucosal hypertrophy, aimed at restoring respiratory function.
columella correction. This manipulation involves changing the bridge between the nostrils.
Authentic rhinoplasty. Aimed at cases when it is necessary to raise the back of the nose.
Grafting. Surgery to enlarge a small or very short nose.
Nose tip correction.
Contour rhinoplasty. It implies a cosmetic correction of the shape of the nose with the help of fillers (gels).
Secondary rhinoplasty (repeated). This is a more difficult task in surgery. It implies a correction of the shape of the nose after an unsuccessful operation. In this case, it is more difficult for the surgeon to work, especially when it comes to correcting other people's mistakes, because the surgeon initially sees only the outer nose, does not imagine what awaits him inside. Sometimes a seemingly not so complicated nose, when “opened”, can turn out to be the most difficult, like a brick-by-brick house, you first have to disassemble the nose, then reassemble it.

Indications for rhinoplasty:

"saddle" shape of the nose;
thickening of the tip of the nose;
excessive length of the nose;
wide or large nostrils;
breathing problems;
wide back of the nose;
deformations (after injuries);
congenital deformity;
curvature of the nasal septum (with "cleft palate", "cleft lip");
hump.

Contraindications

infectious diseases;
malignant neoplasms;
diabetes mellitus (we are talking about not compensated);
psychological illnesses;
blood clotting disorders;
diseases of the cardiovascular system;
age less than 18 years;
atrophic rhinitis;
it is forbidden to do operations during menstruation;
pregnancy
lactation period;
inflammatory processes in the oral cavity;

Two weeks before surgery, the patient should stop taking any aspirin-containing drugs;
One day before the operation; it is necessary to refuse fatty foods;
The patient should not eat or drink six hours before the operation;
On the day of the operation, it is better to refrain from smoking.

Operation.

After the preparatory stage for rhinoplasty is completed, and it includes a preoperative consultation, tests, a conversation with an anesthesiologist.
It's time for the operation. First of all, the patient should not worry, tune in to a good outcome.
Before the operation it is necessary:

wash off makeup;
remove all jewelry;
remove varnish or other coating from the nails.

The operation, once again, is performed under general anesthesia, which is supplied by drip.
The patient is asleep during the operation, is unconscious in an intubated state. The anesthesiologist during the operation is in the operating room and closely monitor all the devices.

Depending on the technique of the operation, and the desired result, the doctor performs incisions and tissue detachment (in the inner edge of the mucosa or in the columella area).

Nostril plastic. Occurs without interference in the bone structures of the nose. Correction occurs by excision of mucocutaneous and skin fragments along the contour of the nostrils at the base of the nose. In the final version, small scars remain, which become invisible by the year.

Septorhinoplasty. It implies the correction of not only aesthetic moments, but also the restoration of nasal breathing - the correction of the curvature of the nasal septum. During the operation, the curved cartilaginous and bone parts of the nasal septum are removed, which make it difficult for the patient to breathe.

Conchotomy. It consists in resection (partial or complete removal) of pathologically enlarged turbinates. The turbinates are bony protrusions in the lateral wall of the nose, covered with a mucous membrane. This operation is one of the types of operations to restore nasal breathing.

columella correction. The operation involves engraftment of cartilage tissue (in case of need for an increase), and excision (in case of a decrease in volume). Most often combined with rhinoplasty.

Authentic rhinoplasty. It is a manipulation aimed at raising the height of the back of the nose. This can be done by placing a graft from the cartilage of the nasal septum and auricle or an osteochondral graft from the rib.

Grafting. It implies an increase in the length of the nose. The choice of surgical technique depends on the initial shape of the nose. In some cases, downward rotation of the tip of the nose will help, in another case, a decrease in the support of the medial legs after resection of the quadrangular cartilage.

Nose tip correction. The operation involves changing the shape of the tip of the nose, the technique also depends on the original nose.

Contour rhinoplasty. Nose reshaping with gels. Depending on the desired result, the specialist introduces the gel into the corrected areas.

Secondary rhinoplasty. The hardest thing about rhinoplasty. Aesthetic surgery aimed at changing the nose after an unsuccessful initial intervention. The consequences of poor plastic surgery can be very different. The technique for performing secondary rhinoplasty already depends on this.

After the operation is performed - open or closed, the doctor applies a plaster and plugs the nasal passages to prevent bleeding.

Tampons are removed from the nose after at least 6 hours. It all depends on the individual, and is performed at the discretion of the surgeon.
The plaster is usually worn for 8-9 days, after which it is safely removed along with sutures (in case of open rhinoplasty).

the first days it is better not to be active, lead a calm lifestyle, have more rest;
physical activity banned for a month;
saunas, baths, hot baths and solarium are prohibited for 3 months;
the first week it is better to eat warm food and drink warm drinks (not cold and not hot);
it is forbidden to wear glasses for 3 months, use lenses.

Side effects that you do not need to be afraid of after surgery:

hematomas around the eyes;
extensive swelling of the face and nose;
difficulty breathing (congestion due to swelling of the mucosa);
after surgery, weakness and nausea are possible;
numbness of the nose, as well as a violation of the usual facial expressions;
nasal discharge (blood, mucus);
temperature rise;

Let's also talk about complications of a more serious nature. After all, forewarned is forearmed.

Complications that you may encounter:

Aesthetic discontent (external);
"saddle" shape;
nose curvature;
drooping tip of the nose;
coracoid deformity;
scars and adhesions;
divergence of seams.
perforation of the septum;
toxic shock;
abscess (inflammation);
breathing problems caused by an incorrectly performed operation.

Rhinoplasty gives an excellent result, makes the patient happier, helps many to get rid of complexes, to become more self-confident. But, the decision on the operation should be weighed, deliberate. If you don’t know exactly what you want, don’t understand what doesn’t suit you, and what you expect from nose plastic surgery, it’s better to wait and take your time.

Strongly lifted columella after rhinoplasty. Specific complications in the area of ​​the tip of the nose. Complications that are likely to be encountered