The Nose is the most prominent feature of your face – it can define who you are. Your face is composed of an abundance of subtleties, some of which get more attention than others. As we communicate, we look into each other’s eyes or at the lips. Right in the centre of this triangle of communication is the nose. A nose that is too big or crooked, with a hump on the bridge, or a heavy plunging tip, quickly draws the observer’s attention. Our view gets distracted from the eyes and the lips, which substantially reduces the appeal of a beautiful and well-balanced face.
PIEZO Rhinoplasty, also referred to as Ultrasonic rhinoplasty, is a new technology that has revolutionised the world of medicine by allowing surgeons to create more refined nasal contours and cut bone without the need to break them anymore. For over 100 years, rhinoplasty surgeons had to rely on the same principle, using a hammer and a chisel to break your bones to permit bone movement and other forms of altering. Ultrasonic technology opened up a new era of delicate treatment options for aesthetic bone refinement. Piezo uses highly selective technology which allows changes to be made to the bone, without causing any trauma to adjacent tissue. Patients benefit from significantly less pain, bruising, and swelling after Piezo Rhinoplasty, and have an overall reduced post-operative downtime.
Mr. Bran has extensive experience in Piezo Rhinoplasty and is frequently invited to meetings in order to share his expertise and to train colleagues in Piezo Rhinoplasty.
What is the goal of rhinoplasty?
Rhinoplasty surgery aims to improve the contours of your nose. This includes the size and width of the nose, the profile of the bridge and the shape of your tip. Should there be a crooked or deviated nose which requires correcting, improvement of symmetry will help creating a well-balanced and natural appearance. In patients with nasal breathing issues, improvement of nasal airway passage will be an integral part of their rhinoplasty.
What are the benefits of rhinoplasty?
Rhinoplasty is considered the most difficult surgical procedure in the face. Even though highly complex and very challenging, a rhinoplasty is the most powerful surgery to change the overall character of a face. Not only can it enhance your entire facial attractiveness, many patients have reported a boost in confidence and an enhanced quality of life.
It is important to remember, that even though a beautifully contoured nose may be considered a success, it does not guarantee an improvement of self-esteem or self-confidence in every patient.
Before your procedure
Understanding how you feel about your nose is key to understanding your aesthetic goals. Mr. Bran will place a lot of emphasis on those particular details by listening carefully and assessing every detail of your nose as you describe areas of concern. He will then review your medical history and perform an endoscopic exam of your nose. This will include analysis of your nose when speaking and smiling as well as a functional assessment of your nose when breathing with your mouth open and closed. During your consultation photographs will be taken for your medical record. Using computer-assisted simulation programs we will then morph your nose I accordance to your personal aesthetic goals and realistic outcomes. Once a a new shape of your nose has been identified, Mr. Bran will explain each detail of his tailored surgical approach to you. Appreciating your personal aesthetics, managing your expectations and elaborating a realistic goal is key to planning a successful rhinoplasty journey.
Preparing for your Piezo rhinoplasty
Preoperative assessment is critical in order to select appropriate patients for Rhinoplasty Surgery. Apart from a physical examination you will have a discussion about your current and past medical history, and any medication you are currently taking or have recently taken. You will be asked about allergies, particularly drug allergies. If required, an anesthetist will see you before your surgery. Depending on your medication, you may be asked to stop or change certain drugs for a duration of time.
You should refrain from taking Aspirin, or non-steroidal anti-inflammatory drugs such as Ibuprofen in the week before your surgery.
In order to optimise your healing, we strongly advise all our patients to stop smoking at a minimum of 2 weeks prior to your surgery and refrain from cigarettes or any other nicotine containing products for 2 weeks after their procedure. Smoking significantly impairs your post-operative recovery and doubles the risk of complications such as delayed wound healing, poor scars or altered results.
