The augmentation rhinoplasty is a surgical procedure utilised to enhance the shape of the nose or alter its profile by adding implants for a stable result designed for longevity.
Implants create a quicker and simpler operation that can be performed under local anaesthetic. The procedure, among others, can add height to the nose bridge or alter the shape of the nasal tip to increase its projection.
Client who consider augmentation rhinoplasty have:
- short nose
- retracted columella
- flaring nostrils
- a wide & low nasal dorsum
- thick & sebaceous skin overlying the tip and supratip
- poor tip projection and support with weak lower lateral cartilages
- thin & small amount of septal cartilage
- acute nasolabial angle
- thickened alar lobules
Preparation for your operation
The procedure can be done under local anesthesia.
DO NOT take any Aspirin and NSAIDS drugs for at least 2 weeks prior to surgery. (Aspirin may be re commenced after 48hrs post op.) If you take Aspirin or any other form of blood thinning medication for a medical condition, please discuss this with Dr. Thanakom.
The procedure usually takes 1-2 hours and you can go back home on the same of your surgery.
Step 1 – Anesthesia
Medications are administered. The procedure usually performed under local anesthesia.
Step 2 – Incision
Sharp subcutaneous dissection was carried on from the incision to the lower border of the nasal bone to create a symmetrical pocket over the tip and supra-tip area. The sub-periosteal dissection was continued with periosteal elevator from the lower border of the nasal bone. The upper dissection was limited at the marked line for the superior border of the preplanned prosthesis pocket. The lateral dissection was performed to achieve the adequate pocket space, which depended on the size of the prosthesis. The dissected pocket was irrigated with normal saline and the hemostasis was secured. The custom-made S-shape implant was inserted. The contour and position was checked. Common materials for implants include Gortex or soft silicone.
Other features that can be improved at the same time as augmentation rhinoplasty:
- Bridge augmentation: this can be achieved using the patient’s own cartilage, taken from the septum or the ear. Often, hand shaped Gortex implants can be used for this purpose.
- Alar base reduction: to reduce the width of wide nostrils.
- Tip refinement: typical requests for the tip include, refining a bulbous appearance, projecting or deprojecting. In most cases, when changes to the tip are requested, changes to the other parts of the nose are required as well. This is because the nose is a three dimensional features, and changes made to one area can change the way the other areas appear in contrast.
- Tip projection: sometimes the tip area of the nose can appear short and round – this is improved by projecting the tip away from the nose more, often times combined with tip defining techniques to give this area more shape.
- Narrow nasal bones: Often the bridge of the nose appears to be too wide. In this case, the nasal bones are narrowed.
Step 3 – Closing the incisions
Stitches are then used to close the incision.
After the operation, you will have dressings in your nostrils for a day or so which will prevent you from breathing through your nose. You will also have a firm splint over your nose for the first week or two. There should be very little pain in your nose but, if you have a bone graft taken from your hip, you can expect this to be quite painful for about 10 days, particularly when you walk. You will be given appropriate painkillers to help with this.
Expect to have bruising and swelling of your face, particularly around the eyes, which will take up to three weeks to settle and during part of this time your nose is likely to be covered by a firm splint. Once the initial swelling has settled, you will find that your nose feels rather stiff and numb. The numbness will disappear slowly during the next few months but the stiffness is likely to be permanent.
Keep the head elevated while sleeping in the first 3 days. Do not lie on side for 1 week, this may cause the nose misshaping.
What are the risks?
Very occasionally, the operation can be complicated by heavy nose bleeding either shortly afterwards or, after a week to 10 days which may require treatment in hospital. There is a small risk that infection could adversely affect the success of the operation. Were it to happen, it may be necessary to remove, temporarily, a manufactured implant if that has been used. Sometimes a manufactured implant will extrude through the skin of the nose or its lining and need to be removed. This can happen months or years later, and is more likely if a large implant has been used or if the nose is accidentally injured.
When will the cast be taken off and does this hurt?
The cast is removed approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling moves downward.