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Difference between rhinoplasty and septoplasty

Clínica Sanza Articles of cosmetic surgery

What is a simple rhinoplasty, a complete rhinoplasty and a septoplasty?

A rhinoplasty is a surgical intervention which allows the nose to be remodelled, improving the aesthetical frontal view and the side profile.

When the main goal is to improve the breathing function, it is called, septoplasty.

The term rhinoseptoplasty, combines the two purposes, hence, aesthetical and functional.

There are two principal techniques:

  • Simple Rhinoplasty

This is the simplest and most used technique. It consists in correcting the cartilaginous area of the nose and offers a great advantage: no scarring.

This technique improves the small details from the broad or fallen nasal tip, the septum or nasal dorsum; with this, we improve the undesired facial traits in a beautiful and harmonic nose that favours the patient’s profile and personality.

This does not require nasal plugs, there is barley any bruising and there is no need for a nasal splint as there is no bone contact.

  • Complete Rhinoplasty

This intervention is more complex than the simple rhinoplasty. It is used for greater nasal defects, such as, nasal tip defects, nasal dorsum or secondary rhinoplasty.

In this procedure, the nasal structures are accessed through a minimal incision in the base of the nasal columella. With this, we can have complete access and visibility of the nasal structure, which permits us to sculpt and retouch the tip cartilage or the nasal bones, creating or remodelling the nose into a new structure.

This procedure can be proceeded with general anaesthesia or with local anaesthesia and a sedative, requiring a 24-hour hospital stay and nasal plugs during 24 to 48 hours. A nasal splint is needed for 10 to 15 days. Also, there is a high chance of bruising under the eyes and eyelids that will disappear within 1 to 2 weeks.

The intervention creates a nasal morphology and profile which is harmonic with the rest of the facial structures, especially if it is combined with a mentoplasty, molarplasty or an otoplasty (in these cases the procedure would be called, profileoplasty).

In general, the patients that ask about this surgery, are looking to achieve the following:

Rinoplastia, cirugía de la nariz

  • Nose size reduction
  • Eliminate the nasal hump
  • Modify the nasal dorsum
  • Modify the nasal tip
  • Close or reduce the nostrils
  • Modify the nasal angle towards the lips
  • Modify the nasal angle from the forehead to the nose

The operation consists in reducing or remodelling the osseocartilaginous skeleton.

To obtain a proportional and harmonic result, it is important to take into consideration all the patients facial features and not just the nose as an independent structure.

Sometimes the patients look for a famous model’s nose, however, these may not be adaptable to their own faces.

If the rhinoplasty is executed by an ideal and up to date professional it will generate great satisfaction. For this, it is fundamental that the surgeon has knowledge on all the surgical techniques to achieve the optimal results for each patient.

Who are the optimal candidates for this type of surgery?

Rhinoplasty is recommended for patients that wish to improve the aesthetical appearance of the nose, correct genetical or accidental deformations.

Just as any other type of surgical intervention, rhinoplasty should be executed in patients that have good health, this is why the surgeon on a first visit could ask for detailed information to evaluate any risk factor.

There are no specific age limits, however it is important to have the bones and cartilage completely developed before operating. For this, we recommend from 15- 18 years of age, as the nose will not change from this age onwards.

To evaluate the candidate, the surgeon has to measure and analyse all the facial structures.

How do I choose the surgeon that has to operate my nose?

The patient that plans a nose surgery has to choose a Plastic Surgeon, as these are the ideal professionals. In Spain, the surgeons that execute the rhinoplasty, such as the rhinoseptoplasty, are Plastic Surgeons.

It is also very important to check the surgeons formative background and professional work experience.

How is the first visit with the surgeon?

The first visit with the surgeon is the most important, as it gives the patient the opportunity to express all the queries, fears or expectations with regards to the procedure and the results that they wish to obtain. The general health will be evaluated and a medical history will be generated.

In a first visit, we explain to the patients that nasal surgery has a double purpose. On one side, to create a natural, attractive and aesthetical contour, and on the other hand, correct any anatomical structure with an abnormal breathing functionality.

The end result varies in regards of the anatomic bone structure, cartilage and nasal skin, making each individual patient unique. This is why we explain to our patients in front of a mirror all the techniques, surgical possibilities which are closest to the patient’s desires.

How is the procedure?

A Rhinoplasty has to be performed in an equipped surgery, within a hospital or a clinic.

