RHINOPLASTY
Rhinoplasty, or nose surgery, is a facial beautification operation. It is a functional
and aesthetic balance operation that affects the overall harmony of the face and
the quality of life of the person.
I have three basic rules regarding this surgery:
1. If there is no function, you don’t feel beautiful.
A nose that prevents breathing, reduces the sense of smell, causes frequent
sinusitis attacks, or has dryness and crusting inside the nose makes a person
unhappy. Therefore, you don’t feel beautiful.
A nose that is harmonious with the face. Every face has different needs. An overly
upturned, overly curved, artificial-looking nose, or a nose with a thick bridge that
protrudes from the forehead, does not beautify the face.
A nose that is harmonious with the face.
Every face has different needs. An overly upturned, overly curved, artificial-looking
nose, or a nose with a thick bridge that protrudes from the forehead, does not
beautify the face.
A face that is harmonious with the nose.
Rhinoplasty was performed, but it is still not perfectly harmonious with the face.
So, can natural changes be made to the face? For example, an intervention on the
chin, filling the forehead area, correcting under-eye hollows…
This approach makes rhinoplasty not just a surgery, but a balanced study where
science and art come together. You should be able to discuss this with your
doctor, and then the choice should be yours. You can have it done or not.
Remember, if you evaluate all the options before the surgery, you won’t regret it.
GENERAL PROCESS
EXAMINATION
Patient Process and Preliminary Consultation
We recommend that all our patients for whom we plan rhinoplasty have a
preliminary consultation before surgery. For our patients living abroad, we conduct
this consultation online.
In the online consultation, the patient and the doctor communicate one-on-one;
detailed information is provided and the patient’s expectations are clearly
understood. After this consultation, our patients can schedule their surgery
appointments.
Arrival in Istanbul and Examination
When the patient arrives in Istanbul, Turkey, we welcome them to our office on the
first day.
One of the most important steps in this consultation is a detailed examination.
Evaluation of the inside of the nose is of great importance.
Septum (nasal septum)
Conchae (nasal turbinates)
Sinuses
are examined in detail.
Even if the patient does not have a significant breathing complaint, a functional
evaluation must be performed. Because healthy breathing is the foundation of a
successful rhinoplasty.
3D Analysis and Planning
After the examination, three-dimensional photographs of our patients are taken.
This imaging system is one of the most important stages of surgical planning.
Thanks to three-dimensional analysis:
Possible post-operative results are realistically shown
The patient’s wishes and expectations are clarified
Not only “how it will be” but also “how it will not be” is evaluated together
This process is extremely valuable for creating a common aesthetic understanding
between the doctor and the patient.
Conclusion
Our goal is to achieve a nose that is unique to each patient, harmonious with the
face, natural, and functionally healthy.
Therefore, correct communication and correct planning from the very beginning of
the process are at least as important as the surgery itself.
1.2. ANESTHESIA AND HOSPITAL
Hospital Selection and Safety
I perform my surgeries in fully equipped hospitals with international certifications.
I do not perform these surgeries in small medical centers or small clinics. The
hospitals we work with are not just places where minor cosmetic surgeries are
performed;
they are also well-equipped centers where major surgeries are carried out. This is
extremely important in terms of patient safety.
Anesthesia Treatment and Surgery
Pre-operative Preparation
Following our initial consultation, our patients are directed to an anesthesia
examination and anesthesia administration.
Routine tests are performed in the hospital before the surgery. These tests are
standard assessments to ensure the surgery is performed safely.
Since our patients are generally young and healthy individuals, surgical risks are at
the lowest level. If the risk is above this lowest level, we generally do not plan the
surgery.
Risk Assessment
There is a known risk class associated with anesthesia. There is no such thing as
zero risk; however, risks are classified from lowest to highest.
Rhinoplasty is an elective surgery and should be performed in the best and safest
way. Therefore, we prefer to proceed with medications that have the lowest risk
class. The anesthesiologist provides our patients with detailed information on this
matter.
