It is generally believed that the bridge of the nose is straight, because straight is the central shape of the bridge of the nose, which is more common than other prominent, concave or other imaginable irregular shapes. The tall and straight shape is often loved by people. Europeans and Americans regard a high nose as beautiful, which looks tall, strong and healthy, and can have better heating function; Black people have wider noses; The yellow nose is flat and small. China people have slim faces, flat foreheads and narrow noses. Frontonasal process to the tip of the nose, male approximate straight line, female slightly concave arc; Nose slightly upturned, soft and beautiful.
Specific nasal aesthetic standard parameters have been counted by scholars, and the values are as follows:
1, length of nose: the length of nose is 1/3 of the length of forehead. The length of the normal nose is generally 6-7.5 cm, and the length of the saddle nose is short, often less than 5.8 cm. Long nose is larger than 1/3 of forehead length, and short nose is smaller than 1/3.
2. The position of the nose on the face: Draw a circle with the root of the nose as the center and the distance from the root of the nose to the outer corner of the eye as the radius to show the basic position of the nose on the face. Children pass through the corners of the mouth, and adults pass through the nasal column and alar edge.
3. The shape of the nose: From the front, the inner end between the eyebrows gradually tapers to the root of the nose, and the transition point is at the horizontal position of the pupils of both eyes, and the bridge of the nose has begun to form.
4. Nasal height: the height of the bridge of the nose at the root of the nose is generally not less than 9 mm, which is about 12 mm for men and11mm for women; The most depressed point of the nasal root: the line of the forehead and the line of the bridge of the nose form a triangle with the forehead, and the most depressed point of the nasal root is at the vertex of this triangle. For those with high nose bridge, the apex of the triangle in both eyes is slightly higher than this line, and for those with low nose bridge, it is lower than this line; The root of most people's nose is the most concave point. At the level of the line connecting the corners of the eyes, the dorsal nasal line is generally parallel to the line connecting the helix to the mandibular body.
5. Nose angle: the angle between the forehead and dental floss. The connecting line between the forehead and the back of the nose is the angle between the bridge of the nose and the plane of the face. The ideal angle is 30-33 degrees, which is about 23-38 degrees according to the statistics of Ling in China, and slightly less than 30 degrees for women.
6. Nose-lip angle: The angle between the front end of the nose columella and the bottom of the nose and the red lip of the upper lip is generally 90- 120 degrees, which is obviously increased in saddle nose deformity, showing the abnormal feature of nostril upward. If the angle is too large, the length of the nose is obviously shortened.
7. Frontonasal angle: the angle formed between the back of the nose and the brow (the angle between the nasal bone and the nasal process of the frontal bone). The normal angle is about 120 degrees, which is equivalent to the level of upper eyelash margin and inner canthus. This angle is related to the curvaceous beauty of the nose. When the angle is less than this, the external nose protrudes; when the angle is high, the long nose is deformed; when the angle is low, the short nose is deformed.
8. Tip height: Tip height refers to the distance from the tip of the nose to the base of the alar. Generally, the ideal height is equivalent to 1/2 of the length of the nose, about 26 mm for men and 23 mm for women. Anything under 22 mm is of low nose type.
Ninth, the curvature radius of the tip of the nose: Uchida thinks that the ideal curvature radius of the tip of the nose is 8- 12mm.
Due to national characteristics, many people in China, especially women, have noses that do not meet aesthetic standards. The nose is low, and the back of the nose is sunken to varying degrees (saddle nose). It is suitable for low nose, straight nose, mild camel nose and low nose tip. Rhinoplasty can greatly change people's mental outlook and make them look beautiful and foreign. But rhinoplasty can only partially change the shape of the back and tip of the nose, and can't shape the nose you want at will. There are many other factors that will also affect the overall effect of the operation. Therefore, the shape of the nose should be discussed in detail with the doctor before the operation. After the examination and evaluation, the doctor will tell you the possible effect of the operation.
Rhinoplasty
The standard rhinoplasty is to implant a shaped implant under the skin of the back of the nose to change the shape of the nose. Rhinoplasty is suitable for men and women with low nose, and sometimes it is used to correct the secondary deformity of cleft lip and saddle nose left after trauma.
If you look closely, you will find that many people's faces are not symmetrical on both sides. Before operation, doctors often can't accurately know whether the shape of the nasal bone surface is regular; If the convexity of nasal bones on both sides of the midline is inconsistent, the alar will be skewed after operation. Many people's alar long axis is not on the midline, which is not obvious when the nose is low, but will be revealed after the nose is high. Implants are usually implanted under the fascia of nasal dorsum or under the periosteum of nasal bone; Too shallow implantation or too thin skin and soft tissue of patients may make others feel the existence of implants. Most of these cases can be solved by minor repair surgery.
