Is swelling dangerous after rhinoplasty? Morozov Sergey plastic surgeon - questions to the doctor Why swelling appears after rhinoplasty

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Although beauty is easily recognizable, it is often difficult to give an objective definition. It can be characterized by a combination of factors such as symmetry, aesthetically pleasing proportions and relationships. In an attempt to standardize and define the look of classical beauty, they have been the subject of study for centuries. Understanding the proportions, angles, measurements and their relationships that are considered standard for an attractive face helps the plastic surgeon understand the reasons why a given patient's facial features are outside the accepted norm and why he is dissatisfied with his appearance. In the presence of asymmetry, disproportion and incorrect relationships, the surgical plan is determined by the need for their correction.

The success of rhinoplasty depends on a thorough analysis of the nose and surrounding facial structures. The purpose of this article is to present clinically acceptable aesthetic proportions of the nose and face that are useful to evaluate before performing rhinoplasty.

Nose and face analysis

Examination of the patient before rhinoplasty begins with assessing the proportions of the nose and face. Although there is a huge variety of types of noses and faces, general rules have been developed that determine their attractive proportions. There are many different methods for assessing facial proportionality, some of which rely on complex and difficult to apply measurements. The diagrams below provide general settings that can be easily used to examine a patient both before and during rhinoplasty.

The face can be roughly divided by horizontal lines into three equal parts (Fig. 1):

1) from the border of hair growth on the forehead (trichion) to the glabella (glabella);

2) from the glabella to the base of the nose (subnasale);

3) from the base of the nose to the chin (menton).

Rice. 1. The face is conventionally divided by horizontal lines into three equal parts. The upper third runs from the hairline to the glabella, the middle third from the glabella to the subnasale, and the lower third from the subnasale to the mentone.

In turn, the lower third of the face can also be divided into three parts - one third is the upper lip, and two thirds are the lower lip and chin. Using vertical lines, the nose and face can also be divided into five parts - the width of the base of the nose is equal to the distance between the inner corners of the palpebral fissures and the width of each of them (Fig. 2).

Rice. 2. The face is conventionally divided into five parts by vertical lines, so that the width of the base of the nose is equal to the distance between the inner corners of the eyes and the width of the palpebral fissure.

The nose in profile should stand like a right triangle with side proportions of 3:4:5, so that its protrusion is 60% of its length (Fig. 3). The nasofrontal angle begins approximately at the level of the upper eyelid sulcus, and the protrusion of the chin forward should correspond to the lower lip.

Rice. 3. The height of the nose and its length are in the form of a triangle, the aspect ratio of which is 3:4:5. The ratio of height to length is 3:5, which makes the protrusion of the nose equal to 60% of its length.

Among these general aesthetic rules, there are variations due to individual or ethnic differences; however, significant deviations may explain why the patient is dissatisfied with his appearance. Most patients have facial and nasal asymmetries that need to be discussed preoperatively. These asymmetries may not be noticeable to patients before surgery, but there is a good chance that they will become extremely sensitive to them after the intervention.

Nose skin

Before rhinoplasty, it is necessary to assess the condition of the skin and soft tissues covering the nose. Under the thick and oily skin of the nose, changes made in its osteocartilaginous structure are poorly visible. Many surgeons believe that in the presence of thick, sebaceous skin, swelling lasts longer, hiding the final result of the operation. However, the skin may fit tightly, showing the slightest deformation and unevenness underneath.

The skin in the area of the nasofrontal angle is usually thicker, and above the hump (rhinion) is thinner (Fig. 4). From the rhinion to the tip of the nose, the skin becomes thicker again, and the number of sebaceous glands in it increases. The skin covering the tip of the nose can vary from thin, emphasizing the underlying cartilage, to thicker, causing the tip to widen and bulge. The skin of the alae of the nose is also thick, with a high density of sebaceous glands, and the skin in the columella area is usually thinner than any other part of the nose.

Rice. 4. The thickness of the skin on the bridge of the nose changes. The thickest skin is usually at the tip of the nose, while the rhinion is covered with the thinnest skin.

Steven S. Orten and Peter A. Hilger

Facial analysis before rhinoplasty

If you decide to undergo surgery to correct the shape of your nose - rhinoplasty - you need to understand that you will have to face the problem of swelling in any case.

Swelling after rhinoplasty of the nose occurs in everyone, the difference is only in the degree of its severity.

The main reason is the specificity of the operation itself: during surgery, detachment of the skin occurs, which is an absolutely necessary condition for creating a new shape of the nose.

When a detachment occurs, the blood vessels are damaged, resulting in decreased blood circulation and fluid outflow.

It is pointless to make a complaint to the surgeon about swelling - this does not depend on his qualifications, but only on the volume of the operation, as well as the individual properties of the patient’s body.

The swelling subsides only when normal tissue blood flow is restored.

After the operation is completed, a plaster cast or a special splint must be applied to contain swelling, while fixing the shape of the nose.

How dangerous is he?

Edema is a natural phenomenon and does not pose any danger.

With proper care and compliance with all medical recommendations, all side effects will disappear in due time, not even a trace will remain of them.

How long does it last?

