WHAT IS POLYGON RHINOPLASTY?
One of the most important discussions related to rhinoplasty between surgeons and patients who want to undergo rhinoplasty, is with which technique surgery will be performed, open or closed. Both techniques have their advantages and disadvantages. The most important point for the surgeon and the patient is the result for sure. Whichever technique the surgeon uses, the aim is providing a scarless, matte nose skin, the nose without numbness, preserving the naturalness, having non-surgical look, breathing and smelling easily and having comfort after the surgery. The Polygon Technique is a technique which combines the advantages of the open and closed method. Like the closed surgery, it is performed through the nostrils without cutting and removing the skin on the nose. The connective tissue which ensures the mobility of the nose tip is preserved and corrected. In contrast to the open surgery, it is the connective tissue of the elastic nose, which upholds the nose tip. With the Polygon rhinoplasty, all of these procedures are done under periosteum and the perichondrium and therefore mimic muscles, blood vessels and nerves and the skin are preserved as untouched. Therefore, the trauma is reduced to minimum and the postoperative healing process is shortened. The risk of pain, swelling and bruise is reduced to minimum. During the surgery, thanks to the preserved blood vessels and a careful surgery, the anatomic structures of the nose can be seen much better and millimetric shaping can be performed. In Polygon rhinoplasty, the cartilages of the nose tip, nasal bones and the structures within the nose can be seen clearly and shaped as with the open surgery. With this technique, no maneuver is performed blindly without seeing. I use the open as well as the closed method as needed. For patients whose nose tip is damaged quiet heavily, who have experienced a serious trauma before or have a grave deformation, I prefer the open technique. Except these patients, I use Polygon rhinoplasty technique for others. I think that the surgery results and the surgery comfort are superior to other techniques.
WILL THE NOSE TIP BE SOFT AND MOVABLE?
In the past years, the hardness of the nose tip and numbness after rhinoplasty were annoying results. It caused an operative look that the nose remained motionless without joining other mimic movements of the face due to the hardness of the nose tip. At the same time, a pain and tingling feeling during influenza, cleaning and blowing the nose, sleeping face-down and especially kissing cause discomfort. In order to overcome these problems, it was necessary to understand the supporting structures of not operated noses and to develop techniques, which would still ensure the mobility of the nose tip.
Anatomically, the nose has a very complex structure. Even today new information comes out as a result of detailed researches on the anatomy of nose. In the light of new information, it has become very clear how important the connective tissue which constitutes the naturally movable structure of the nose is. In addition, this connective tissue system is very effective for the aesthetic look of the nose. Scientific researches show that the details of the noses looking beautiful without operation are constituted from these connective tissues. It is again this connective tissue system which functionally provides breathing and open airway functional. Muscles of the nose cling to nasal cartilages with the help of this connective tissue and assist to provide open airway.
Acknowledging the details of nose anatomy better in the recent years, provides significant developments in rhinoplasty techniques and aesthetic results. These new techniques aim at protecting the anatomical structure of the nose as much as possible, reducing the tissue damage minimum, minimizing the cuts and achieving nonsurgical results.
In Polygon rhinoplasty, the connective tissues, which ensure the support of the nose tip, are preserved. It provides connective tissues which preserve the mobility of the nose tip. Even in the early phase after the surgery, nose can be softer and more elastic. Simple things we frequently do in daily life like sleeping face-down, kissing or cleaning the nose do not constitute a problem anymore. The preservation and correction of these connective tissues deliver more natural results in the aesthetic sense.
SCHEDULING THE REVISION SURGERY
- The imitation of the shapes and the lines of nasal bridge, nose tip and wings of the noses which are accepted naturally beautiful without operation and not creating an operated impression when looking from outside
- Having a mobile nose tip. No pain while kissing, intranasal cleaning, blowing the nose and sleeping face-down. No numbness and loss of sensation on the nose.
- Correction of nasal septum deviations and asymmetries which existed prior to the surgery as much as possible.
- Open airway. Easily breathing and smelling.
