Rhinoplasty – Rhinoseptoplasty

The nose can have both functional and aesthetic problems that can be corrected during the same operation. Rhinoplasty is one of the most requested cosmetic surgery procedures in Italy and abroad. It allows the correction of defects of the form (hump, twisted or deviated nose) or excessive size of the back, of the tip (falling, asymmetrical, globular, hypertrophic) of the shape and size of the nostrils. It is very common that in addition to the aesthetic corrections (Rhinoplasty) we must also associate the functional ones on the septum (septoplasty) and on the hypetrophic turbinates (Rhinosettoplasty).

How do you decide what changes to make to the nose with the rhinoplasty?
Thanks to the progress of cosmetic surgery, modern rhinoplasty allows to obtain, according to the patient’s wishes, results much more natural than those of years ago, simply eliminating the specific defects of “that” nose, without upsetting its shape. Before surgery, the Specialist Surgeon visits the nose by evaluating the internal parts (of the nasal cavities to evaluate the presence of deviations of the septum, hypertrophy of the turbinates) and performs three-quarter, frontal and axial photographs with which it analyzes together with the patient all the characteristics and defects of the nose. Together they plan the corrections to be made to remove all those unwanted aspects. To maintain a pleasant harmony of the nose with the rest of the face and profile, the surgeon, in making the program of the changes to be made, must take into account the racial elements of the individual, the characteristics of his features, the shape of the rest of the face such as that of the forehead and of the chin, of the color of the hair, the eyes and the skin. The expert Aesthetic Surgeon analyzes with the patient all the details of the corrections to be performed, advising and guiding it with the utmost care and attention, in the delicate moment of the planning of the Rhinoplasty intervention. Some people want to see the shape of the nose after the Rhinoplasty surgery on the computer: this method can help to understand that one’s appearance will change, but it can not give certainty of a certain result. In other words, it is good to be wary of those who show that the nose is easily modifiable, also it is not certain that what has been achieved with the photo-editing software of the computer can be realized with the real capabilities of the operator surgeon. To understand how the nose can change, the surgeon must explain what changes he recommends to make to each individual element that makes up the nasal pyramid, and show pre and post operative photos of patients with similar problems and the actual result obtained from them. From these images you can see if the surgeon really knows what he says.

At what age is rhinoplasty possible?
The growth of nasal structures ends at the age of 15 for women, 16 for men, so it is technically possible to carry out Rhinoplasty or Rhinosectoplasty surgery starting from this age, especially if there are functional problems that suggest the intervention, however, before ascertaining that the young patient is fully aware that he is undergoing surgery. Very often rhinoplasty is required by young adults who have a clear picture of their nose and the corrections they wish to make. Sometimes the Rhinoplasty is also requested by elderly people to correct an aesthetic defect of the nose, always poorly tolerated during the lifetime but never accepted or, in other cases, to eliminate the inevitable signs of aging that occur also on the nose, as the tip increases in size and tends to go down. The nasal function and the aesthetic appearance of the nose can be corrected in the same procedure. Very often together with the aesthetic intervention there is also the correction of defects that affect the respiration, resulting from a deviation of the nasal septum, and / or a hypertrophy of the turbinates. In these cases it is important that the surgeon not only has abilities in cosmetic surgery and a specific expertise in functional surgery of the nose and he can perform the required aesthetic (external) changes with the Rhinoplasty and the functional (internal) of Septoplasty by doing so that they adapt and are best prepared to integrate with the others.
In such cases the best results are obtained when the nose surgeon is a specialist both in Plastic Surgery and in Otorino, as in the case of Prof Bracaglia. Finally, in some cases, Rhinoplasty surgery (secondary rhinoplasty) is required to correct and improve the result of a previous operation (rhinoplasty outcomes), which, performed by insufficiently experienced hands, did not meet the patient’s expectations.