Nasal swelling appears during surgery (primary), which is dealt with by an experienced surgeon, having a good understanding of the swollen tissues.

Primary - lasts 10 days, waning after about two weeks.

After removing the plaster, generally for a month or a month and a half, the swelling, called secondary, still persists. It is much less pronounced than the primary one:

fabrics are slightly thickened;
the tip and bridge of the nose are widened.

After two months after rhinoplasty surgery, they talk about residual swelling, which in most cases is no longer noticeable to others.

Stages of the recovery period

The recovery period after rhinoplasty goes through approximately 4 stages.

First week

Thanks to the plaster cast, the swelling on the nose will not be too pronounced, but may spread down to the cheeks and chin.

tilt your head and torso, lift weights;
press on your nose, touch your face with your hands;
sleep on a low pillow: It is better to sleep in a semi-sitting position to increase the flow of blood from the head;
expose your face to high temperatures and hot water (you cannot visit a bathhouse, sauna, warm yourself by the fireplace, and under no circumstances make hot compresses);
use cosmetics (including creams);
take diuretic (diuretic) drugs, since these drugs wash out calcium, and this impairs the healing of postoperative wounds;

Second and third weeks

At the end of the first week:

plaster casts are removed, as well as internal splints and seams;
the internal structures of the nose are washed;
breathing improves;
swelling persists;
the nose is deformed;
often the swelling is more pronounced compared to the first week after surgery.

By the end of the third week, swelling is usually reduced by half.

During this period you need:

sleep on your back (to prevent fluid accumulation in the soft tissues of the face;
avoid hot air, water, overheating;
Handle your face very delicately when washing, do not rub your nose or put pressure on it;
avoid bending the head, heavy physical labor, intense exercise;
if the swelling is still quite noticeable, you can use lymphatic drainage ointments and gels after consulting a doctor.

Video: Features of rehabilitation

Before the end of the third month

In the period from the third week to the third month, cosmetic recovery occurs, swelling gradually disappears.

But the appearance of the nose is not yet ideal; there is still slight swelling of the tip of the nose and nostrils.

During this period, in order to get into shape as quickly as possible, it is necessary to exclude:

smoking and alcohol abuse;
sleeping on your side and stomach
nose rubbing;
long and frequent head tilts;
wearing glasses that fit tightly to the bridge of the nose.

Up to a year

From the third month to a year, the final stage of recovery continues.

During this period, swelling is almost invisible, and the nose takes on its final shape.

It should be noted that in patients with thick skin, swelling lasts longer than in patients with thin skin. This is explained by the fact that thicker skin requires more nutrition, which means it has a larger number of vessels and veins that will be damaged during the operation. Accordingly, their recovery time will be longer.

Photo: Before and after surgery

How to relieve swelling after rhinoplasty

To quickly get rid of swelling, you need to follow some recommendations.

By performing them, you will not only minimize the risk of complications, but you will be able to quickly enjoy the results of rhinoplasty.

Nonsteroidal anti-inflammatory drugs also produce a decongestant effect.

Be careful when using vasoconstrictor drops, do not overuse them.

You also need:

Healthy food: first of all, minimize the consumption of salty, sour, spicy foods;
no smoking: Smoking impairs blood circulation, especially in small capillaries, as a result of which the tissues swell more. In addition, smoking can lead to the development of a serious complication in the form of tissue death or necrosis;
eliminate alcohol consumption, especially carbonated alcoholic drinks: champagne, beer, etc.;
remove the source of stress and try to experience as many positive emotions as possible.

Drugs

Various ointments, gels and creams provide a good anti-edematous effect:

Badyaga is an excellent remedy for relieving swelling– product of animal origin;
troxevasin ointment– an antiprotective agent that has a pronounced anti-edematous effect;
drug "Traumel" (ointment, gel)– an excellent homeopathic remedy that has high regenerative properties and is good at reducing swelling.
ointments "Lioton", "Panthenol".

Physiotherapy

Also assigned:

phonophoresis(treatment of the affected area with ultrasound in combination with a drug);
electrophoresis(treatment of the affected area with electric current in combination with a medicine);
phototherapy(the therapeutic effect consists of exposure to a combination of near-infrared and blue ranges on the area of edema).

Traditional methods

Traditional medicine works quite effectively in the fight against swelling:

Good old aloe also helps in this case: you need to cut a leaf of this plant lengthwise and apply the cut to the swollen area;
Dried arnica, which can be drunk as tea, will also help.(brew 2 teaspoons per glass of boiling water) 2 times a day, and also use as compresses;
Compresses based on decoctions of string and chamomile help with swelling of the nose: a piece of bandage or gauze soaked in the broth must be applied to the swollen area for 20 minutes, and the procedure must be continued for at least a week;
the decongestant properties of ginger are known, a piece of the root of which can be thrown into tea leaves, can be brewed as an independent drink - cut about 4 cm of ginger root into thin strips and add 2 liters of water, brew in a thermos, add honey, lemon and drink throughout the day. Ginger should be used with caution; it is not indicated for everyone, in particular, people with high acidity of gastric juice, hypertensive patients, allergy sufferers, etc.

But we must remember that the use of decongestants is temporary.