People with swept forehead, low eyebrow arch, low middle face and backward chin often can't make their faces beautiful by rhinoplasty alone. According to the situation, breast augmentation with eyebrows, chin or other plastic surgery at the same time or successively may make the face more symmetrical and harmonious.
Successful rhinoplasty will make you more confident, but others will not change their views and attitudes towards you. In addition to their own conditions, the experience, patience, aesthetic orientation and full communication with you are the key to the success of the operation.
Common rhinoplasty materials
Solid silica gel is a commonly used rhinoplasty material at present. Although the incidence of complications can reach 5% ~ 20%, it is still one of the first choice materials for rhinoplasty because of its good biocompatibility and low price. Its main disadvantage is that it can not establish blood circulation with the body and form tissue connection, and it is only wrapped by fibrous tissue, so it can penetrate the skin at weak tissue. Due to the contracture of fibrous capsule, it can cause the surface of silicone prosthesis to protrude, which affects the appearance effect.
Artificial bone material mainly refers to hydroxyapatite, so it has good biocompatibility and no side effects such as teratogenesis, sensitization and carcinogenesis. However, due to the lack of support, the effect on people with low nasal tip is poor.
Autologous bone tissue is one of the earliest materials used for rhinoplasty. Its main advantages are easy survival after transplantation and no rejection. Autologous bone tissue of rhinoplasty is mostly taken from ilium, but also from ribs, tibia, skull and so on. Autologous bone augmentation rhinoplasty has some problems, such as poor elasticity of bone tissue and difficult shaping. Therefore, the postoperative appearance is not very natural, the autogenous bone is inconvenient to obtain, the bone source is limited, and the resection will cause secondary pain and even complications for the patient. Bone resorption can also occur for a long time, leading to changes in external morphology, which is difficult for patients to accept. At present, it is rarely used in rhinoplasty and beauty. However, for the correction of complex nasal deformity or severe saddle nose, autologous bone transplantation is still needed.
Autologous cartilage tissue is often used for rhinoplasty. Its main feature is that it has no blood vessels and is easy to survive. After implantation, it has no irritation to the tissue, can maintain its original volume and cell morphology for a long time, and is easy to cut into the required size and shape, so the appearance after rhinoplasty is natural and realistic. Like augmentation rhinoplasty with autologous bone tissue, augmentation rhinoplasty with autologous cartilage tissue may be deformed by absorption. At the same time, surgery will also cause trauma outside the nose, which is unacceptable for patients without special deformities. Autologous cartilage for rhinoplasty is the most commonly used cartilage, followed by auricle cartilage and nasal septum cartilage. The former is rich in bone resources and suitable for severe deformity, which requires a lot of bone; The latter is suitable for those with mild saddle nose or low nasal sound caused by limited bone source.
Rhinoplasty with allogenic tissue refers to rhinoplasty with fresh cadaver bone and cartilage tissue as rhinoplasty materials after special treatment. After augmentation rhinoplasty, allogenic bone and cartilage only played a temporary mechanical support role, and were eventually replaced by autologous bone. Because of the difficulty in source, quantity and quality, allogenic tissue was gradually abandoned.
At present, the heterogeneous tissues used for rhinoplasty mainly include bovine nasal septum cartilage, bovine costal cartilage and calf sternum, which can be used for human rhinoplasty after special treatment. Its advantages are convenient and abundant materials and easy molding. Its disadvantage is that although it has been specially treated, some individuals still have weak antigenicity and may be rejected: they have different degrees of absorption, so the long-term effect is not satisfactory. It is difficult to be widely used because it can only be used in human body after special treatment. At present, few people use heterogeneous tissues in rhinoplasty.
Clinical observation shows that liquid silica gel rhinoplasty is easy to cause persistent erythema, swelling, skin necrosis and granuloma, and liquid silica gel can spread and infiltrate around, and the boundary is unclear and difficult to deal with. Many domestic scholars advocate that it is forbidden to use it or use it with caution.
Expanded polytetrafluoroethylene (ePTFE): from the medical point of view, it is the most ideal biological tissue substitute at present. Because of its good biocompatibility and unique microporous structure, it is non-toxic, non-carcinogenic and non-allergic. Human tissue cells and blood vessels can grow into its micropores to form tissue connections, just like autologous tissue (so it is difficult to take out swelling).
At the same time, there are many kinds of rhinoplasty materials currently used. Some injectable liquid materials fuse with surrounding soft tissues after injection, so it is very difficult to take them out completely. Their most fatal disadvantage is that once the effect is not ideal, it is not easy to take them out completely, which makes plastic surgeons have a headache.