How is the Surgery of Rhinoplasty performed?
Rhinoplasty (or rhinoseptoplasty) is performed inside the nasal cavities, through the nostrils, and, therefore, is invisible from the outside. The intervention consists in modifying the shape of the bones and cartilages that make up the rigid structure of the nose. First of all, the skin from the cartilages is freed from the inside. The most important moment is represented by the small and delicate changes, millimetric, which are performed on the cartilage of the back, the tip and on the bones in order to change the shape in the desired manner. At the end of the Rhinoplasty operation, the skin, thanks to its plasticity and elasticity, re-positioning itself on this new nose. At the end of the intervention inside the nostrils are placed two small soft pads, easily removable and without pain, because covered with oily ointment that does not adhere to the mucous membranes. They are removed the following morning, a few hours, then, from the end of the intervention slipping out easily with a slight pull. The person is discharged and returning home on the back of the nose only carries a small one a rigid plate, fixed with a plaster. This is removed after a week and for another seven days a paper towel remains on the nose. Two weeks after surgery, the nose is completely free. After a rhinoplasty or rhinoseptoplasty it is rare that a complication such as partial correction of the defect can occur, or that the healing of the tissues of the nose can occur unevenly and symmetrically in the two parts, that small irregularities emerge from the intervention or a deficiency of the respiratory function: these problems are infrequent and however can be corrected with a possible minor retouching. In expert hands, complications are more rare and, usually, smaller and the result is more likely to match the desired one or in any case to get closer to it. After the rhinoplasty or rhinoplasty surgery, even if it can be a surprise, as a rule there is no pain. Immediately after the operation the nose and cheeks have a swelling that, in most cases, is reduced by a lot in a couple of weeks. The professor. Bracaglia in his activity of rhinoplasty that takes place in Rome removes the nasal swabs the morning after the intervention, before discharge. A light but effective protective dressing with which the patient returns home is left for seven days. Limited daily activities can be resumed quickly, within two or three days, while it is advisable to wait at least a month before wearing glasses. After only three weeks you can gradually return to the sun.

What kind of anesthesia is performed?
Rhinoplasty surgery, such as that of complete Rhinosettoplasty, is usually performed under general anesthesia with one day of hospitalization, but, in cases of Rhinoplasty limited to an element of the nose (eg the single tip), it is also possible to perform it in local anesthesia, without admission, or with sedation, in day hospital.

What is a Closed Rhinoplasty or an Open Rhinoplasty?
The “Open” Rhinoplasty and the “Closed” Rhinoplasty are differentiated by the access way in which the structures of the nose are reached. The corrections to be made on a given nose can be carried out more effectively with the “Open” or “Closed” technique. He is the expert Surgeon who programs from time to time, for each individual patient of his, the most effective approach to solve the defect or defects of cartilage or bones of the nose
When does the surgeon select closed rhinoplasty or open rhinoplasty?
Using the Closed or Open technique is not, that is, a rigid choice but must be selected according to the individual case. The surgeon must necessarily know and know how to use more techniques in order to obtain the best result in any case. With the Rhinoplasty Closed the structures of the nose can be reached by an access only inside the nose, while if you use the open one only makes a tiny incision of about 3mm, underneath the not visible sub-area, which allows many modifications to be made to obtain even more precise modifications, especially of the cartilaginous portion of the nose and especially of the tip. The experienced Surgeon knows how to choose the best path in each case according to what changes he has decided to make. The selection of which technique to choose is made in order to obtain the most perfect and reliable correction of the shape and function of the nose.

Rhinoplasty is one of the most complex interventions of Aesthetic Surgery that must be performed by highly experienced surgeons. If well planned and performed in a precise manner, it provides great satisfaction both to the Surgeon and to the Patient. On the other hand, if Rhinoplasty is performed by an inexperienced surgeon, partial or even unpleasant results can be obtained. In such situations, the patient goes in search of a specially prepared and experienced surgeon who is able to solve his problems with a Secondary Rhinoplasty surgery.

What types of defect interventions are they most frequently in rhinoplasty outcomes?
The defects that can be found may be due either to excess or defective removal of cartilage or bone structures, or performed irregularly or asymmetrically between the two sides of the nose. the nose is a structure made up of numerous cartilages and bones that are articulated with each other and are joined together to form a unique scaffolding. The corrections of the results of a rhinoplasty must be preceded by a careful and meticulous and precise assessment of each individual defect. In some cases the first surgeon limited himself to making an insufficient correction of the aesthetic and functional defects of the nose and the secondary rhinoplasty must complete a rhinoplasty which was only partially outlined and not completed properly. Other times, on the other hand, if the first surgeon made excess excision, the excess cartilage or bone tissue must be replenished with secondary rhinoplasty. To this end, specific reconstructive and aesthetic plastic surgery techniques are used. . They are the alar cartilages with their medial and lateral crura, the Domi, the triangular cartilages, the nasal bones and the spines, the quadrangular lamina, the ploughs, the perpendicular lamina, the nasal process of the Palatine bones. All of these structures may have been modified incorrectly or removed in an entirely inappropriate manner with consequent alteration of the morphology of the nose.