Only some hormonal-containing medications directly affect the degree of swelling (for example, the injectable drug diprospan).

But the decision to prescribe them can only be made by a doctor! And the best healer for edema is time.

And your patience, which in this case must be shown inevitably, because the truth is that rhinoplasty is a very complex operation, and the recovery period after it is quite long.

A wide nose is characterized by a rounded, dense and fleshy tip without obvious relief. With thin skin, it is distinguished by splitting in the cartilage area.

Sometimes patients invent a problem and follow current fashion trends, having a completely proportional and neat nose shape. Find out whether the defect is real in your case: mentally draw strictly parallel vertical lines from the corners of the eyes to the chin (for clarity, you can use a pencil or other oblong object). If the wings of the nose protrude beyond the line, it means the tip is really wide.

Rhinoplasty of a wide nose is a frequent request for modern surgeons. If the structure of the back is correct and proportional, the operation affects only the tip of the nose. Manipulation extends to cartilage and soft tissue.

The structure of a wide nose

A wide nose is a “merit” of genetics. The problem is almost never associated with post-traumatic and other complications. A voluminous and shapeless tip of the nose is quite common among Slavs. This is due to the ethnic specificity of the structure of the soft tissues of the face.

The main features of the structure of a wide nose:

Widely spaced domes of large wing cartilages
Convexity of the lateral crura cartilages
Excessive thickness and “stumpiness” of the soft tissues of the nose

In patients with a wide nasal tip, adjacent defects in the form of a hump and other irregularities of the back are rarely observed. Therefore, rhinoplasty is limited to an isolated surgical field.

How is wide nose rhinoplasty performed?

Wide nose rhinoplasty is performed under general anesthesia or in combination with intravenous sedation. In such cases, I operate exclusively in an open manner, creating access from the columella. Closed rhinoplasty provides much less opportunity for jewelry correction of cartilage and soft tissues, so it is almost not used in this situation.

A wide nose rhinoplasty plan is developed during a face-to-face consultation. To do this, I talk with the patient about their expectations and goals, and then perform a 3D modeling. The procedure helps me come to a consensus with the person, obtain from him comprehensive information on personal preferences and wishes, clearly identify my own capabilities and demonstrate the final result of the operation with an accuracy of 90%. For 3D modeling, I take pictures of the face in different projections with the latest Vectra H1 camera. Then I transfer the images into a computer program, display them on a large monitor, and show the patient the actions that can be performed on the nose during surgery.

Having agreed on the result with the patient, I direct him to immediate preparation for rhinoplasty, which includes a series of tests and examinations. Based on their results, I determine the body’s readiness for surgery and make sure that there are no absolute or relative contraindications.

Rhinoplasty of a wide nose takes place according to the following protocol:

Premedication
Introduction of general anesthesia
Formation of access from the columella
Detachment of skin flap from cartilage
Narrowing and artificial delineation of domes
Approximation of domes in relation to each other
Partial excision of the lateral crura
Moving the lateral legs to the desired position
Removal of excess skin and subcutaneous fat from the tip of the nose
Resection of the skin in the area of the wings of the nose and their mobilization (due to this, a general narrowing of the nostrils occurs)
Stitching the arches (vaults) of the tip of the nose to stabilize the structure
Applying cosmetic sutures to wounds, inserting turundas or splints into the nasal passages, immobilizing with plaster or splints

With complete rhinoplasty, an osteotomy is additionally performed in different variations, depending on the current problems.

The listed actions apply to both the shapeless “bulb-shaped” and the forked tip of the nose.

The role of skin thickness in wide nose rhinoplasty

Skin thickness is a fundamental factor in the visual outcome of rhinoplasty.

Paradoxically, it is difficult to operate on a wide tip of the nose with thin skin. Only rhinoplasty virtuosos can handle this well. The surgeon requires extreme care and correct preliminary calculations so that the final aesthetics of the nose is satisfactory to the patient. However, with thin skin, it is easier to achieve an elegant and defined nose, as well as a significant reduction in comparison with the original.

A nose with thick skin is easier to operate on, but this feature often makes it difficult to create a chiseled and “sculpted” tip. In addition, thick skin is more prone to severe scarring, which may require corrective rhinoplasty later.

Non-surgical wide tip rhinoplasty: is it possible?

Non-surgical rhinoplasty (nose contouring) is designed to provide additional volume in areas of pits, dips, potholes and other atrophic irregularities in the nose. To level the hump, filler is injected at its base and end - this way the dorsum of the nose becomes smooth and straight. A wide nose cannot be corrected this way. The only exception is asymmetrical widening of the nose (but in this case, the opposite, filled side will become wider).

Some surgeons mean by non-surgical rhinoplasty injections of hormonal drugs - glucocorticosteroids (Kenalong, Diprospan, etc.). They are able to soften and split (partially) cartilage tissue, which allows you to model the nose “manually” and eliminate a number of imperfections in the wings and tip. The injection is followed by fixation of a special splint that compresses the desired areas of the organ. Only a plastic surgeon (not a cosmetologist!) should carry out such actions. They require careful calculation of the dosage and depth of drug infusion. Otherwise, the outcome of the procedure may be disastrous.