Additional Medical Conditions and Medication Use
If our patients have any existing medical conditions or are regularly taking
medications,
We obtain detailed information about these before they arrive. For example:
Thyroid diseases
Diabetes
Other chronic diseases
If they have these conditions and are also taking these medications.
The anesthesiologist may request additional consultations if necessary.
Preoperative Information
Before surgery, our patients are informed and evaluated in detail on the
following issues:
Medications to be used and discontinued
Special conditions regarding existing illnesses
Questions about general health status.
After all this preparation process is completed, surgery is usually performed
the next day.
SURGERY
Surgery Duration
Primary rhinoplasty surgeries generally take approximately 1.5-2 hours.
You can breathe through your nose after surgery. However, for the first week,
you may generally feel like you have a cold or flu. That is, your nose will not
be completely blocked, but it will not be completely open either. During this
period, you may experience:
Mild headache
Fatigue
Post-nasal drip. These are quite normal.
We do not expect severe pain. Simple pain relievers such as paracetamol are
usually sufficient.
Swelling and Bruising
There will be swelling around the eyes after surgery. Bruising varies from
person to person. It may be mild in some patients, while it may be more
pronounced in others. If it occurs, it usually resolves largely within 4-5 days.
One of the most important reasons for less bruising and swelling is the
preservation (protective) surgery we use in operations. Thanks to this technique,
tissues are better protected and the healing process is more comfortable.
Splint (Plastic Mold) and the First Week
After the surgery, a plastic mold (splint) is placed on the nose. This mold
usually stays on the nose for 5-6 days.
Actually, this splint has no direct function, but it helps to control swelling.
On the 1st or 6th day:
The splint is removed.
The inside of the nose is cleaned.
After this procedure, our patients feel significantly more comfortable.
Taping and Return to Daily Life
After the splint is removed, tapes are applied to the nose. Our patients can fly and
return to their place of residence with these tapes. In other words, approximately
5-6 days after the surgery, after the necessary checks are done,
there is no problem with them traveling. After one week, we ask our patients to
remove the tapes on their noses themselves.
First 2 Weeks
After a total recovery period of approximately 2 weeks:
The nose looks better than before the surgery.
A more natural appearance is achieved.
People looking from the outside usually don’t notice that surgery has been
performed.
However, the nose is still swollen. Especially:
The tip of the nose.
The side walls.
Swelling may persist in areas such as the radix region.
Final Result
It takes time for the nose to take its final shape.
This process is usually completed in 1 to 1.5 years. However, a natural and
harmonious look can be achieved even earlier.
POST-OPERATIVE PROCESS
Return to Daily Life
Our patients can shower the day after the surgery. They can do their daily
activities.
There is usually no problem with bending and standing up.
Sometimes I see my patients walking outside and shopping the day after the
surgery.
Sometimes, when my patients come for a check-up on the 5th or 6th day, they say
they feel tired and rest at home.
This situation is somewhat related to the individual’s constitution.
We generally do not impose any restrictions on our patients after the surgeries we
perform. Going out, traveling, and walking around outside with someone is
allowed.
First Week
During this first week, the sense of taste and smell may be somewhat weak. After
the splint is removed and the inside of the nose is cleaned at the check-up, our
patients feel significantly better.
Sports and Physical Activity
Approximately 2 weeks after surgery:
Light sports
Swimming
Running
such activities are allowed.
We recommend waiting approximately 4 weeks before wearing glasses.
Activities with a Risk of Impact to the Nose
We recommend delaying sports that carry a risk of impact to the nose. At least
8-10 weeks should pass before engaging in such activities.
First Follow-up and Patient Experience
The first post-operative follow-up is very important for us. When the splint is
removed and the nose is opened, our patients usually feel a great sense of relief.
However, we specifically point out that the appearance may be slightly different
and swollen at this stage. This is because the nose is still edematous at this stage
and does not reflect its final appearance. Touching and Cleaning the Nose
After this check-up, we tell our patients that they can comfortably touch their
noses. They can clean and gently rub their noses with their fingers to keep the
nasal pores open. Since we preserve the bone and cartilage structure in primary
surgeries, our patients can touch, clean, and even gently squeeze their noses.
