Rhinoplasty (nose surgery) is one of the most frequently performed aesthetic procedures in plastic surgery. The trend in modern rhinoplasty over the last 20 years has shifted from techniques involving excessive reduction of the bone-cartilage skeleton to methods that preserve natural anatomy by leaving as much cartilage as possible in place, filling in missing areas, correcting contour irregularities, and restoring structural support using suturing techniques. Preoperative analysis and clinical evaluation, improvements in technique, and the increasing prevalence of open-approach rhinoplasty have led to a better understanding of nasal anatomy and nasal surgery, allowing for more consistent and predictable aesthetic and functional results.

As with all aesthetic procedures, it is crucial to allocate sufficient time for a preliminary evaluation before rhinoplasty. It is very important for the patient to first describe their concerns, as this helps determine the relationship between the perceived deformity and the patient’s perception. Sometimes, there can be a very significant difference between the visible deformity and the patient’s perception; in such cases, making a decision about surgery should be done very carefully, as it may further increase the patient’s postoperative dissatisfaction. For example, a person might have a perfectly acceptable and aesthetically pleasing nose, except for a millimeter-sized hump, but this becomes such a significant problem that it affects their daily life. They constantly look in the mirror, attribute all their problems to this perceived flaw, and believe that surgery will change their entire life, improve their mood, and make them a completely different person. If this person is not properly understood by the physician, it can create problems after the procedure. This condition, known as “body dysmorphic syndrome,” is not rare and should be correctly diagnosed. If possible, consultations with relevant departments should be sought before deciding on surgery.

The nose is not an independent part of the face. It must be in harmony with the other structures of the face, and its own anatomical parts must also be in harmony with each other for a nose to be aesthetically pleasing, natural, and proportionate. The nose should be evaluated in conjunction with its bone and cartilage skeleton, the skin and soft tissue covering them, and its airway function. Many proportions and angles expected in an aesthetically pleasing nose are described in nasal analysis. Certain key values ​​should be considered, particularly the angle between the base of the nose and the lips, the angle that the line passing through the nostrils makes with the plane of the face, the ratio of nasal width and length to facial width and length, and the amount of nasal projection and rotation angle; however, these mathematical and geometric values ​​are not sufficient indicators of the complex three-dimensional structure of the face. The most accurate approach is to examine the nose as a three-dimensional structure with all its elements, keeping these ratios and norms in mind, and to make an accurate diagnosis by evaluating it with a good aesthetic “eye” and determining a surgical strategy accordingly. In this context, it is beneficial for both the patient and the surgeon to present the possible post-operative appearance by directly or in three-dimensionally altering pre-operative photographs using certain computer simulation programs. Although the changes obtained from these images do not have a direct relation to the maneuvers performed during surgery, it can help the patient understand how the changes in their nose will affect their facial appearance and also help the physician determine a strategy for the changes to be made. However, it should be remembered that when performing rhinoplasty, you are using a scalpel, scissors, and suture holder, not a mouse, and what you are changing is not a picture or a sculpture, but a three-dimensional organ, a living human being. Because of this difference, results obtained from photo-based studies cannot guarantee the outcome of the procedure. Like all parts of the body, the nose has a dynamically changing nature. It should be kept in mind that the desired appearance of the nose will change over time, and precautions should be taken accordingly.

Contrary to popular belief, the open and closed techniques used in rhinoplasty are not a subject of real debate. In the open technique, in addition to the entry points used in the closed technique, an entry is also made through a structure called the “columella,” located just below the tip of the nose. This leaves a barely noticeable, millimeter-sized scar in this area after surgery. This method is generally preferred in cases where the nasal tip is severely deformed and significant changes are necessary, or in secondary surgeries. The closed technique may be preferred when the nasal tip and appearance are relatively good, and the problem is more pronounced on the nasal bridge. The open technique offers advantages over the closed technique in terms of better visualization of nasal anatomy, providing a wider and more detailed view, and allowing for safer and more detailed procedures on the nasal tip. However, some authors claim that the closed technique affects the lymphatic and venous circulation of the nose, resulting in longer-lasting postoperative edema, and that the structures providing nasal projection are better preserved in the closed technique. It should also be remembered that in rhinoplasty, what you do afterward is far more important than the entry method. Protecting the nasal cartilage and bone structure as much as possible, avoiding excessive reduction, extraction, and miniaturization, working according to an anatomical plan, making changes according to a pre-operative strategy determined specifically for each patient, determining a treatment appropriate to the diagnosis, anticipating and taking precautions against possible changes in the nose over time, avoiding excessive corrections that would disrupt the natural appearance, and remembering that the nose is an organ for breathing and preserving its functional integrity are the keys to achieving the desired result in both open and closed techniques. When all these critical points are followed, the importance of the technique naturally diminishes. Furthermore, it is much more important for the surgeon to use the technique they are accustomed to, feel most comfortable with, and can predict the results of – in short, the technique they know best.