Preoperative preparation
The doctor will tell you how to make preoperative preparations, including your diet, some medicines, smoking and ways to clean your face. Seriously following the doctor's instructions will make your rhinoplasty go smoothly. 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 the doctor is also very important. When you see a doctor for the first time, the plastic surgeon will ask you what your nose looks like. Check the outline structure of your nose and face; Discuss various possibilities with you and so on. The doctor 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 the doctor chooses general anesthesia, you will fall 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 doctor will lift the skin of the nose from the nasal bone and the cartilage below, and then carve the nasal bone and cartilage according to your requirements and the doctor's skills, or directly implant the carved nose pad 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 with a length of about 1 cm inside the nostril edge at the junction of the columella and the alar. Through this incision, a spacious cavity is separated under the fascia of the back of the nose or/and the periosteum of the nasal bone, and then the prosthesis is carved according to the requirements of patients and the skills of doctors, 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. The doctor will control these discomforts with 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 the doctor will ask you 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. Doctors advise not to do strenuous exercise, such as running and swimming, which will raise blood pressure for 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.
Questions and answers about rhinoplasty
Q: What kind of rhinoplasty works well?
A: Generally speaking, the more obvious the nose bridge collapse, the better the rhinoplasty effect. The nose skin is slack, the nib is fine and delicate, the skin is smooth and meticulous, and the rhinoplasty effect is good; On the contrary, the skin of the nose is tight, the nose is not only big, but also thick skin, large pores, more oil, and poor surgical effect. The nose of the so-called head meat is obviously not as beautiful as the former, but its change (on the original basis) may be quite obvious, which is exactly the result expected by doctors and patients, and it also loses the purpose of surgery. Everyone has their own specific situation, and the surgical effect is not the same.
Q: What's the reaction after rhinoplasty? What should I pay attention to?
A: On the day of rhinoplasty, the shape of the nose is slightly swollen, which will be slightly aggravated after operation. Generally, the swelling will begin to decrease after three days. Pay attention to keep the local clean and the incision dry to avoid external force collision. Take antibiotics orally for about 5 days to prevent infection.
Q: What are the complications of rhinoplasty? What is more serious?
A:
1, on detumescence and blood stasis
In rhinoplasty, a cavity should be separated at the back of the nose and a silicone rubber prosthesis should be placed in it. Due to the trauma of the operation itself, postoperative swelling and congestion are inevitable. The degree and duration of swelling and congestion vary from person to person, which is also directly related to surgery. Generally, the duration of swelling and blood stasis is about one week. Therefore, if you want to receive rhinoplasty surgery, you must first arrange the time so as not to affect your normal work and life. In addition, cold compress after operation and hot compress after 48 hours are beneficial to detumescence and blood stasis.
2. About the exposure of prosthesis
After rhinoplasty, skin or mucous membrane perforation and prosthesis exposure may occur. It mainly occurs near the incision of nostril and at the tip of nose. The early stage of nasal cavity is mainly characterized by a small amount of secretions, forming nasal scab, and finally the silicone prosthesis is exposed or worn out; The tip of the nose glows locally at an early stage and feels nervous, then gradually turns red and becomes thinner until it is perforated. Silicone-like prosthesis is exposed or worn, and there is often a small amount of secretion. These conditions are mainly related to surgery. One is that the separation cavity is too shallow, and the other is that the prosthesis sculpture is too wide, too thick and too sharp, which is also related to the postoperative influence. Therefore, once the above information is found, you should go to the hospital as soon as possible to avoid infection, or larger perforation and skin ulceration, forming scars.
3, about the nose askew
Nasal deviation is the most common complication after augmentation rhinoplasty. Common nose skew includes nose root skew, nose axis skew, nose tip skew and nose axis offset. Part of the reason is the patient's own conditions, such as the axis of the bridge of the nose is not straight, the nasal septum is twisted, and the nasal columella is skewed. It is more caused by the operation itself, such as the small and incorrect separation cavity during the operation, the incomplete separation cavity, the uneven thickness and the poor sculpture of silicone prosthesis. It is worth mentioning that psychological factors can also cause the nose to "skew", there is no absolute "positive", only relative "positive". Under the psychological hint, sometimes people think that the nose is skewed to one side, so we should pay attention to this problem. Slight nose deviation can be manually reset under the guidance of a doctor, and severe nose deviation can only be corrected by surgery again.
4. About appearance
Harmony is beauty, and so is rhinoplasty. First of all, we should coordinate with other facial organs to show the height, width, radian and so on of the nose appearance. Even in terms of appearance itself, there are problems such as the coordination between the bridge of the nose and the nose, and the coordination between the bridge of the nose and the nostrils. For example, a blunt nose is ugly to make a narrow nose.