After two weeks, we expect our patients to be able to: “Blow your nose as desired,
and touch it as you wish.” The properties of the tissue may change, but it is not
possible to damage the product itself.
Taping and Misinformation
We do not recommend long-term taping.
On the internet, you can find different information such as;
“Don’t touch your nose”
“Tape your nose at night”
“Don’t shower after surgery”.
However, there are no such restrictions in our procedure.
Follow-up and Control Process
We ask our patients to send photos at certain intervals after surgery:
2 weeks
2 months
6 months
1 year
and regularly every year thereafter.
Lifelong follow-up is very important for us.
Revision and Long-Term Results
We assure our patients that no major changes will be needed in terms of safety.
In other words, the post-operative process;
Major revisions requiring the removal of rib cartilage, causing collapse or
significant deformation, are not needed.
However, as with any surgery, minor adjustments may be necessary. In
approximately 3-4 out of 100 patients, minor problems such as:
A slight protrusion
Slight asymmetry
A slightly more upturned or lower nasal tip than expected may occur.
In these cases, a simple adjustment lasting 10-15 minutes is usually sufficient.
Crooked Nose
Everyone may have some degree of asymmetry in their nose. We already know that everyone has
a certain degree of asymmetry in their face. (It should be noted in parentheses: Sometimes the
patient doesn’t notice, but the nose has been crooked for a long time.)
Why Does it Occur?
Crooked noses are primarily caused by two factors:
Genetic structure
Past major or minor traumas
These traumas may include:
Pressure in the womb
Difficult birth
Falls or bumps in childhood
Most of the time, genetic factors and traumas play a role together.
How Much Can Be Corrected?
Regardless of the cause, approximately 85-90% of crooked noses and asymmetries can be
corrected. In other words, after surgery, the nose:
Becomes much straighter than before
However, it will not be perfectly straight, like it was drawn with a pencil
Generally, a minimal asymmetry of 10-15% may remain.
Why Isn’t It Perfectly Straight?
There are two main reasons:
1. Healing Process: During surgery, the shape of the tissues is altered. However, the healing
process varies from person to person, and this can affect the outcome.
2. Facial and Bone Structure (the most important reason): When we consider the facial skeleton,
the nose sits in a central cavity.
In some people:
Years of breathing problems
Facial asymmetry
This bone structure is not perfectly symmetrical.
In this case, no matter how straight we make the nose, a small asymmetry may remain due to the
underlying structure.
Since it is not possible to change the base of the skull, this situation cannot be completely
eliminated.
Result
The basic rule is:
A crooked or asymmetrical nose will be significantly straighter after surgery than before. But the
goal is not a perfect line, but to achieve a natural and balanced result that is harmonious with the
face.
Thick Skin
In rhinoplasty surgeries, we primarily alter the shape of cartilage and bone structures. While
thinning or improving the skin is possible in some cases, these are limited interventions. You can
think of it this way: Imagine the bone and cartilage structure as a chair, and the skin on the nose
as a cover that blankets the chair.
The Difference Between Thin and Thick Skin
If this cover is too thin, it shows all the imperfections, big and small, on the chair underneath.
Therefore, very thin skin is also difficult for the surgeon. (In my surgeries, maintaining the integrity
of bone and cartilage tissue is an advantage in this regard.)
If the cover is slightly thicker, this is generally more advantageous. However, the situation changes
as the cover thickens:
If it’s thick like a blanket → it shows less of the underlying structure.
If it’s very thick like a carpet → it shows almost nothing of the procedure performed.
Therefore, thick skin is also a separate challenge for the surgeon.
Things to Consider with Thick Skin
The most important point with thick skin is this: The underlying structure must be very strong.
Because thick skin can put pressure on the underlying structure over time, affecting its shape.
Therefore, in patients with thick skin:
Bone and cartilage tissues should not be excessively removed.