RISKS PIEZO RHINOPLASTY SURGERY
In accordance with the Montgomery judgement, the following risks and side-effects are associated with Piezo Rhinoplasty surgery:
RISKS PIEZO RHINOPLASTY SURGERY
In accordance with the Montgomery judgement, the following risks and side-effects are associated with Piezo Rhinoplasty Surgery:
|PAIN||Moderate discomfort is expected; suitable pain medication will be provided.|
|BRUISING||Common, may last for 2-3 weeks. Avoid Aspirin / Ibuprofen.|
|SWELLING||Swelling will occur. It can take 6-12 months to fully resolve.|
|BLEEDING||Minor oozing is expected for 4-5 days post-OP. Major bleeding is rare. Haematoma (blood collection – risk is less than 0.1%) may require drainage or return to surgery.|
|INFECTION||Occasionally, mild infection. Rarely serious infection. If required, appropriate antibiotics will be prescribed.|
|Some diminished sensation is expected around the tip of the nose and the Columella. It can take up to 6-12 months to return to normal.|
|SCARRING||With any incision there is a risk of delayed healing and poor scarring, which can lead to hypertrophic scars or keloid formation.|
|IRREGULARITY||Uncommon, may occur at bridge or tip of the nose – more likely with thin skin.|
|ASYMMETRY||Uncommon, any pre-operative asymmetry will be pointed out and the operation will aim to improve this. Can occur temporarily due to swelling.|
|ALTERED SMELL||Altered or diminished smell can occur. Can take 6-12 weeks to resolve.|
|WATERY EYES||Occasionally, may last 2-3 weeks|
|Occasionally required (approximately 10-15% of all rhinoplasties). Recommended after 12 months.|
|PNEUMOTHRAX||Very rare. Can only occur if rib cartilage needs to be harvested (e.g. in revision rhinoplasty or ethnic rhinoplasty).|
|This is a clot that forms in the deep veins of the lower limbs causing pain, inflammation, and swelling. This will require immediate medical attention.|
|This is a clot which has travelled to the lungs causing chest pain and shortness of breath. This will require immediate medical attention.|
A good candidate for rhinoplasty surgery has one or more of the following:
- realistic goals and expectations
- a nose that is too big or too wide
- a bump on the bridge
- a tip that is either bulbous, droopy, or pointing upwards
- a crooked, deviated nose
- you are a non-smoker or can stop smoking for a minimum of 2 months
- unrealistic expectations
- patients that experience a lot of personal or professional stress
- you were told by others (partner, colleagues, friends or family members) that you should have a rhinoplasty
Piezo rhinoplasty is performed under general anaesthetic and can be offered as a day procedure. For out-of-town patients we suggest an overnight stay at the hospital in the first night after your procedure. In the following days patients can use our special rates at some of the hotels in Marylebone and Chelsea.
Piezo Rhinoplasty takes between 2-2.5 hours in primary cases, which means a nose that has not been previously operated.
During most primary rhinoplasties the contours or alignment of the nasal bones need to be addressed. Different to conventional methods (e.g. using rasp, hammer and chisel) Piezo rhinoplasty enables us to improve the contours of the nasal bones with no trauma to the soft tissue surrounding the bone. This results in less post-operative pain and discomfort. Although less than if a conventional rhinoplasty method were used, you should still expect some swelling. The initial swelling will extend down to your cheeks and your upper lip in the first days after surgery. Patients report breathing impairment and a tender feeling along their nose due to swelling. Some patients experience oozing from the nose in the first few days post-operatively. You will be given adequate pain medication and appropriate instructions how to take care of your nose and how to keep your discomfort at a minimum.
We advise our patients to plan enough time for their recovery. The minimum after Piezo Rhinoplasty operation is usually 10-14 days. In this time, you should expect swelling around your eyes and cheeks. Most of the swelling will usually resolve over the first week. Due to the delicate nature of our nasal structures, residual swelling can take up to 10 weeks to settle. You may be advised to use a specific nasal spray to elevate any temporary breathing difficulties you may be having due to swelling. You will also be advised to sleep with your head elevated to help reduce swelling. After 6-7 days the sutures used to close the incisions will be removed. The cast on your nose will be removed around day 10. Patients can go back to their daily activities approximately 7 to 10 days after surgery. We advise our patients to avoid strenuous activities or exercise completely for 3 weeks after surgery.
Incisions are placed across the columella, the piece of skin between your nostrils. If a narrowing of the nasal base is required, additional incisions will be placed on the floor of your nostrils. The scars will initially be red and raised, however as scars continue to mature they will become barely visible. Mr. Bran wrote his PhD on scars and continuously improved his surgical techniques in order to create the least noticeable scars.
What can complement Piezo rhinoplasty
In order to find out more you should book a confidential consultation with Mr. Bran. As an expert in facial plastic surgery, he will be able to answer all of your questions and explain the details of your tailored procedure.