[Edit this paragraph] IV. Preparation process before rhinoplasty
It will tell you how to make preoperative preparation, including your diet, some medicines, rest, smoking and methods of cleaning your face. Follow the instructions carefully and your rhinoplasty will be smooth. Two days after the operation 1-2, you should try to arrange another person to take you home or accompany you in the hospital. Your communication with is also very important. At first glance, the plastic surgeon will ask you what you like about your nose. Check the outline structure of your nose and face; Discuss various possibilities with you and so on. I will also explain to you some factors that affect the operation process and results. These factors include the structure of your nasal bones and cartilage, your face shape, your skin thickness, your age and your expectations.
Selection of anesthesia mode
Rhinoplasty can be performed under local anesthesia or general anesthesia, mainly depending on the scope of operation. If you choose general anesthesia, you will be asleep during the whole operation and feel nothing. If you choose local anesthesia, you will stay awake during the operation, but your nose and surrounding tissues will feel numb and insensitive, but occasionally you will feel a little uncomfortable. You just need to relax.
Surgical method
Rhinoplasty usually takes 1-2 hours, although some complicated operations may take longer. During the operation, the skin of the nose will be lifted from the nasal bone and the cartilage below, and then the nasal bone and cartilage will be carved according to your requirements and techniques, or the carved nasal support will be directly implanted to achieve the desired effect. Finally, sew the skin back to its original position.
Most rhinoplasty is done in the nostrils, and no trace can be seen after operation. Implants are made of materials that are compatible with human tissues, such as silicone rubber and polytetrafluoroethylene. Rejection is extremely rare and easy to carve.
At present, most rhinoplasty operations form an incision about 1 cm on the inner side of the nostril edge at the junction of the nasal columella and the alar, through which a spacious cavity is separated under the fascia of the nasal dorsum or/and the periosteum of the nasal bone, and then the prosthesis is carved according to the patient's requirements and techniques, or directly implanted into the already carved prosthesis to achieve the desired effect. Finally, sew the skin back to its original position.
Some complicated operations often need to make an incision on the columella, and an inconspicuous scar will be left on the columella after operation.
Polizel's therapy
Within 24 hours after operation, your face will swell, and you will feel nose pain and dull pain, which will be controlled by drugs. On the first day after operation, it is best to lie in bed (except going to the toilet) and hold your head high.
You will see swelling and bruising around your eyes 1 day after operation, and reach the peak in 2-3 days after operation. Cold compress will relieve some swelling and make you feel better. The swelling usually disappears gradually 2-3 weeks after operation.
It is common to have some bleeding in the first few days after the operation. You will feel stuffy nose for a few weeks after operation, and you will be asked not to blow your nose during this time.
Most patients with rhinoplasty can go to the scene the day after operation and resume their studies one week after operation, but it does take 3-4 weeks to fully return to normal.
You should gradually return to normal activities after the operation. It is recommended not to do strenuous exercise, such as running and swimming, which will increase blood pressure 2 -3 weeks after operation. Don't hurt or bruise your nose for two months, and don't expose yourself to the sun too much. When washing your face, combing your hair and using cosmetics, you should move gently. You can wear contact lenses after surgery, but it is usually 3-4 weeks after surgery.
The swelling and bruising in the first few days after a brand-new nose operation may make you forget that your nose will look good. In fact, many plastic surgery patients will feel depressed in the first few days after surgery, which is very normal and understandable. Rest can make this unpleasant period of depression pass smoothly. Your nose will look better every day, and your spirit will gradually get better. 1 -2 weeks later, you will feel that you have never had an operation.
However, the healing of surgery is a slow and gradual process. The swelling of the tip of the nose may last for several months. Sometimes it takes a year or more to see the final result. At the same time, you may experience abnormal reactions from your family or friends. They may say that your nose hasn't changed before and after the operation, and some people may even resent you for changing the view of your family or friends. If this happens, you must remember the purpose of your planned operation. If the operation itself has catered to your wishes, then your operation is successful.
[Edit this paragraph] V. Aesthetic standard of nose
Can you give a standard to the beauty of the nose? This is influenced by culture, customs, habits and aesthetic concepts. Every country, every nation and everyone has different ideal nose types. As far as the Han nationality in China is concerned, the normal and beautiful nose is a bottom-down triangular pyramid, which is located in the middle of the face 1/3; The ideal external nose length is 65438+ 0/3 of the face length; The ideal width of the external nose is the width of one eye, which is what ancient painters in China called "horizontal three" and "vertical five"; The ideal nose shape is an inclined plane with a narrow top and a wide bottom, and the inclined plane intersects the face at 25-30 degrees; The ideal height of the tip of the nose is 65438+ 0/3 of the length of the nose, the tip of the nose is round, the nostrils are flat, and the columella is 90 degrees from the upper lip.