Many patients who apply for rhinoplasty also have breathing problems. In such cases, we successfully perform airway opening procedures in the same surgery at our clinic. In addition, for patients who do not have breathing problems but have airway narrowing or mild septal deviation as surgical findings, we prefer to perform “septoplasty” to prevent postoperative breathing problems. We recommend performing these procedures as part of the same surgery because there are many disadvantages to doing them in two separate sessions. In some cases, deviations in the septum, a structure composed of bone and cartilage that divides the nasal opening into two, can also affect the pyramidal region of the nose and cause asymmetry in the nostrils; this results in what we call a crooked nose. In this situation, in addition to interventions targeting the septum, deviations in all structures of the nose, including the upper and lower cartilage, nasal tip, and nasal bone, must be meticulously addressed and corrected.

Nose surgery in men must be considered a completely separate category. A man who clearly has had a nose job is undesirable and significantly negatively impacts his social life. Therefore, excessive narrowing, reduction, and lifting should be avoided in men. Unfortunately, the attempt by aesthetic surgeons to apply the proportions they are accustomed to seeing in women’s noses to men often leads to unpleasant results. A hooked nose that might not look good on a woman could fit perfectly with a man’s facial features and “suit” him. Therefore, great care must be taken when responding to a man’s request for cosmetic surgery. In men, we generally perform surgery for deviations, asymmetry, and septal deviations that cause breathing problems. The angle between the nose and the lips should be narrower in men than in women. The nasal bridge should not be excessively lowered, the upward rotation angle of the nose should not be excessively increased, and the lower cartilages should not be narrowed if possible. Bearing in mind that doing something “less” is more difficult, every step should be controlled and planned carefully. Because even if a nose looks beautiful on its own, a “feminine” appearance in a man is not a desirable result.

We always perform rhinoplasty under general anesthesia, and while the duration varies depending on the nature of the nasal deformity and the presence of septal intervention, the average surgery time is 2-3 hours. After an overnight stay, we discharge the patient the next morning. Pain after rhinoplasty is a rare occurrence. If pain does occur, standard painkillers are sufficient. Swelling radiating to the eyelids varies from patient to patient, but generally lasts 2-3 days. In patients without breathing problems, we usually remove the nasal packing the next day. Since this packing is placed only in the tip of the nose, it does not cause pain during removal. In patients with significant septal deviation and those undergoing septal intervention, we use silicone packing with holes for breathing, which we remove after 5-7 days. We do not experience excessive discomfort or pain during the removal of this packing either. In the first week after surgery, we remove the thermoplastic nasal splint and apply thin tape to better control swelling. These tapes remain in place for 5 days before being completely removed. Although our patients generally prefer to rest and not work during this one-week period, we see no problem with you returning to work after the 3rd day post-operatively, unless it’s a very strenuous job. Unlike the old plaster cast method, the splint we use after rhinoplasty, made of heat-molded plastic, is small, elegant, and aesthetically pleasing, making it less bothersome for the patient socially. We recommend protecting your nose for the first 2-3 months and avoiding glasses if possible. The initial appearance of the nose after the splint is removed is not the final appearance; it takes at least 6 months for the nose to reach its final shape, but a large part of this “settling” process occurs in the first few months as the swelling subsides. Especially in patients with excessively arched noses or sagging and large nasal tips, it takes longer for the wider skin to shrink to accommodate the surgically reduced skeleton, and since changes in the nose will continue during this process, some patience may be required.

As with any aesthetic procedure, there is no seasonal preference for the timing of rhinoplasty; it can be done in the summer as well. As long as the nose is protected from the sun and external factors during the first 3 weeks after surgery, there is no problem with going on vacation.