5. Body surface projection of prosthesis
Some people can see at a glance that it is the result of the operation after rhinoplasty, which is what people call "very fake". That is, the contour of the rhinoplasty prosthesis can be seen outside the skin, that is, the body surface projection of the prosthesis. Under strong light, it can be seen that the nose bridge is "transparent" and it is easy to shake the rhinoplasty prosthesis by hand, which is completely caused by the shallow implantation level of the rhinoplasty prosthesis. The only way to solve this problem is to have another operation. Put the prosthesis in the right position.
6. The serious complication of rhinoplasty is the ulceration of nasal skin.
This is caused by the continuous excessive pressure exerted by the implant on the skin, and it is also the result of the patient's overemphasis on raising the nasal tip and the operator's deviation in evaluating the skin compliance. If you find that your nose, especially the tip of your nose, is red or white after operation, you should return to the clinic as soon as possible. If necessary, cosmetic surgery or implants can be taken out to avoid leaving skin scars.
Other complications include infection, implant rejection, poor wound healing and abnormal nostril margin.
Q: What is the reason for the failure of rhinoplasty?
A:
1, the indication of rhinoplasty is not grasped properly, for example, simple rhinoplasty for complex saddle nose will not have a good effect.
2. Improper selection of materials often leads to exclusion, which really can't completely correct the nose shape.
3. Insufficient preoperative preparation, such as improper trimming of nose hair, insufficient disinfection of nose and materials or overdue infection.
4. Improper material dressing may lead to long, short, too high, too low and irregular nose shape, or the tunnel at the back of the nose is too shallow, not straight, layered or improperly cut, which may easily lead to bad nose shape or infection.
5. Poor postoperative cooperation and irregular filling of materials during the operation will also lead to poor nasal shape, and improper postoperative treatment or repeated surgery in a short time will often lead to adverse consequences.
Q: About repair?
Answer: if rhinoplasty is to make an incision in the nostril, there will be no scar after operation; If nostril reduction surgery is performed, an inconspicuous scar will be left at the root of the nose after operation. Almost 65,438+0/65,438+00 patients undergoing rhinoplasty need a second minor operation to correct some minor defects, and even the most experienced plastic and cosmetic surgeons may have some unexpected problems. The second operation is usually a minor operation and can be performed in the outpatient operating room.
Q: Will the medical solid silicone implant for rhinoplasty bend recently?
A: No, the prosthesis is peeled off from the nasal tissue and then inserted. The fibrous tissue around the prosthesis can form an envelope, which tightly wraps and fixes the prosthesis, and the silicone prosthesis will not be deformed.
Q: Will the nose after plastic surgery take a long time to cause morphological changes?
A: At present, the medical solid silicone prosthesis is used, which will not cause deformation, skin discoloration and suppuration even after a long time.
Q: I have received injection rhinoplasty, and there is a tumor at the root of my nose after operation. Can I treat it?
A: In the past, rhinoplasty was injected with paraffin, organic gel and other liquids. Over time, such substances will deteriorate and harden into tumors. At present, this method is rarely used. In this case, we can operate again. The method is as follows: first, cut and peel it to the back of the nose at the entrance of the nose, then take out the original injected foreign body with instruments, and then release the silicone prosthesis.
Q: I have done rhinoplasty and silicone prosthesis implantation before, but I feel a little low. Can you go higher?
Answer: This process is very simple. Like general rhinoplasty, make an incision at the original incision, take out the original implant, and then implant a new, higher implant to reach the desired height.
Q: Will rhinoplasty affect the normal function of nasal cavity?
Answer: Rhinoplasty is carried out between the nasal bone and the cartilage of the dorsum of the nose, and has nothing to do with the nasal cavity, so it will not affect the physiological function of the nasal cavity, and there will be no rhinitis, nasal congestion, runny nose and olfactory changes.
Q: About preoperative communication?
A: Be sure to tell the doctor whether you have had nose surgery before and whether your nose has been injured, no matter how many years ago. You should also tell the doctor whether you have allergic symptoms, difficulty breathing, whether you are taking medicine (including vitamins) and whether you smoke. Ask the doctor all your questions without melancholy, especially those related to your expectations and postoperative results.
Q: How high is the rhinoplasty?
Answer: the subject often asks for a higher nose. Some people even think that the higher the nose, the more "foreign". In fact, whether the nose is handsome or not must first be coordinated with your face. Generally speaking, the male's nose should be slightly higher and wider, and the female's nose should be slightly curved to make the tip of the nose slightly upturned, which is more lively and beautiful. Usually, the long face can be slightly higher to show its three-dimensional aesthetic feeling, the face should be wide and thick to match the face shape, and the round face should not be too long and too high to avoid disharmony. In addition, the choice of nose type depends on the height of your forehead and chin.
References:
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