The nose should not be reduced in size unnecessarily.
The aim is to create a strong, balanced structure that can support the skin.
Conclusion
Thick skin can reduce the visibility of aesthetic changes. Therefore, our approach is:
To create a more solid structure
To avoid excessive reduction
To achieve a natural and long-term stable result.
Male Nose
The dynamics of a male nose are different. Therefore, male rhinoplasty is often described as a
more difficult surgery.
Some surgeons even say they don’t perform male nose surgery. There are quite famous surgeons
abroad and in our country who do act this way.
In my practice, however, the situation is different. I have many male patients. In fact, I can say that
the number of my male and female patients is almost equal.
Basic Approach
There are some generally accepted rules in male rhinoplasty:
A pronounced curve should not be made on the bridge of the nose.
The tip of the nose should not be excessively lifted.
I agree with these.
But I go a little further on this point and say: It should not be obvious that a male patient has had
surgery.
Naturalness and Facial Harmony
Naturalness is important for every patient. However, it is not correct to apply this rule in the same
way to everyone.
Some patients have such balanced and strong facial features that a more prominent and sharp
nose can look very good on these faces. In short: If it suits you, it can be done.
Patient Expectations
The vast majority of male patients:
Don’t want a curve
Don’t want an upturn
I also support this approach.
In fact, some patients:
May want a slight hump to remain
May prefer the tip of the nose to be slightly lower
This actually gives the male face a more characteristic look.
Result
The goal in male rhinoplasty is:
To obtain a nose that is not noticeable
That looks natural
That is harmonious with the face.
The best result is one that doesn’t give the feeling of having had surgery.
Drooping Nose Tip
The tip of the nose is made up of cartilage, ligaments, and connective tissues. These structures
provide support to the cartilage at the tip of the nose.
These structures attach to the septum located at the back. In other words, the nose has major
and minor support mechanisms.
Why Does it Occur?
If the septum is not in the midline, but shifted to the right or left, this support for the nasal tip
decreases, and over time the nasal tip droops downwards.
You can easily check this yourself: When you touch your nasal tip, you can feel whether the firm
cartilage at the back is in the middle.
Septum Problems
Sometimes the septum may be in the midline, but it is set back.
This is usually due to:
Curvatures in the back of the septum
Shortening and backward movement of the septum
In ethnic noses, the septum may be structurally located further back.
Treatment Approach
What needs to be done in this case:
Correct the septum
Relocate it to the midline
Shape the nasal tip
Establish and strengthen the connection between the septum and the nasal tip
Important Point
If only the nasal tip is shaped, but the septum is not strong enough or this connection is not
established, the nasal tip may droop again over time.
Result
The basic principle in nasal tip aesthetics: It is not just about shaping, but about creating a strong
support system. When this is achieved, both aesthetic and long-term stable results are obtained.
Large Nose (Big Nose)
Skin and Healing Process
During surgery, we shape the cartilage and bone tissue. In other words, we create the skeleton, or
framework, of the nose.
The skin adapts to this new structure over time. This is independent of the technique used.
Why Does It Take Time?
This is why the nose takes its final shape within 1-1.5 years after surgery.
In fact, this process is the skin’s adaptation process to the newly created skeleton. That is:
Cartilage and bone are shaped
The skin adapts to this structure over time
Skin Care and Touching
During this process, I especially tell my patients: Keep your skin clean.
If the pores are open, the skin heals faster and healthier. I also tell my patients: “Don’t be afraid to
touch your nose.”
The Issue of Taping
Some doctors recommend long-term taping after surgery. I do not recommend this.
There are two reasons for this:
The tape can cause skin irritation and inflammation.
It can negatively affect the healing process by closing the pores of the skin.
Technical Approach
In my surgeries, I preserve the integrity of cartilage and bone. I use a condom (protective)
technique.
Therefore, I do not need long-term taping.
Result
The most important thing in the healing process is:
Keeping the skin healthy.
Naturally adapting to the new structure.
When this process is managed correctly, the results are both more natural and more stable.