- Less swelling in the early phase as much as possible and no bruises if possible
- Minimum nose tip edema
WHAT IS DONE AT THE PRE-SURGERY EXAMINATION AND INTERVIEW ?
Prior to rhinoplasty, identify very clearly that what disturbs you. Clarify your expectations by thinking that what you would like to have to be changed after surgery.
The detailed nose examination prior to the surgery is very important. During that examination, I check intranasal bones, cartilages, concha and the airway in a very detailed way. I examine the nose skin, nasal bridge, cartilages at the nose tip, nostrils and the nose base. After the examination, for some cases it can be necessary to do computer tomography or x-ray of sinuses.
After finishing the examination, I take photos from every angle in the photo studio. In order to understand the facial mimic movements and the movements of the nose, I shoot a video from different angles.
After the shooting finished, we evaluate the photos and videos together. Then, we make simulations on the photos. The most important point concerning the simulations on the photos is being realistic. Everybody who can use Photoshop, can also make beautiful noses. Whether reaching that result or not is the most important point after the surgery. We need to reflect the findings we learned in the examination into simulation and be realistic. For example, it is not realistic to make a pretty small nose simulation to the person whose skin is thick.
FREQUENTLY ASKED QUESTIONS
In which ages is rhinoplasty performed?
For rhinoplasty, it is preferred to perform the operation after the age of 18 and above when the nasal development completed. If there is a deformation structurally or occurred after a trauma and affects the functions like breathing and smelling, the operation can also be done before the age of 18.
Which points should be taken into consideration in the period prior rhinoplasty?
The nose operation is an extremely special surgery in which millimetric changes are very important. Therefore, the pre-surgery phase, surgery phase and post-surgery phase should be planned very clearly and everything should be performed under optimal conditions. Before the surgery, blood-thinners like aspirin, painkillers, herbal tea like green tea should be discontinued 10 days prior to the surgery. After deciding the surgery, you will be given a list containing food and beverages you should avoid for the period of 10 days.
Controlling swellings after the surgery has an impact on patient comfort and the result. Therefore, I pay attention not to perform surgeries on women during their period.
Smoking is a factor which affects the recovery and reduces the nutrition of the nose after the surgery. To quit smoking 2 weeks prior to and 2 months after the surgery will increase your comfort as well as the result of the surgery.
Take a lukewarm shower one night before the surgery and wash your face with an antibacterial soap. Do not put on makeup while coming to the hospital and leave your jewelry at home. Listening to music helps you to feel less stressed.
For the surgery, you must not have eaten for 6 hours and must not have drunk anything for 3 hours. This period should be planned according to the time of your surgery. You should be at the hospital at least 1 hour prior to the surgery. You will be put up to your hospital room and given sedative in order to overcome your stress.
Which technique will be used for rhinoplasty?
If you have not undergone rhinoplasty before and there is no deformation on the nose, I always prefer the Polygon rhinoplasty under closed periosteum. This is a technique which does not harm natural connective tissues, nerves, veins and the skin and protects them. The surgery is performed through the nostrils and under the periosteum and the perichondrium without cutting the skin. I personally prefer this technique as the surgery results are much better, the recovery is faster, edema is less and the comfort of the patient is higher. The Polygon technique permits to reach all regions of the nose without opening the skin of the nose.
The choice of anesthesia for rhinoplasty
The Polygon rhinoplasty is a very delicate surgery which is performed under very thin periosteum and perichondrium. The nose is penetrated through nostrils with little cuts. For these operations, millimeters are very important. By allowing a good view without bleedings in order to perform millimetric changes, we want the blood pressure of the patient does not exceed 70-80 mmHg during the surgery. We can ensure such a low blood pressure on a permanent basis and for a long period of time only with general anesthesia. If the surgery is performed in a low blood pressure, the nose does not swell during the operation. As a result we can perform very delicate interventions without losing nasal aesthetic details.
Rhinoplasty surgery can also be performed under local anesthesia, but this is not a very preferred method. The blood pressure cannot be always controlled. Nonetheless, for smaller scale revisions, local anesthesia can be preferred.