[Edit this paragraph] VI. Which noses are suitable for rhinoplasty?
1, low nose bridge: refers to the root of nose to the tip of nose, and the whole nose bridge is relatively low. Strictly speaking, all ethnic groups have an average bridge height. If it is lower than this value, it is called a low nose. Some people regard the height of the bridge of the nose of the western nation as the standard, but think that their own bridge of the nose is low, which is obviously inappropriate. In addition, to determine the height of the bridge of the nose, we should also consider various characteristics such as face shape.
2. Saddle nose: It is a common nose deformity in China. Like a low nose, the height of the bridge of the nose is lower than that of normal people. The bones and cartilage of the bridge of the nose are mostly concave, but the tip of the nose is upward and saddle-shaped.
3, straight nose bridge: the height of the nose bridge is ok, but the shape is straight and lacks a conical feeling. The highest point is not at the tip of the nose.
4, nose tip drooping nose: nose tip drooping, the highest point of the nose is located at the back of the nose wing.
5, the nose root is low and flat nose: the nose root is low and flat, the shape of the tip of the nose and the back of the nose is acceptable, the eye distance is wide, and the nose is short, which is out of proportion.
6, wavy nose: There are two depressions on the central axis of the back of the nose, which makes the central axis of the nose incomplete and smooth.
7. Nose recumbent: It is common in secondary nasal deformities after cleft lip surgery due to poor development of the tip of the nose, incorrect nostrils and wide and flat alar.
[Edit this paragraph] VII. Selection of implant materials:
Whether it is congenital or caused by disease or trauma, people have been looking for suitable materials to cushion it.
There are two main methods of rhinoplasty, transplantation and implantation.
Transplantation: tissue transplantation, which mainly fills the nose with bone and cartilage tissue.
Bone and cartilage tissue transplantation has three situations:
① Heterogeneous bone and cartilage transplantation, that is, transplanting animal bone and cartilage tissue into human nose. Animal bones and cartilages are rich in resources and have a long history of use. However, due to the antigenicity of xenogeneic bone and cartilage, its rejection and late absorption limit its use.
② Allotransplantation of bone and cartilage tissue uses other people's bone and cartilage tissue as filler. Although this method can achieve good results, its source is difficult, its application is limited, and there are still problems of rejection and late absorption.
③ Autologous osteochondral transplantation uses the patient's own bone and cartilage as the filling material. Autologous cartilage carving is easier, while autogenous bone carving is more difficult. The advantage of this method is that there is no rejection and it can exist forever. The disadvantage is that it is very painful to take bone and cartilage from patients; Can not be formed in advance, thus prolonging the operation time; Buried for a long time, it will also undergo slight absorption deformation.
Implantation: all kinds of artificial implant materials are implanted into the nose.
Up to now, people have used platinum, gold, silver, vaseline, paraffin oil, ivory, plexiglass, liquid silicone rubber and so on. Due to their inevitable complexity, these materials have now been abandoned. At present, the nasal cavity filling material widely used in clinic is medical solid silicone rubber. Medical solid silicone rubber has the advantages of stable performance, small properties, moderate texture, pre-forming, no deformation in the body, easy treatment of postoperative complications and unsatisfactory appearance, and no adverse reactions when used correctly. It is a rhinoplasty material with the longest clinical use, the largest quantity and the widest range. With the development of science and technology, some new nasal cavity filling materials have appeared in recent years, such as polytetrafluoroethylene, medical porous materials, hydroxyapatite, methyl methacrylate and so on. These materials have the advantages of convenient source, no absorption in the body, no damage to the donor site, pre-forming and shortening the operation time. As a foreign body, although it is not easy to cause human rejection, it is easier to be discharged than autologous tissue. People are generally concerned that whether these materials will cause cancer after being implanted into the human body is still inconclusive. According to the medical solid silicone rubber widely used in clinic and used for a long time, no obvious carcinogenicity has been found so far. As for which material is good, it is difficult to draw a conclusion. It depends on the patient's nose, the source of the implant material, the patient's requirements and his surgical hobbies. Due to the short clinical application time of the new material, whether the new material can stay in the body safely and for a long time requires long-term clinical case follow-up observation to make a final judgment.
[Edit this paragraph] VIII. Matters needing attention after rhinoplasty
1, local cold compress with ice pack at the beginning of operation can reduce postoperative swelling. From the fifth day after operation, local hot compress should be done to promote recovery.
2, rest: simple rhinoplasty, can not be hospitalized, pay attention to rest at home after surgery.
3. The prosthesis has not been wrapped by fibrous membrane within one week after operation, and it is in an unstable stage. Be extra careful not to touch, squeeze or bump this part.