The surgery is performed with general anaesthesia or local anaesthesia and a sedative, with this, the patient will not feel any pain during the procedure.

The choice of the anaesthesia will depend on the patient’s characteristics, following all indications that the surgeon considers the most safe and appropriate for the surgery.

Depending on the Doctor, the patient and the used technique, a rhinoplasty can be executed as an ambulatory procedure (with no hospital stay) or with a half or a complete 24h hospital admission.

The duration of the rhinoplasty procedure can vary depending on the case, ranging from 1 to 3 hours.

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Differences between an aesthetical and a functional rhinoplasty

Let’s see now in detail the differences between the aesthetical surgery and the functional surgery:

  • Aesthetical Rhinoplasty

    This operation corrects different aesthetical nose defects. Once this defect is localized, it is the surgeon’s responsibility, through facial preoperative analysis, to establish a new shape which is balanced and proportional to the rest of the face.

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  • Septoplasty or deviated nasal columella correction

    The deviation of the nasal columella can be caused by genetical or traumatic causes (this last one, is associated with a columella and conchae alteration) which can cause not only breathing problems but aesthetical changes too (bent or asymmetrical nose) and pain symptoms, such as, head, audition pathologies, sinusitis and pharyngitis.

In a septoplasty, cartilage and deformed bone structure parts are eliminated or repositioned into the medial axis. Also, this type of operation is accompanied by the aesthetical rhinoplasty, which is called rhinoseptoplasty.

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Non-surgical alternatives to a rhinoplasty

For less severe cases with only small nasal defects, such as a small hump, there are non-surgical options available.

  • Non-surgical Rhinomodelation or Rinofiller

    Nasal fillers or rinofillers are made of hyaluronic acid, a natural substance naturally found in our system. Therefore, it has practically no side effects and can be used by all type of patients. Hyaluronic acid can be used to eliminate slight aesthetical defects, such as small humps. Nevertheless, this technique can only be used in small noses: if the nose is large or there are great nose defects, surgery will be the only solution.

The great advantage of the rhinofiller is the fast application (30 minutes with an ambulatory process) and the speedy recovery (nearly immediately). However, the disadvantage of the rhinofiller is the lasting time, which is a maximum of 12 months, and it can not be used on big noses or large defects.  

  • Rhinoplasty with tensing threads

    This technique can be used on the nose tip, by a thinning or a lifting effect. Rhinoplasty with suspension or tensing threads is a fast and ambulatory process which can be executed with local anaesthesia and does not require hospitalization, allowing the patient to return to their day to day activities with complete normality.  The threads are introduced through a small entry point from the base of nose and then pulled back to the posterior area of the nose. Nevertheless, if the nose has to be thinned, the threads will go from one side of the nose to the other horizontally.

The advantage in regards to a surgical procedure, is the velocity of the process and the minimal post-treatment effects, such as, slight swelling and bruising where the injection has been held, that will disappear in a few days.

The disadvantage is that it is not a permanent result and will only last approximately 12 months, maximum 18 months.  

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Tips before the surgery

Rhinoplasty is a surgery that creates worry among patients, we recommend to follow certain steps and to follow the following guidelines:

  • Preoperative testing (blood test, electrocardiogram, X-ray) to evaluate the health and avoid unnecessary risks.
  • Eliminate the use of vasoconstrictive and anticoagulant medication (aspirin and certain analgesics) during a minimum of one week previous to the surgery.
  • Eliminate the use of cigarettes and alcoholic drinks during at least 1 month previous to surgery.
  • Cleanse properly the day before the surgery.
  • Do not use make up the day before the operation.
  • It is recommended to be accompanied by a family member or friend the day of the intervention, this way there can be help if there should be swelling of the eyelids posterior to the operation.

Rhinoplasty post-operative

Contrary to the main thought, nose surgery is not painful.

The great inconvenience is the use of nasal plugs during 24h which can be uncomfortable or the use of a nasal splint during 7 to 14 days.

Regardless of these two inconveniences which are very common in a rhinoplasty, the post-operative procedure is well tolerated.

The appearance of bruises during the post-operative process, varies in regards to each patient. However, bruising in the subpalpebral area is common and normally lasts at least 10 days. Once this period of time has finished, the bruises will disappear.

It is also common to have edema (swelling), particularly on the nasal tip. The accumulation of inflammatory liquid is normal and will fade away within days, finally disappearing within a month. After 10 – 15 days the patient can start their normal daily activities.