Rhinoplasty of a wide nose is a complex operation, the flawless execution of which can only be done by a good experienced surgeon. A responsible approach to choosing a doctor will ensure you the pleasure of contemplating the results of the operation and their sustainable preservation throughout your life.

To avoid complications, be scrupulous in choosing a plastic surgeon and clinic! Be honest with the doctor at the first consultations and during the preoperative examination - do not hide information about existing chronic diseases or injuries. Do not forget that the success of rhinoplasty largely depends on compliance with nose care standards during the restoration process.

Photos before and after wide nose rhinoplasty

Cost of wide nose rhinoplasty in Moscow

The cost of wide nose rhinoplasty in Moscow varies quite a bit. Many clinics offer their patients incomplete prices that do not include certain mandatory expenses. All prices that you will find on my website are “turnkey” and include:

Consultation (optional - with 3D modeling)*
Accommodation in a hospital with meals
The work of an anesthesiologist, assistant surgeon, junior medical staff
Anesthesia that is easily tolerated
Carrying out the operation
Modern materials used during the operation and during the recovery period
Dressings and examinations for 1 year after surgery

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Customer Reviews

I will be grateful to the doctor all my life! I had a terribly large, hooked Armenian nose. A lot of complexes hindered me in everything...

Hi all!!! I hope my post will be useful to those who are deciding on plastic surgery or have already experienced these sensations)) As you know, February 13, 2012...

I’ve been wanting to get my nose done for a long time, but somehow I didn’t dare, then several of my friends got their noses done and I...

Hello, I am interested in rhinoplasty. I am 23 years old, I had an operation to correct a septum when I was 6-7 years old. After the operation, almost...

Good afternoon, I’m interested in a question: do you do rhinoplasty in installments? The amount is not small ((And this is a dream...

I want to have a cheek lift, a circular blepharo and nose. Is it possible in one operation or not? Price? How long to come? On the recommendation of Maria from Rostov...

I have shin asymmetry and want to increase the shin on one leg. how much will it cost and how long will you stay at the clinic?...

Good afternoon I saw information on the website about the cost of rhinoplasty in Moscow: 240 thousand rubles. Please tell me what is included in this price? Best regards, Love...

Hello Sergey Viktorovich. I have the following problem: Not a big hump on my nose and not a very long tip. I wanted to do rhinoplasty, but in the septum...

Hello, do you do closed rhinoplasty? If yes, then in what cases?...

Good evening, I am interested in the cost of rhinoplasty. Currently the price listed is 210,000, is it a fixed price or does it vary...

Hello, I have a problem with my nasal septum, how much will it cost for support in St. Petersburg and for the nearest time...

Good afternoon I am planning to have rhinoplasty done by S. Morozov, I would like to do it after the New Year, but usually Happy New Year...

Good afternoon Sergey Viktorovich! Please tell me, is it possible to have rhinoplasty with simultaneous breast augmentation? Or does everything need to be done step by step? How...

Good afternoon Dear Sergei Viktorovich, I would like to clarify the following point. Is primary rhinoplasty possible with simultaneous removal of a nasal polyp?...
All questions

Questions about plastic surgeries performed by plastic surgeon Sergei Morozov

Catherine

Hello, doctor! I want to correct a deviated nasal septum, which is the cause of difficulty breathing. I’m also thinking about improving the tip of the nose. I would like to do septorhinoplasty with you, in St. Petersburg. What is the total cost + what other expenses will I need? Thank you, I'm waiting for your answer!

Ekaterina, hello. if the nose has not been operated on, such rhinoplasty will cost 200 thousand rubles in St. Petersburg. This cost includes everything except the preoperative examination (tests). Tests can be taken at any medical center, including at your place of residence. You can take it at our clinic and then it will cost about 10 thousand rubles. Other expenses may be related to living in St. Petersburg and other expenses that are not directly related to the operation.

Hello, could you tell me if you give diprospan injections into the nose of other patients? (/cost) It’s just that my surgeon is against diprospan and doesn’t inject it into his patients. A year has passed since rhinoplasty, the skin has not settled on the beautiful frame: (I really hope for your help. Thank you for your answer)!

Hello. There is one subtlety here, very significant, diprospan gives a real improvement in the appearance of the nose only in the case (and we are, of course, talking about noses with thick skin) when a good rigid frame is created under the skin of the nose and the skin is, as it were, stretched over it. This is the main condition for a good result of rhinoplasty of a nose with thick skin. If it is followed, the injection will definitely have an effect. If there is no such frame, the effectiveness of the injection is very doubtful. This concerns the rigidity of the frame and this can be checked by gently pressing with your fingers. As for the “beauty of the frame” - how is this known if the skin “has not shrunk”.

Hello! Tell me, please, is it possible to change the nose something like in the photo? And approximately how much does such an operation cost in St. Petersburg?

Hello Alena, Yes, you can change the shape of your nose this way. Such an operation requires the use of a rib graft, since the nose itself does not have the amount of tissue that is required for such changes in the shape of the nose. The cost of such an operation in St. Petersburg will be 250 thousand rubles. Similar operations (results) are presented in galleries both on my website and on my Instagram.