What types of surgical techniques can be used to correct a rhinoplasty?
The program for recovery of a rhinoplasty is an intervention in which, in addition to recovering the compromised aesthetic appearance, it is also necessary to restore correct breathing. The intervention must be based on a careful and precise preoperative recognition of the damage done to the bone and cartilage of the nose. Its scaffolding is made up of numerous cartilages and bones that are connected and interlocked together to form the structure of the nose itself. The surgical techniques are highly refined and specific and may involve the use of cartilage autografts taken from the same patient. Secondary Rhinoplasty generally has a painless post-operative course, but with recovery times a little higher than those of primary rhinoplasty. The experience and skill of the plastic surgeon expert in nose surgery is able to achieve very good results both in terms of aesthetics and function.

Prof. Bracaglia, as Specialist particularly dedicated to Aesthetic Surgery, has perfected and devised new surgical techniques for the improvement of Rhinoplasty which are now available to the Colleague Plastic Cosmetic Surgeons of the International Scientific Community from the “National Institute of Health” e dal “National Center for Biotechnology Information” – USA : http://www.ncbi.nlm.nih.gov/pubmed/23524747 http://www.ncbi.nlm.nih.gov/pubmed/22842447 http://www.ncbi.nlm.nih.gov/pubmed/22544129 http://www.ncbi.nlm.nih.gov/pubmed/15037172 http://www.ncbi.nlm.nih.gov/pubmed/16044235 http://www.ncbi.nlm.nih.gov/pubmed/15710127

Rainbow graft: a technique for the replacement of the lower lateral cartilages, improvement of tip projection, and correction of external nasal valve dysfunction. Bracaglia R, e Coll J Craniofac Surg. 2013 Nov;24(6):1882-5. “

Nougat graft”: diced cartilage graft plus human fibrin glue for contouring and shaping of the nasal dorsum. Bracaglia R e Coll. PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 130, p. 741-743 2012

A technique to make spreader graft fixation easier. Bracaglia R e Coll. PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 129, p. 857-859 2012

Alar Cartilage Grafts for Repair of Complex Tip Defects: Cosmetic Surgery in Aid of Reconstructive Surgery BRACAGLIA R, e Coll. PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 130, p. 378-380, . 2012

Management of Patients Undergoing Rhinoplasty While Receiving Anticoagulant Therapy Bracaglia R, e coll AESTHETIC PLASTIC SURGERY, vol. 36, p. 1087-1089, 2012

Chirurgia Estetica. Bracaglia R In: ENCICLOPEDIA MEDICA ITALIANA III aggiornamento della II edizione.. p. 628-645, FIRENZE:Enciclopedia Medica Italiana, USES Ed. Scient 2008

Secondary rhinoplasty Bracaglia R e coll . AESTHETIC PLASTIC SURGERY, vol. 29, p. 230-239 2005

“Endoscopic excision for postrhinoplasty mucous cyst of the nose” Bracaglia R., e Coll – British Journal of Plastic Surgery 2005 Mar; Vol. 58 Issue 2, Pag. 271-274.

“Rinoplastiche in nasi torti” BRACAGLIA R E COLL XXV Congresso Nazionale della Società Italiana di Medicina Estetica, 23 – 25 Aprile 2004. Verona – Italia.

“Double lateral osteotomy in aesthetic rhinoplasty” Bracaglia R., E COLL – British Journal of Plastic Surgery 2004 March; Vol. 57, Issue 2, Pag. 156-159.

Rinoplastiche in nasi torti BRACAGLIA R. e coll XXV Congresso Nazionale della Società Italiana di Medicina Estetica, 23 – 25 Aprile 2004. Verona – Italia.