Advice to follow during the postoperative process:

  • Do not blow the nose during the first weeks.
  • Follow the surgeon’s instructions in regards to nasal hygiene.
  • Avoid lowering the head the first few days.
  • Do not use glasses during the first weeks.
  • No drinking or smoking during the first 2 weeks.
  • Avoid any physical efforts which are intense and possible impacts, especially during the first weeks.

Rhinoplasty results

The aesthetical rhinoplasty results improve the shape of nose without radically altering other facial traits. The results can be seen 10 days after taking away the nasal splint.

The final results are seen at 6 months, when the edema and inflammation are completely disappeared. The changes are seen previous to six months, however as more time passes the changes are greater.

The obtained results are permanent and definitive throughout the years.

To obtain good results, the nose lines should be harmonious, the nostrils symmetrical and the angle between the lips and nose well defined.

To obtain natural results, the surgeon hast to have great experience and an artistic vision. It’s fundamental that the nose does not cause attention, it should be in balance with the rest of the face and the operation should not be noticed. Also, the results should have a great level of functionality together with the aesthetical result.

An important fact to have in consideration is the type of nasal skin. Thick skin retains the shape of the nose and does not adapt so well to the new cartilaginous structure until past a few months.

The scars are internal from exception of the reduction of nostrils. If the patient has been operated with the open technique there can be a slight scaring in the narrowest part of the columella which can be a straight line, in the shape of a stairway or V shaped, with time they disappear and will not be visible.

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Secondary Rhinoplasty

Some patients need to go through another intervention to correct certain defects that remain after the first surgery. The 7-8% of the operated patients need a retouch to improve the results obtained in the first intervention. These interventions are particularly indicated at patients that did a partial rhinoplasty.

When we correct a nose perforation, an irregularity of the nose tip or of the nostrils, or a deviation of the pyramidal point, we then talk about reconstructive plastic surgery.

The secondary rhinoplasty can be executed 6 to 10 months after the first surgery. It is performed with local or general anaesthesia and the postoperative process is similar to the first operation. Nevertheless, the risks can be greater. This is why the secondary rhinoplasty and it’s planification has to be led by a specialist.

Risks and possible complications to a nose surgery

The possible side effects of a nose intervention are the following:

  • Temporary edema or inflammation.
  • Bruising around the nose and eyes.
  • Nasal haemorrhage.
  • Congestion sensation.
  • Nose redness due to the capillary dilatation.
  • Pain in the treated area.

Doubts and frequently asked questions

Which is the difference between a rhinoplasty and a rhinoseptoplasty?

The rhinoplasty is a morphologic nasal pyramid remodel. The rhinoseptoplasty consists in the remodelling of the nasal pyramid, however, it is also executed to correct the functionality of the septum and the inferior nasal conchae.

From what age onwards can a rhinoplasty be executed?

The most important factor is the physical maturity of the patient. There are patients that have infantile physical traits even after 18 years of age and others that have complete bone maturity at 16 or 17 years of age. There is a need of common sense and an accurate diagnosis evaluation on behalf of the surgeon.

What surgeon should I contact for a rhinoplasty?

Rhinoplasty (aesthetic and functional) is a surgery executed by plastic surgeons.

Is it a painful operation?

The patient does not feel nothing as he is sedated. In the postoperative process there can be slight pain, however, very tolerable. The Doctor can prescribe analgesics to calm the pain, nevertheless, the patients hardly take any medication as the pain is minimal.

In what position can the patient sleep after the intervention?

The best angle to sleep in is with the headrest elevated approximately 30º higher. All positions are accepted, except the prone position (head and abdomen facing down) during a minimum of 1 month.

Do colds or sneezes change the results?

The first few days it is advised to sneeze with the mouth, after there is no problem.

How long until physical activity can be started again?

Minimum 2 weeks, after this, progressively the intensity and frequency can be incremented.

Can I travel by aeroplane once I have been operated?

After 7 days there is no problem. The ideal situation would be to let pass the postoperative period.

Can I go to the beach after a rhinoplasty?

                It is advised to avoid the beach, the pool water and the sunshine for at least 10 days post-surgery and only with the Doctors consent. Also, sun protector is essential.

Can a rhinoplasty be executed twice?

Yes, nevertheless, the surgeon is the one who will advise of executing or not the procedure. Also, there has to be a minimum of 6 to 8 month wait from the initial operation.