Good afternoon Is it possible to have rhinoplasty while wearing braces? What are the prices for full rhinoplasty in Moscow and are there installment plans? Thank you.

Hello. It is possible to do rhinoplasty if you have braces, and we now have quite a lot of such patients. The cost of complete primary rhinoplasty in Moscow is now 230 thousand rubles. There are no installments.

Sergey Viktorovich, hello. Please tell me, do you perform operations to correct only the nasal septum? If so, what is the approximate cost range for such an operation and what is included? Is it possible to do it in Moscow? Thank you, best regards, Anna.

Anna, hello. I perform such operations (correction of the nasal septum to improve nasal breathing). The cost of the operation in Moscow at the Medlange clinic will be 85 thousand rubles.

Victoria

Hello! I had rhinoplasty two years ago. The nose is still terribly swollen, the tip of the nose is hard and the skin is thick, although it was thin before. I wanted to know if you give Diprospan injections?

Hello. To resolve the issue of diprospan injections, you need to look at the nose in order to understand what needs to be done. Swelling during primary rhinoplasty almost completely disappears 12 months after surgery. Therefore, to figure it out, you need a consultation or at least a photo. Photos are needed in two projections, full face and profile, the whole face, in adequate quality - it’s better not from a phone, but taken with a camera.

Victoria

Hello! I am very interested in frontoplasty, namely the reduction of the brow ridges, because when they are lowered they look like a drooping upper eyelid. Do you carry out similar operations and costs? Sincerely,

Victoria, hello. I don't perform such operations.

Hello! How much does otoplasty cost for both ears? You just need to remove the protruding ears.

Hello. Otoplasty will cost 65 thousand rubles. This is local anesthesia. Under anesthesia - 80 tr.

Veronica

Hello. I am interested in the full cost of the ENT surgery and how many days I will need to stay in the hospital. The nasal septum is curved - on the right in the cartilaginous section, on the left the ascending ridge along the nasal septum in the osteochondral section. The injury is already 19 years old. I am 33 years old. Rhinoseptoplasty is indicated. In my city they don’t take my case. They advised me to contact your clinic. Thank you!

Hello. To answer your question, I need to clarify this: are we talking specifically about ENT surgery? You write ENT surgery and then you write rhinoseptoplasty. ENT surgery is the correction of the septum, conchae, etc., that is, everything. which is aimed at improving nasal breathing. Rhinoseptoplasty - includes all these components + improvement of the shape of the nose. These operations differ significantly in scope. complexity and, accordingly, cost.

Sergey Viktorovich, hello! You answered me that you only use Arion implants, and at the same time, surgery with anatomical textured ones costs 230 thousand. rub. (everything included, except tests). I would like to clarify, is this the cost of ARION implants with hydrogel (bioimplants) or with SoftOne® cohesive silicone gel? The first ones are very interesting: with hydrogel. Do I need to undergo the entire list of tests at my place or only at your clinic? If you have, I would like to know how much all the tests cost. And another question: how long should I stay in St. Petersburg, taking into account the removal of stitches and all dressings: three days, a week? I would like to know in order to estimate the cost of this item. Thank you very much for your attention!

Zarina, hello. This is the cost of surgery with implants filled with silicone gel. With hydrogel, the implants themselves are about twice as expensive and this filler makes no sense. Actually, it doesn't, in my opinion. But if you want, I can select and place such implants, since the principles of marking and the surgical technique itself are no different. It is better to take tests in advance and come with the test results in hand. otherwise you will waste two days in St. Petersburg in vain. It is enough to stay in St. Petersburg for 10 days.

Good afternoon, my name is Zhenya. 29 years. I had rhinoplasty in 2007. The nose is crooked, secondary rhinoplasty is needed. I live in Kazakhstan. Almaty. Tell me, is it possible to consult online? Do a simulation? Negotiate a price and set a date remotely? To fly straight to the operation.

Evgenia, hello. Yes, everything can be done this way. Send it. please email me [email protected] Full face and profile photos of the whole face in adequate quality. Specify what to model. After you look at the photo and we discuss everything, I will be able to indicate the cost of the operation and set a date.

Hello, Sergey Viktorovich! Do you do facial lipofilling? Sincerely, Yulia.

Julia, hello. In some cases, I perform facial lipofilling as an auxiliary procedure in eliminating age-related changes in the eyelids and/or facelift. As a separate procedure, facial lipofilling is rarely required.

Hello! I had septoplasty 3 months ago, and after it I had a pronounced hump, I had it before the operation, but after it it became very noticeable, it felt like the tip of the nose fell after the operation and a dip appeared just above the tip of the nose, which and forms a hump! I read it, and they say that the doctor could have removed a lot of cartilage, the supporting part of the nose! And it acquired a saddle shape! Of all the options, rhinoplasty with the installation of your own “cartilage” is distinguished! How can I get my old nose back? Do you have any experience? How do you see my problem and how much does the operation cost?