4. If you feel unwell after operation, you should arrive in time.
[Edit this paragraph] 9. Contraindications for rhinoplasty:
1, the age is below 18 and it is in the development stage.
2, facial or physical infection (such as furuncle or folliculitis).
3, the nasal sebaceous glands are rich or have rosacea.
4. People with allergies.
5. People who are mentally unstable or have doubts about the filling materials.
[Edit this paragraph] X. Risk and prevention of rhinoplasty
The risk of rhinoplasty is usually cosmetic surgery. According to the statistics of American Plastic Surgery Association, 10% of rhinoplasty operations need secondary operation or repair. The health risks of rhinoplasty include infection, nerve damage and poor appearance.
infect
This is a common problem faced by all surgical operations. Only after the aseptic technique is gradually improved and the infection is effectively controlled can surgery flourish. Rhinoplasty itself is a sterile operation. As long as the patient is healthy and has strong resistance, and there is no infection focus (such as folliculitis, furuncle and skin injury) at the operation site, strict aseptic operation will be carried out during the operation, and attention will be paid to prevent the wound from being polluted after the operation, and antibacterial drugs will be used to prevent infection if necessary. In addition, people's facial blood circulation is rich and their anti-infection ability is strong, which is also the reason why rhinoplasty is not easy to be infected.
Injure nerve
The nervous system of human body is the "communication system" of human body. The more nerve trunks and branches appear in different parts of the central nervous system, the thinner the branches are, and they spread all over the whole body "system", "region", "department" and "family" like cobwebs. Only when the continuity of nerve branches is interrupted, the subordinate "area" will be inaccessible, and the "area" will be unable to command and paralyzed. The place where rhinoplasty is "constructed" is a "remote area", and there is no communication "cable" passing through it; Furthermore, the nerves of the nose are distributed in the soft tissue layer, and the "structure" of rhinoplasty is below it. Unless you haven't seen medical training, rhinoplasty is unlikely to damage your nerves.
Poor appearance
Whether you can get a good and satisfactory nose through rhinoplasty depends on your experience and skills. Frequently asked questions include:
The bridge of the nose is too narrow, not soft, and looks "fake" (unnatural), which makes people know that it is made at a glance;
The nasal root is too high, and some reach the forehead, forming the so-called "Tian Tong nose";
The nose root is high, the nose tip is low, and the appearance is indecent;
The face is slender, the nose is wide, the nose is stupid, and the facial proportion is out of balance;
My nose is crooked.
The above situation mostly occurs in rhinoplasty surgery (statistics in the United States are 10%), which is related to experience, patients' own conditions and later recovery nursing. It is inevitable that mistakes will occur. Plastic and cosmetic surgery calls these postoperative defects "secondary deformities after rhinoplasty". If the defect is obvious, you must have another operation to remove, repair or replace the silicone stent.
1. Trimming: If the shape of the nose changes from high to low, from long to short, from wide to narrow, and from crooked to straight, use solid silica gel to take out the bracket to correct the problem and put it back after reaching the ideal shape. This operation is simpler than the first operation, and because it is ready-made, there will be no obvious swelling reaction after operation.
2. Replacement: If you want to change the nose shape from low to high, from short or narrow to wide, you must take out the old one and replace it with a new one. Rhinoplasty stents are generally carved in advance under the stage, sent to disinfection, and can be implanted after the operation (without trimming or slightly trimming). One of the advantages of this is that the operation time is short, and the other is that there is enough time to carefully carve the model under the stage. The "patient" sits by, observing while carving, putting the model on the patient's nose to see if it is suitable, and repeatedly trimming it if it is not suitable until it is satisfied. Replace the rhinoplasty bracket because the old bracket covers the original shape of the nose, and I don't know what the replaced bracket should look like, so it's best to bring the original photo before rhinoplasty, so that you can have a good idea when carving. Otherwise, we have to take out the old bracket on the operating table, which means that it is being designed and carved more than the original shape.
Necrosis of nasal tissue
After augmentation rhinoplasty with solid silica gel stent, there will never be large-area necrosis of nasal tissue, but there are also local ulceration and necrosis, mainly due to lack of experience:
1, the tip of the stent was not smooth and sharp, but the tension was great, and the skin was very thin, and the patient did not pay attention to it (did not seek medical treatment in time). Finally, the skin was perforated and silicone was exposed;
2, the stent is too high, resulting in excessive skin tension on the back of the nose, leading to ischemic necrosis and rupture;
3. If infection occurs, timely treatment will lead to ulceration, which is the most serious complication of rhinoplasty. As long as patients and patients pay attention to prevention, these problems can be completely avoided.