Rhinoplasty for oily skin. Analysis of the nose and face 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.

Many of my colleagues believe that working with the tip of the nose is the most delicate and difficult stage of rhinoplasty. I don't think so. There's really nothing particularly complicated here. In order to narrow the nose, it is necessary to remove the posterior pterygoid cartilage:

Thanks to this, we can narrow and slightly raise the tip of the nose. Like this:

Having sufficient experience, I perform all these manipulations in a closed way. Thanks to this, as well as a special technique for periosteal detachment, it is possible to avoid unwanted internal scars and complications that make rhinoplasty one of the most unpredictable plastic surgeries.

Look how much the faces of these young women have changed. It would seem like a small correction, and their features became noticeably more refined. They both even look younger!

A harmonious nose with a beautiful, regularly shaped tip made this young girl’s facial features softer. And most importantly, only after the operation did she finally feel confident. All photos were taken after a short time ( only 4 weeks) after operation. With time ( when the swelling finally goes away) girls' nose lines will become even more graceful, and the noses themselves will become thinner and more feminine.

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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

The skin of the nose has uneven thickness. At the nasofrontal angle the skin is quite thick - up to 1.25 mm. Gradually thinning, the skin thickness is already 0.6 mm in the area where the triangular cartilages, septal cartilage and nasal bones come into contact with each other. Thickening of the skin is observed in the lower third at the tip of the nose. Hardening of the skin in this area is often a consequence of hypertrophy of the sebaceous glands.

The results of surgical correction of the nose depend both on the type of skin, its thickness and structure, and on the condition of the sebaceous glands and subcutaneous fat. The thickness of the skin covering the nose largely determines the outcome of rhinoplasty.

At thin skin surgical interventions on the soft tissues of the external nose must be carried out with great care to avoid necrosis and the formation of through holes in the nasal septum. Moreover, when reducing the size of the nose, thin skin will shrink to a greater extent than thick skin. In this regard, the plastic surgeon can plan relatively significant changes when correcting the shape of the nose. But at the same time, even minor irregularities in the back and tip of the nose can be visible through thin skin.

At thick skin and the significant thickness of the subcutaneous tissue, correction of the shape and size of the nose can be done only to a limited extent. To a greater extent, this applies to the correction of congenital nasal defects, which are characterized by thick, porous skin at the tip of the nose. Such skin contracts poorly and tends to take its previous position.

If previously skin with a thick subcutaneous layer was a contraindication for aesthetic rhinoplasty, today it is possible to sufficiently predict the result after surgical correction of the nose. During rhinoplasty, methods are used to correct both the supporting structures of the nose and the thick, porous skin. In some cases, laser skin resurfacing is additionally used.

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 with the advice of 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.