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Rhinoplasty

Rhinoplasty is a surgical procedure that can clearly yield immense cosmetic gains: the cost-benefit balance is generally very favorable. Patients of Dr. Wever are usually very aware of this, they have a sharp aesthetic self-image and a clear idea of the changes they desire. An absolute condition for this procedure is, however, that the result is as close to perfection as possible.

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The proportions must therefore perfectly enhance the face and no disturbing residual deviations should be visible. This goal is not easily achieved however. There are only a small number of surgeons worldwide who are able to combine the aesthetic eye, skills, experience and personality to achieve this in a majority of cases. So, this procedure never becomes “self-evident”: a good rhinoplasty surgeon will continue to work hard throughout his/her career, want to constantly learn, strive for perfection every day and have the patience to work with millimeter precision for hours on end.

Rhinoplasty surgeons should work systematically, so they can establish routine. Which ‘technique’ the surgeon uses is of much less importance than the experience and skill he/she has with one particular technique. The long term must also explicitly be taken into account here: a nose that looks perfect after surgery can be in need of revision in ten years’ time. In clients with relatively thick skin who have the desire for a ‘very small’ nose, it is good to consider this. Breaking down a nose to make it small is actually technically very easy. Maintaining a clean and beautiful shape in the long term is a significantly more difficult challenge. Your surgeon should address both aspects in his or her advice.

In addition to the individual qualities of a surgeon, other factors play a significant role in determining the end result. The thickness of the skin and firmness of the underlying cartilage are particularly important. If the skin is thicker and stiffer than average, the cartilage is generally weaker than average. This combination can make it difficult to make a nose sufficiently ‘small’ in the short term, while in the long term it may actually become too small. Ultimately, a certain amount of coincidence or “luck” plays a role. The healing process is predictable in most cases but can strongly vary individually. Unintentional residual deviations that negatively affect the aesthetic result can occur. Usually these can be corrected with limited resources.

A so-called “crooked nose” can be difficult to fully correct. The asymmetry is often present throughout the entire nose, and moreover in a complex way. In many cases, the nasal septum is crooked and has an irregular shape. Accordingly, the onset height and depth of the nostrils commonly differ, and the arch of the nostrils are asymmetrical. Quite regularly, the attachment of the nasal septum to the nasal bone is not in the midline, resulting in a difference in resilience between the left and right side. The cartilage in one nostril may be shorter than the other and there may be a difference in convexity. This structure is not always fully correctable, so that once operated there is a risk of residual crookedness. Using a firm material - firmer than one’s own cartilage (such as costal cartilage) - can sometimes provide a solution. Using costal cartilage in every crooked nose, however, is a little excessive. Besides, costal cartilage can become warped over time. In other words, if your nose is crooked before the surgery, there is a definite risk this will still be visible after surgery.

Patients who choose Dr. Wever for their rhinoplasty are typically very precise and set a high bar. As a surgeon, it is a great challenge and responsibility to live up to these expectations time and time again. Fortunately, success is almost always guaranteed. In some cases, however, a touch-up is required to achieve the final look. The chance of this occurring varies per patient but is on average probably 10-20%. A touch-up is performed approximately twelve months after the initial surgery. The result of a rhinoplasty can improve significantly during the first twelve months of healing. Moreover, the tissues remains stiff for months after surgery, making it difficult to adjust at an earlier date.

On rare occasions patients ask us for a ‘small’ rhinoplasty. Slightly adjusting the nostrils or narrowing the nasal tip can be a solution to the patient's problem. Almost always, however, when the nose is not approached as a whole, the chance of dissatisfaction increases significantly. A ‘small’ rhinoplasty hence does usually not work. The various parts of a nose can be operated separately, but cosmetically they are intertwined and form a single unity.

Rhinoplasty is not a major procedure and complications are rare. The procedure takes 1½ to 2½ hours on average and almost always takes place under general anesthesia. No nasal packing is used. A nasal splint is applied to the nose to prevent swelling. Slight bruising might develop around the eyes, but this is usually mild and barely visible after a week. Breathing may be reduced for several months after the surgery, in rare cases this may be permanent. The nasal splint and stitches remain in place for one week, after which they are removed. Although swelling will most definitely still be present at this time, the result can be seen immediately. During the first few months, the nasal bridge might remain somewhat broad and the nasal tip swollen. This residual swelling can last up to a year. For those with thicker skin it can take even longer to subside. At this stage, selfies always make a nose look bigger than it really is. We therefore explicitly advise against taking selfies during the first months. Besides, swelling of the nose is usualy much less visible to bystanders than the patient may think.

We recommend our patients to take two weeks off of work. You can of course work from home during this period of time. If you actively work in (social) media or your appearance is important professionally (model, for example), we sometimes recommend that you plan two months of rest after undergoing a rhinoplasty.

As mentioned before, the main risk of undergoing rhinoplasty is there being small imperfections that need to be undone. This is no problem for the vast majority of our clients. They can appreciate the cosmetic gains and have the patience to wait. Every year there are a few patients however, who have more difficulty with this. In some cases, this is because the imperfection is too disturbing. Sometimes the perception of imperfection is more extreme than what is realistically visible. Although this is inherent to patients who strive for a high degree of perfection and we are accustomed to it, it should not be something that is emotionally disruptive to you. If you are a perfectionist and your appearance is extremely important to you, ask yourself whether you are strong enough to deal with the “bad luck” of imperfections and have the patience to wait for a final touch-up. If you are unsure about this, a rhinoplasty may not be a suitable procedure for you. Please discuss this with our staff during your consultation.

Additional procedures often performed during a rhinoplasty are chin augmentation or a small neck lift. A class II overbite is quite common in the Netherlands and often occurs in combination with a large nose. Combining rhinoplasty with a chin augmentation and in some cases a small neck lift extends the operation time by about an hour but yields a final result that is unachievable with only rhinoplasty.

Rhinoplasties performed per year: more than 200

10-20%

Percentage
touch-ups

10-20%

Percentage
touch-ups

2

Heaviness
score (1-5)

2

Zwaarte
score (1-5)

2 wk

Recovery time
in weeks

2 wk

Hersteltijd
in weken

<1%

Serious
complications

< 1%

Ernstige
complicaties

Rhinoplasties before and after

before – simulation – after

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