Hello. Such a situation, when the support of the nose decreases after surgery on the septum, is possible and I would not say that it is very rare. This depends on the amount of cartilage removed and the strength of the nasal skeleton. Why this happened specifically in your case - I will not undertake to give a categorical answer. In some cases, with very severe (especially traumatic) deformation of the septum, it is necessary to remove a lot of septal cartilage and the risk of loss of support increases. In terms of what can be done, there are two options to solve this problem. One option is to restore support to the nose by restoring the damaged septal “frame” (frame) from the costal cartilage and either “return” the previous shape of the nose, or eliminate other shortcomings in the shape of the tip and back of the nose, since the operation in any case is voluminous and will affect all sections (back and tip) of the nose. To return exactly the previous shape of the nose - no one can guarantee this anyway. This option is more labor-intensive, but more correct and will give the best and most stable result. The second option is a partial solution to the problem. Without complete restoration of the supporting cartilaginous “frame,” the consequences of loss of support, namely retraction above the tip of the nose, can be partially eliminated. You can take a cartilage fragment (in this case, a fragment of cartilage from the auricle is sufficient) and fill this recession by placing a graft from the “ear” cartilage under the skin. This will make the deformation less noticeable. since the back will be more even, but the drooping of the tip of the nose will remain. The result will be, let’s say, partial and less stable, that is, drooping of the nose over time is more likely than with the first option. But it's easier, faster and... of course, cheaper.

Hello Seregey) I had septorhinoplasty a year and a half ago in Moscow. The result does not fully satisfy me. There was a straight nose with a small hump, and crooked. Result: the bridge of the nose was cut off more than desired and the curvature remained, now even more noticeable than before. Moreover, from the side of the curvature, there is sticking, as if a finger had pressed on the side of the bridge of the nose, like a dent. I understand that ideally a repeat is needed, but after such a long recovery, Diprospan injections, after swelling that has gone poorly and for a long time, and the looks of my friends in which I saw the question, “Why did you do that?,” I won’t risk deciding on a second operation. In rare photos I now like myself, because... the nose is crooked and not straight((((My plastic surgeon is apparently upset, but I understand him, what to do now... I make no claims that this will change... The doctor advises filling this depressed area with hyaluronic acid, MB and the back will seem higher than now. But I don’t know whether to agree or not. How can I imagine that now I’ll have to fill it out all my life???? It’s not a fact that it will turn out well, and I’ll just get used to the straight nose, and after time it’ll all happen again will appear((((Sergey, I really want to hear your opinion. And if I still decide to use hyaluronic acid, how often should I use it, and does it give me bumps? And also, it’s a pity that you work only in St. Petersburg. Photo I can't upload. I'm 25 years old.

Masha, hello. I can't answer adequately without a photo. Front and profile photos are required. You can send it to my email address [email protected] Hyaluronic acid - there are different preparations of hyaluronic acid, the speed of their resorption differs - you need to look at the drug. It also depends on the body. This is of course a solution to the problem, but not the best. Approximately - every 4-6 months you will have to finish it off. As for Moscow, I operate in Moscow every Sunday.

Good day, Sergey! Tell me, please, do you work with thick skin on the nose? Is it possible to make a neat little nose in this case? And is it possible to find out the approximate cost of the drug in St. Petersburg?

Anna, hello. Just like any surgeon. As a rhinoplasty practitioner, I regularly deal with thick skin and work with such patients. The basic rule is that you cannot shorten your nose excessively - then you can get a beautiful result. This is related to that. that with thick skin there must be a sufficiently strong and pronounced frame of the nose so that the skin is well “stretched” and does not spoil the shape of the nose.

Good afternoon, Doctor! Tell me, how much do the prices for re-rino differ in Moscow and St. Petersburg? How often do you visit Moscow? And how do you manage patients undergoing surgery in Moscow? Thank you

Hello. I visit Moscow almost every week (on Sundays). Accordingly, the patients whom I operated on come to me for examinations on this day. The difference in cost for revision rhinoplasty in Moscow and St. Petersburg is about 30 thousand rubles.

Sergey, hello) your opinion is very important. A year and a half ago (not you) I had septorhinoplasty. Moscow plastic surgeon. Result: on one side of the nose there is a swelling (where did it even form if it wasn’t there before the rhino and the tip was not operated on...), and on the opposite side - on the contrary, there is a dent, as if someone pressed on the side of the back with a finger...). The nose looks asymmetrical. Crooked. And not directly in profile, as agreed. Maybe it’s in the tissues of my nose, maybe I’m just unlucky... but the doctor said that apparently I’ll have to fill this dent with hyaluronic acid, and once again I did diprospan for the swelling ((((I still don’t understand how this happened. ...that I must accept the fact that the result of the operation was not entirely successful. I understand that I will not dare to undergo a second operation. Sergey, what would you do in my place? Agree to hyaluronic acid? Or is this also a risky thing? Maybe the gel will spread lumps? And the fact that this is all temporary, and I will have to take these injections for the rest of my life? Yeah... I’m just afraid to take the risk a second time, in case they make it even worse....(

Polina, hello. It is impossible to accurately answer your question without a photo. Tentatively, I can say that the optimal way out of this situation may be a repeat operation. Hyaluronic acid will be completely absorbed and injections will have to be repeated constantly. As for diprospan, it is very effective in some cases. Sometimes it allows you to avoid minor corrections. But the capabilities of diprospan are very limited. If you have already had several injections and have not received any results, you can obviously conclude that further injections do not make sense. If you haven’t had any injections yet, there may be results. A very small asymmetry may go away, a significant one is unlikely, but it may become less noticeable. Then it’s up to you to decide whether you are satisfied with the result or whether you want to undergo a repeat operation.