The points to be taken into account prior to rhinoplasty
Rhinoplasty is a surgery in which millimeters are very important. All variables must be under control. The nutrition control prior to the surgery is crucial in order to have bloodless surgery and to reduce the swellings after the surgery. Some food stuff has a blood thinning effect or affects the function of the cells, which provide coagulation.
Prior to the operation, the consumption of citrus fruits, herbal tea, green tea, onion, garlic, cumin, Omega 3 diets, Chinese food, red fruits like cherry, strawberry ,raspberry, almond, peanut, walnut, soy, pulses and cacao must be limited. In order to reduce edema, pickle, mineral water and salty food which have a high sodium level, should be avoided.
I do not perform surgeries during periods. During periods, the risk of bleeding and swelling is higher. Women are much sensitive towards pain and stress during that period.
Aspirin, pain killers and some influenza must be discontinued 7-10 days prior to the surgery. Prior to the surgery, tests are done concerning the bleeding and coagulation, but some very rare bleeding disorders cannot be detected with these tests. Therefore, you should mention during the examination if there has been any bleeding in any period of your life, which could be stopped very difficult.
Take a lukewarm shower one night before the surgery and wash your face with an antibacterial soap. Do not put on make-up. Remove nail polish. Remove also metals like earrings or piercings.
Staying at hospital during rhinoplasty
Your blood tests are done one or several days prior to the surgery. Our anesthesiologist checks your blood tests by examining prior to the surgery and informs you. It is sufficient to come to your reserved hospital room one hour prior to the surgery. In order to control your excitement prior to the operation, you can be given tranquilizer during the preparation phase. The surgery takes approximately 3 hours. Sometimes it can be shorter and sometimes longer. During the surgery, the time is not restrictive. The surgery continues until the planned result is achieved.
3-4 hours after the surgery, you can be released from the hospital but it will be more comfortable for you if you stay one night at the hospital.
The post-surgical recovery period
After the surgery, our nurses will explain to you in detail how you will perform your nose care at home and how you will take your medication. In the first 2-3 days, the edema control is very important. After this, the edema will regress very fast. In the first 2 days, we apply cold compressions on the forehead and cheeks. You should avoid bending etc. in order not to increase the blood pressure in the head. Sleeping in half-upright position or with 2-3 pillows in the first days, will cause less edema. You can take short, lukewarm showers. The splint on your nose will not be affected due to short contact with water. Even immediately after the surgery, you can breathe very easily through your nose. On the 2nd or 3rd day, a control examination is done. If a silicon splint has been inserted, it will be removed. The inta nasal region is cleaned und the airway is controlled. Between the 7th and 10th days, the adhesive plaster and the splint on the nose are removed. The Polygon rhinoplasty is a careful surgical technique which protects the tissues, minimizes the trauma and allows for a faster recovery. As soon as the splint is removed, in most cases, no adhesive plaster is needed. Our patients do not have duties like massaging or pressing on the nose.
What should be paid attention after the surgery?
The patient should be careful about traumas, which the nose could experience after rhinoplasty. The nasal bones regain their stability approximately in 6 weeks. During this period of time, it is more appropriate not to wear any items like glasses which could constitute weight on the nose. You can wear contact lenses. If no bruise occurred, you can go to the sun. After 3 weeks, you can swim in the sea. Take the prescribed medicine regularly.
Sleep 5 nights with 3 pillows.
Do not stay in very hot places.
You can touch your nose, but you should not receive any hits. As long as the splint is on the nose, even the smallest hits can cause pain, but the shape of your nose will not change due to these hits.
You can eat whatever you want, except summer fruits which increase the risk for bleeding.
Do not use any vitamins or any dietary supplements.
Avoid activities which could increase your blood pressure. Do not lower your head forward.
Try to remain in an upright position, except sleeping.
After the second day, you can go outside and take a walk. Do not worry; you will not get an infection.
You can take a shower for 2-3 minutes with lukewarm water without exposing the plastic plaster to excessive water and steam.