Filler-treated nose
About 8-9 years ago, I operated on a patient with fillers. Before the surgery, she told me, “I have
fillers in my nose; I used hyaluronidase and dissolved them.” She even said that she thought one
injection wasn’t enough and had a second one done. However, when I opened her nose during
the surgery, I saw that there were still fillers left.
Facts About Fillers
We have many patients who have had fillers injected into their noses.
I can’t say that fillers are completely wrong; however, their use is quite limited. Especially when
not done by a professional:
Problems ranging from minor deformities
To serious complications
can occur.
Which Fillers?
The most commonly used filler is hyaluronic acid.
I don’t think other fillers (silicone, hydroxyapatite, etc.) are suitable for the nose. These types of
fillers are not suitable for the nose.
The “Filler Dissolves Completely” Misconception
There’s a common misconception about hyaluronic acid: “The filler dissolves completely.”
In reality, this isn’t the case.
Most of the time, some of the filler remains in the nose. This varies depending on the area in
which it was injected, but generally a certain amount remains.
What Do We Do During Surgery?
In noses that have had fillers, we remove this filler during surgery.
Therefore, it is very important for the patient to know that they have had fillers before the surgery.
We specifically ask our patients about this information several times.
Post-Surgery Effects
The healing process may differ slightly depending on the area where the filler is located:
If the filler is in the radix (nasal root) area, this area is reshaped after removal.
If the filler is in the tip of the nose, post-operative swelling may be slightly more pronounced.
However, this is temporary, and the normal healing process is completed. Also, fillers have an
expansion effect on the skin. It may take time for this effect to reverse.
Conclusion
Whether you have had fillers or dissolving injections: You must tell us this before the surgery. This
way, we can manage the process correctly by performing the necessary cleaning during the
surgery.
Thin Skin
Since we usually discuss thick skin more often, we often address thin skin together with it.
However, I believe thin skin deserves its own separate heading.
Thin skin means that all the underlying tissues are more visible. In other words, we are talking
about a more transparent structure.
Characteristics of Thin Skin
In patients with thin skin:
The underlying cartilage and bone structure
Small irregularities
Minimal asymmetries
become more easily visible.
Therefore, thin skin is a condition that requires attention from the surgeon’s point of view.
Surgical Approach
I use conservative surgery in my operations.
Thanks to this approach:
The nasal bridge remains intact.
Cartilage and bone structure are preserved.
The underlying structure becomes smoother.
The words that best describe this are: “smooth” and “intact.”
Thanks to this approach, in patients with thin skin:
The risk of small postoperative protrusions is lower.
The risk of long-term problems is lower compared to conventional (classic techniques where
bones are broken) techniques.
Thin Skin in Revision Patients
Thin skin can be an even more delicate issue in revision patients. In such cases:
We place a tissue called fascia under the skin.
We add fat tissue to its edges.
This fat tissue also acts as a stem cell and contributes to healing.
Conclusion
Thin skin can make the results more visible if the correct technique is not used. Therefore, our
approach should be:
To create the underlying structure as smoothly as possible.
To protect the tissues.
To use supporting tissues when necessary.
Boxy Tip and Bulbous Tip (Wide Nose Tip)
A boxy tip is when the nose tip appears wide, angular, and lacks defined contours. To reiterate: a
boxy tip is a condition where the nose tip is wide and angular, but lacks clear contours.
This is usually not due to the nose tip being large, but rather to its shape not being sufficiently
balanced.
Causes of Boxy Tip
The causes of a boxy tip can vary depending on the patient:
Wide cartilage structure
Weak tip support
Asymmetry
One or more of these factors can make the nose tip appear wide and angular.
What is Bulbous Tip?
Another condition often confused with a boxy tip is a bulbous tip.
In a bulbous tip:
The nose tip is more rounded
It appears more like a ball
The contours are less defined
Thick skin usually accompanies this condition.
Bulbous Tip Approach
The most important point in the bulbous tip is to create a strong cartilage structure.