Rinoplastica in “Chirurgia Plastica” – ” Terapia Medico-Chirurgica BRACAGLIA R Edizioni Universitarie Scientifiche – Roma 2003

Stenosi iatrogena della valvola nasale post rinoplastica: indicazioni e risultati dell’impiego di innesti combinati BRACAGLIA R e coll. Atti 51° congresso Nazionale della Società Italiana di Chirurgia Plastica Ricostruttiva ed estetica pag 198 Verona 19-21 Settembre 2002

Rinoplastica,plastica degli zigomi e del mento, liposuzione del sottomento: come e quando associarli nel riequilibrio del profilo BRACAGLIA R. e coll. La Medicina Estetica (25) 1: 174 2001

La rinoplastica estetico-funzionale: nostra venticinquennale esperienza BRACAGLIA R. e coll. Meeting Annuale Chirurgia Plastica Ricostruttiva ed Estetica della Testa Roma 17 marzo 2001

Rinoplastica: quali correzioni effettuare e quali non per ottenere un naso armonioso nei pazienti con naso torto e gibboso BRACAGLIA R e coll. La Medicina Estetica (25) 1: 172 2001

Impiego di materiali autologhi e non nella chirurgia degli esiti di rinoplastica BRACAGLIA R., e coll. Atti 45’ Congresso della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica pag. 429-437

Chirurgia Estetica della punta del naso: ventennale esperienza personale BRACAGLIA R., e coll. Atti del XVIII Congresso Nazionale di Medicina Estetica pag. 73 Roma, 21-23 marzo 1997

Nostra esperienza nelle correzioni della punta del naso in Pazienti con esiti di labiopalatoschisi

BRACAGLIA R e coll. Atti del 46° Congresso Nazionale della Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica pp. 419-421G. De Nicola Ed. Napoli 1997

Rinoplastica in Chirurgia Estetica – “ Enciclopedia Medica Italiana” BRACAGLIA R. Aggiornamento II, Tomo II° pp 1144-1157 USES Ed. – Firenze 1998

Rinoplastica: programma differenziato nei pazienti di sesso maschile e femminile BRACAGLIA R e coll. La Medicina Estetica (22) 1: 120 1998

Correzione estetica della punta del naso BRACAGLIA R. Atti Incontri di chirurgia plastica – IDI pp.53-54 Roma 29-30 nov. 1998

Reflexion sobre los lineamientos basicos en la programacion de la rinoplastia BRACAGLIA R., e coll. Rivista Argentina de Cirugia Plastica 2(1), 32-36, 1996.

La Rinoplastica:criteri nella scelta delle correzioni morfologiche da eseguire nel recupero di un armonico aspetto estetico del naso. BRACAGLIA R., e coll. La Medicina Estetica, Anno 20, nr. 1, Gen-Mar 1996, pag. 69

Secondary Rhinoplasty: our experiences BRACAGLIA R., e coll. XIII International Congress, pag. 25 New York 28 september – 3 october 1995

Gli esiti di traumi nasali: aspetti della problematica chirurgica BRACAGLIA R., .,e coll. Atti XXXVII Congresso Nazionale della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, pag. 317-322 Monduzzi Editore Bologna 1989

Trattamento chirurgico del rinofima: nostra esperienza BRACAGLIA R., .,e coll. Atti XXXVIII Congresso Nazionale della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, pag. 271-275 Monduzzi Editore Bologna 1989

Rinoplastica e volto BRACAGLIA R., e coll Atti del XXXVII Congresso Nazionale della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, pagg.435-439 Monduzzi Editore Bologna 1988

Rinoplastiche secondarie BRACAGLIA R., e coll Atti del XXXVII Congresso Nazionale della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, pag.465-469 Monduzzi Editore Bologna 1988

L’accorciamento della columella in corso di rinoplastica: tecnica personale BRACAGLIA R., e coll. Atti del XXXVII Congresso Nazionale della Societá Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, pag 517-521 Monduzzi Editore Bologna 1988

La chirurgia della punta del naso negli esiti di labiopalatoschisi BRACAGLIA R e coll. Atti III Convegno del Club Meridionale di Chirurgia Plastica pag. 129-133 Benevento 9-10/12/1988

Neorinoplastiche parziali e totali, Indicazioni sulla scelta tra tecniche chirurgiche classiche e nuove BRACAGLIA R. Atti del Congresso Mondiale di Chirurgia Maxillo-Facciale pp.183-186 Sorrento 25-28/5/1982

Reconstructive surgery of complex tissue losses of the nose. BRACAGLIA R. VI Congresso European Association for Maxillo-Facial Surgery, p.67 Hamburg (West Germany) 13-18/9/1982

Criteri di utilizzazione dei lembi ad isola nella ricostruzione della piramide nasale BRACAGLIA R., e coll.. Atti V Congresso Nazionale di Chirurgia Maxillo-Facciale pagg. 499 – 505, Monduzzi Editore, Bologna 1989