Thanks to the careful surgery during the operation and the cold compressions, you do not need to make any cold or ice compressions on your face.
The silicon which we inserted inside the nose, will cause a feeling of sneeze and activate the sneezing reflex. Sneezing with an open mouth will not damage your nose. If you feel the need to sneeze, press your tongue to your palate; mostly the feeling disappears.
After 5 days, you can have light walks.
Do not perform heavy exercises for 1 month.
Do not wear glasses for 6 weeks.
After rhinoplasty, you can wear contact lenses.
If there are no bruises, it is not necessary to avoid the sun, just do not sweat because of the heat.
After 10 days, you can benefit from the edema dissolving effects of green tea, parsley and pineapple.
The cleaning of the nose after surgery is very important. Before you are released from hospital, you will be explained in detail how to clean your nose.
Are the nasal bones broken during surgeries?
One of the most frequent asked questions of my patients is if the nose is broken during the surgery. Concerning this subject, there is a lot of false information especially on internet. I come across a lot of misleading information like “We perform surgery with laser without breaking the nose”. In the common praxis of today, the laser is not used to shape bones.
The shaping of the bones is one of the most difficult and important parts of rhinoplasty. The majority of the swellings and bruises, which occur after the surgery, develop during formation phase of the bones. Our patients have every right to ask this question. This question means at the same time: Will I have bruises? Will my nose swell a lot? Will I have pain?
In principal, bone shaping is done with the help of conventional methods (bone saw, rasp, etc.) or with bone shaping systems, which have been developed with the help of technology. Within thebone shaping systems, Piezo System and Micro Bone Shaping System are the most used ones. I use micro bone shaping system. In my opinion micro bone shaping systems enable a more effective shaping. Whichever method is used, again the most important point is the result. Also with the conventional methods and a careful surgery, the bones can be shaped without having bruises.
If the nose is hooked not, for the majority of rhinoplasty operations it is necessary to change the shape of the bone structures. Some parts of nasal hump composed of bones and the other parts of cartilage. If the nasal hump removed, the floor and remaining hump of the nose look much wider when looked from the front. If the bones are narrowed, the roof of the nose remains open. If it is looked from the front, a wide and unaesthetic image seems. The roof shouold be narrowed and the pyramid structure should be established like in the nonsurgical noses. Whereas to achieve this for some cases it is enough to narrow the width of the bone on the base, in other cases the bones must be brought together. Like in the “Let down” technique, it could also be necessary to shape the bones from the bottom without damaging the roof of the nose. For these formations, I always use the micro bone shaping system. Eventually, it is possible to do shaping by narrowing the width of the bones whereby the trauma is reduced to minimum.
How can we narrow down without breaking?
The width of the bone at the connecting points between the cheeks and the edges of the eyes can reach up to 5 mm. If we break the bones at this point and narrow the bones without pushing them into nasal cavity, the base of the nose can be narrowed at the same time. Narrowing of the bones can be achieved by rasping the bones. As a result, bones in the shape of thin scraped parts will be removed.
This technique also prevents bruises to occur after the surgery. The bruises which are spread under the eyes and the cheeks are mostly the result of a blind cutting of the nose bones for the narrowing of the nose base whereby the blood vessels which are located in the surrounding areas are damaged during the cutting and bleed inside the soft tissue.
Why do not bruises occur in Polygon technique?
During Polygon rhinoplasty, the periosteum is carefully lifted from the soft tissue above the bone. All blood vessels, nerves and muscles remain within the soft tissue above and the naked bone remains in the lower part. With this, a blood free area is created and the intervention to the bone is done without damaging the blood vessels. Eventually, the blood vessels are not damaged and as a result, bruises do not occur. The more we are careful during the operation, the more the bones and cartilage are protected, the fewer swellings will occur and the tissueswill heal faster.
If the nose base is narrowed, will there be problems in breathing?