Because thick skin puts downward pressure over time.
Therefore:
The septum and cartilage structure must be strong.
The goal is to prevent the nasal tip from drooping in the long term.
The nasal tip may remain stiff for a long time after surgery. This process can sometimes take 1-2
years.
Boxy Tip Approach
In the boxy tip:
The nasal tip is angular and wide.
The alar cartilages (nasal tip cartilages) are generally stiffer.
In this type:
It is important that the septum is straight.
The septum is corrected if necessary.
The cartilage structure is reshaped.
Thin or medium-thick skin is usually present.
Post-Operative Care
Post-operative care for boxy nose tip:
Cartilage contours may become more prominent.
Therefore, if necessary:
Small camouflage tissues (softening tissues) are used.
Result
Although boxy and bulbous nose tips look similar, their fundamental problems and surgical
approaches are different. With the correct analysis and technique:
A more balanced
More natural
A nose tip that is harmonious with the face is obtained.
High Radix
The radix is the point where the nose joins the forehead. In this area, the nasal bones articulate
with the frontal bones (forehead bones).
The muscle structure we call the glabellar complex is also located above this area. That is, the
area between the two eyebrows where Botox is applied.
Postoperative Swelling
When the radix area is treated:
Soft tissues
Muscle structures
become edema.
Therefore, it takes time for the swelling in this area to subside and requires patience.
Difficulty in the Classic Technique
In the classic technique:
First, the nasal bridge is filed down.
Then the bones are broken and an attempt is made to lower them.
However, there is a significant problem here: Lowering the radix area has been a difficult area for
years. Because:
While the bones are broken from the sides,
The root (proximal) part may not be lowered sufficiently.
This can cause the radix to remain higher than it is in some patients. Furthermore, due to the fear
of approaching the frontal sinus, this area is often left untouched.
Protective (Preservation) Technique
In the technique we use, the approach is different:
The nasal bones are freed from the joint line with the frontal bones.
The nasal pyramid is lowered as a whole.
This makes it possible to lower the radix in a controlled and balanced manner.
How Much Should It Be Lowered?
Technically, we can lower the radix as much as we want. However, this is not always correct.
If it is lowered too much:
Excess skin tissue
Accumulation towards the inner part of the eyelid
can occur and an undesirable appearance may result.
Balance is Important
Therefore, radix reduction should be done:
Controlled
Measured
In harmony with the face.
If skin accumulation occurs due to excessive reduction, it is possible to correct it with a minor
intervention later.
Conclusion
The radix is one of the most critical areas in rhinoplasty.
With the right technique and the right amount of intervention:
A more balanced
A more natural
A profile that is harmonious with the face is achieved.
Upturned Nose Tip
An upturned nose tip is when the tip of the nose is turned upwards more than normal. This
condition:
Makes the nose appear shorter
Causes the nostrils to be visible from the front
Why Does it Occur?
An upturned nose tip can occur for two reasons:
Natural anatomical structure
Previous surgeries
Evaluation
The most important point regarding an upturned nose tip is this: The upturn should generally be
evaluated together with the length (projection) of the nose tip. Patients often complain:
Either about the upturned nose tip
Or about the length of the nose tip.
However, these two conditions are usually present together. Therefore, they need to be evaluated
and corrected together.
Surgical Approach
When correcting an upturned nose tip:
The nose tip is lowered
This also increases the overall length of the nose
However, there is an important detail to pay attention to here.
Rim Area
When the tip of the nose is lowered, the rim area, where the nostrils and the tip of the nose meet,
may remain elevated. In this case:
It may not be noticeable when viewed from the front.
However, when viewed from the side, the inside of the nostril is visible.
This is an undesirable appearance.
Therefore, the rim area also needs to be supported and balanced.
Conclusion
When correcting a raised nasal tip:
The height and length of the nasal tip should be evaluated together.
The overall length of the nose should be lengthened in a balanced way.
The rim area must be supported.
The goal is to obtain a more balanced, natural, and harmonious nose with the face.