Hello! How much will primary rhinoplasty cost in my case?

Hello. This is a standard full-scale rhinoplasty. The cost of the operation will be 190 thousand rubles.

Hello, Sargey Viktorovich! I really want to have a nose operation with you, I’ve been studying photos of your work and reviews for a long time, from your answers to questions I realized that I can take all the tests in my city and consult about everything with you, again from my city, and then come for the operation , but I’m interested in one question, I once saw that you can do an operation on credit, so the question is: how realistic is this and what is needed for this? I’m 19 years old, and banks won’t give you such a big loan, exactly, what’s the deal with this in your clinic? Thank you very much in advance for your answer!

Daria, hello. You need to call the Attribute clinic and clarify everything regarding the loan with the clinic administrator. The clinic does not provide loans, but the clinic works with a bank, where it will most likely be easier to get a loan specifically to pay for an operation in our clinic.

Hello, Sergey Viktorovich! I really need your advice. Just recently (a couple of weeks ago) I had my septum corrected. I was denied rhinoplasty because... They said that I have thick and porous skin on my nose, there will be severe swelling (I will have to give injections), such skin contracts poorly and can sag. But I want to have rhinoplasty, I have complexes about my nose (I’m embarrassed to smile), namely, I would like to lower the bridge of my nose and make my nostrils rounder and smoother (all at your discretion, of course). 1 Photo. Before and after surgery. It can be seen that the nostrils are not quite straight; the doctor told me to achieve perfectly straight ones is almost impossible. And the nose looks different from one side to the other. 2Photo. Skin of the nose. 3 Photo. Not my favorite nose in a smile. 4Photo. Profile. Please answer, will you take my nose? I know that it is too early to operate within 6 months after septoplasty. I plan to fly to you in February next year in St. Petersburg. Will you be operating in St. Petersburg this month? Do I need to know for sure and take a vacation for this period (if you can) and how much time (where, with whom) should I make an appointment before the approximate planned date? And of course, if it’s not difficult, what is the estimated cost of such an intervention (examination, consultation, operation itself, hospital)? I apologize for the not very good quality of the photos (I just scaled them down a lot). And if you need clearer photos from a different angle, I can send you an email. I will be waiting for your answer! Thank you.

Olga, hello. Thick skin is not a reason to refuse rhinoplasty; among specialists who perform these operations, this is a well-known thing and is not subject to discussion. Another thing is that the operation is performed incorrectly. as in patients with normal or thin skin. Namely: you cannot significantly reduce the nose, but you need to focus on changing its shape, not size. Very rigid and reliable support structures are required to prevent the tip of the nose from drooping and losing its shape. The recovery process takes longer (12 or more months) and indeed, in most cases, it is necessary to inject appropriate medications into the skin of the nose. But, if all these conditions are met, you can get a very beautiful result, and you can see quite a lot of similar cases on my website (photo gallery). Next, if we move on to your case. The main material from which nasal structures are made during such operations is the septum. Therefore, surgery on the septum must be performed simultaneously so that the removed parts can be used for the rhinoplasty itself. In your case, we will no longer have such an opportunity and, most likely, the material will have to be taken from the costal cartilage, which leads to a more complicated operation, an increase in its duration, etc. accordingly, to an increase in its cost. There will also be a small scar (about 2.5 cm) in the chest area after taking a fragment of rib cartilage. The operation is quite feasible, its cost will be 240 thousand rubles. (St. Petersburg), you can sign up for an operation through my email address, or for a consultation by calling the Attribute clinic (all contacts are on the website). Sign up for surgery - if we are talking about February - 2-2.5 months in advance.

Edema is an obligatory accompaniment of rhinoplasty, occurring in 100% of patients. It spreads not only to the nose, but also to neighboring tissues - eyelids, cheeks and cheekbones.

Postoperative edema is the body’s response to artificial injury. The severity and persistence of edema depends on various factors - from age to individual characteristics. Edema is conventionally classified as superficial and deep. The former are neutralized quickly, the latter within a year. It is for this reason that an objective assessment of the results of rhinoplasty is relevant only after 9-12 months.

Why does swelling appear after rhinoplasty?

The reason for swelling after rhinoplasty lies in the technique of performing the operation. During the correction process, the surgeon peels the skin away from the bones and cartilage. This entails damage to blood vessels and capillaries. Biological fluids stop circulating in the tissues in an optimal healthy manner. Added to this is nutritional deficiency - oxygen and nutrients are delivered more slowly, which reduces the rate of natural regeneration.

Edema is a temporary and conditional complication. It always appears, regardless of the level of competence and experience of the surgeon. The severity of swelling is partly related to the number of tasks during rhinoplasty: the more adjustments made, the larger the swelling will be.