The narrowing of the nose base will also narrow the gaps in intranasal area. The narrowing of the nose base bone will only narrow the nose base without narrowing the nasal cavity. After the surgery, breathing is affected on a minimum level.
If only the nose tip is done or only the nasal hump is removed, will the result be also good?
The nose and its fitting to the face should always be evaluated in a 3-dimensional way. In order to achieve an optimal result; if the shape of one part of the nose has been changed, the remaining parts must also fit. For example, if in a hooked nose only the nasal hump is removed and the nose tip is not touched, the nose may look longer in comparison to the face, the nose tip may be directed downwards and the nose base may appear wide or only shaping the nose tip can make the nasal hump look bigger. Therefore, it is more correct, to evaluate the nose as a whole and to decide the operational steps according to the simulations done on the photos and the examination.
When will the swellings on the nose tip diminish after rhinoplasty?
As the Polygon technique reduces the trauma in the nose to minimum, the swellings are therefore much fewer compared to the other techniques. The lymphatic vessels, which ensure the mobility of the nose tip and which go through the ligaments, are protected within this technique. This provides swellings to diminish fast aas well as a mobile nos tip.The remission of swellings can be different from person to person. Those, whose nose skin is thin, are the luckier in this case. When the reduction of the nose was to a smaller extent, then the skin adaptation will be faster. In the first 6-8 weeks, 80% of the swellings will diminish. The remission of the remaining edema of small scale will be distributed to a period of 6 months.
Why does the skin of people shine who had rhinoplasty?
Our skin has a very complex micro architecture. On the nose skin there are small hair follicles and within these follicles there are fat and sweat glands, which keep the skin, moistened. These complex systems are transferred to the nerves, which come from the deeper parts of the skin. The cutting and opening of the skin will of course damage these systems under skin. A skin which is normally dull and has micro pores, becomes a surface like a smooth and shining marble and gets gradually thinner. As Polygon rhinoplasty is performed under periosteum and perichondrium, the circuit and the nerve layer remain untouched and undamaged. Shining skin, which becomes thinner over the years, is not observed.
Does the surgeon see everything clearer and more comfortable during the open surgery?
In polygon rhinoplasty we see during the surgery everything we want to see. In this technique, blinding can not be shaped without seeing any structure. All structures are smillimetrically shaped by direct seeing through a bloodless surgery. This situation is already reflected in the result. Every surgeon masters in different techniques for sure. But the approach “The closed method is not suitable for you” is not correct. This has nothing to do with the fact that how big the nasal hump is and how deviated and sagged the nose is. With Polygon technique, we can do all kinds of aesthetic and functional corrections. Even for the second or third surgeries, I prefer Polygon technique as long as the nose tip is not deformed too much.
Is it correct that patients with a thick skin will not have good results?
For rhinoplasty operations, the thickness of the skin is an important variable which influences the result. During the surgery, bone and cartilage structures are shaped and the skin is adapted above the formed structure. Noses with a thin skin show the borders and angles of the formed cartilage and bone structures much better. For patients with a thick skin it will take a while until the aesthetic lines are visible. For patients with thick skin, special techniques must be applied. In order to highlight the aesthetic structures in a better way, the bone and cartilage structures are shaped in accordance with the thick skin. For noses with a thick skin it will take more time until the nose has taken its final shape compered to noses with a thin skin.
For patients with a very thick and greasy nose skin and has a heavy rosacea appearance, it would be wiser to prepare the nose skin prior to the surgery and to make it thinner with a medical treatment. The intake of Roaccutane will decrease the sebaceous gland and the secretion and make the skin thinner. Even only this therapy will change the nose structure (especially the nose tip).
Is every closed rhinoplasty the same?
The reason why this technique is called closed is because the visible skin from the outside, which is situated between the two nostrils, is not cut and opened and the surgery is completed through the nostrils. Actually, there exist two types of rhinoplasty done with the closed method. The first one is the surgery whereby the cartilages of the nose tip are not pulled outside and are shaped intranasl without seeing. For the second method, the cartilages are straightened up in the nostrils and are shaped visually. I always prefer the second one.