Quite often, patients themselves provoke intensification and “strengthening” of swelling, neglecting the surgeon’s recommendations during the rehabilitation period. First of all, this concerns smoking. Exposure to nicotine is bad for healing. From tobacco smoke, blood vessels recover worse and take longer, and swelling increases. Ban yourself from smoking for at least a month after rhinoplasty, and you will notice that recovery is easier and faster.

Important: There is a category of patients who believe that by squeezing or moving the cast after rhinoplasty, they will “squeeze out” the swelling. Such actions lead to displacement and deformation of bone and cartilage tissue, reducing the result of rhinoplasty to zero. Of course, this does not make the swelling go away; on the contrary, it increases.

Having noticed any changes in the position of the cast, I decline responsibility for the outcome of the operation.

The mechanism of edema development after rhinoplasty

Primary, or intraoperative edema, occurs during the operation. Competent surgeons know how to level it out. When performing rhinoplasty, the anesthesiologist and I locally administer certain medications to instantly eliminate swelling (which is why The role of the anesthesiologist is very important!!!). This is useful for both me and you: I simultaneously achieve “cleansing” of the surgical field and effective prevention of severe secondary (postoperative) edema.

When completing rhinoplasty, I, like any surgeon, apply an immobilizing bandage to the nose - a plaster cast or a splint. It helps control swelling during peak recovery.

After removing the plaster postoperative swelling may increase sharply, but after 2-2.5 weeks there will be no trace left of it. Only swelling of the deep tissues will remain, but will be practically invisible to prying eyes. It lasts for 3-6 weeks and causes discomfort to the patient - a feeling of heaviness in the nose and nasal obstruction.

Feeling nasal congestion, a person gets scared, believing that rhinoplasty has led to functional complications. However, this is not so: obstructions are associated with transient expansion and thickening of the nasal tissues. This condition does not require therapy, but I advise patients to use mild sea salt sprays and drops for relief. Vasoconstrictor solutions (“Xylen”, “Tizin”, “Rinostop”, etc.) cannot be used.

Residual edema affects the deepest structures of the nose. It is practically invisible, although it can “walk”, moving from the back to the tip or vice versa. It is expressed in the hardness of the nose when palpated. Elimination period is 5-9 months.

What determines the rate at which swelling disappears?

I identify two factors that prolong swelling, which the patient is unable to fight:

Skin thickness. In people with thick, oily and porous skin, swelling goes away slowly, and the tissue takes a long time to heal. Rhinoplasty of a nose with thick skin is a separate topic. Only a few plastic surgeons can handle it well. People with thick skin need to be careful and conscientious about the rules of rehabilitation;
Age. Aging is not limited to age-related changes in appearance. Over time, metabolic processes and biochemical reactions in the body slow down, which inhibits regeneration processes. Prolonged restoration of blood vessels prevents the rapid removal of edema. In mature patients it takes longer to go away than in young patients.

The remaining factors are indirect and can be eliminated by the patient himself:

Bad habits (nicotine and alcohol);
Thermal procedures;
Irrational nutrition;
Domestic injuries (even mild);
Wearing heavy-framed glasses.

To speed up the removal of swelling, follow simple rules:

Sleep on your back with a low, firm pillow;
Refrain from pickles, smoked meats and fast food;
Eliminate smoking and alcohol for 3-4 weeks;
Avoid exposure to heat;
Avoid steaming procedures, including baths and saunas;
Take medications only as agreed with your doctor (many “harmless” drugs like diuretics can seriously harm you);
Handle your face as gently and carefully as possible (when washing, removing makeup, etc.);
Keep your head straight and do not bend down;
Make sure to protect your nose from injury (fasten your seat belt in the car, do not rub or scratch your nose, do not try to clear your nasal passages with foreign objects, do not visit crowded places, do not travel on public transport during rush hour);
Limit physical activity;
Walk more and breathe fresh air (physical inactivity complicates the healing process).

Please discuss the use of any local and systemic medications to optimize blood flow and lymphatic drainage with your surgeon in advance (including Troxevasin, Troxerutin, Traumeel-S ointments, etc.). Self-medication is always harmful, and especially after surgery.

Professional cosmetology in the fight against edema

Rehabilitation is a voluntary step, and I do not force my patients to do it. Its average cost is about 30,000 rubles. As a rule, it includes a course of hardware procedures and/or medicinal injections.

The following methods have proven themselves to be effective in rehabilitation after rhinoplasty:

Microcurrent therapy. Exposure of soft tissue to high-frequency electrical impulses helps to normalize tissue metabolism, activate local blood circulation, stimulate the regenerative and proliferative functions of tissues;
Phototherapy. Irradiation of injured areas with blue and infrared light has a disinfecting and anti-inflammatory effect, regulates metabolism, and promotes intensive regeneration.

Attention: any additional manipulations aimed at accelerating healing or relieving swelling, even if they are performed by qualified doctors, must be discussed with the operating surgeon!

Extremely any massage is contraindicated middle third of the face, including the nose area!

You can minimally speed up the decline of swelling, but you shouldn’t count on a fabulous transformation. Be patient, follow the surgeon’s recommendations, and very soon you will sincerely admire the reflection in the mirror.