Rhinoplasty procedure includes

• First step is to induce you in general anaesthesia. The procedure is always done in general anaesthesia except for very mild corrections which can treated under local anaesthesia. Best choice will be recommended after discussion with you by Dr Amit Agarwal.
• Second step is to infuse mild anaesthestic solution inside nose to control bleeding during surgery. Then a incision is made either using closed procedure where the incision is hidden inside the nose or using an open procedure where the incision is made across the columella (narrow strip of tissue that separates the nostrils). This incision allows access to reshape the nose.
• In the third step, the deviated septum is correctedif required. Septum can be straightened and projection inside the nose is reduced to improve breathing. Cartilage graft is taken from the septum to be used to correct/augmentnose at other parts.
• Fourth step includes reshaping the different structures of the nose which differs in every patient according to their requirements.
• For reshaping of the nose, sometimes implants are required which can be either taken from the body or can use synthetic materials. A piece of cartilage or bone can be taken from the body to fine the desired results. Cartilage is taken from the rib (chest wall), back of the ear. Bone can be taken from the elbow region/iliac crest. Tissues taken the body are the best and give adequate and long lasting results with minimal complications when compared to synthetic materials. Rib cartilage is only needed when major augmentation is required otherwise cartilage from nose and back of ear is sufficient in majority of cases. Dr Amit Agarwal strongly discourages use of synthetic material in nose as complication rates can be as high as 20 %. The incisions are so small, easily hidden and are relatively less painful. So we should not worry about the scars.The scar heals with time and cannot be noticed in six to twelve months.
• Sixth step is to close the incision after shaping the nose as desired. After closure, results are assessed and a packing is placed inside the nose if required and bandage or splint is placed outside for protection and support.

Unfavourable results/complications in Rhinoplasty

Rhinoplasty is always regarded to be associated with many risks as the expectations of patient and operating surgeon do not match primarily because of the limited predictability of the aesthetic result due to the dynamics of the healing process. Many different types of tissues are involved within the closed space of nose.The individual reactions of these tissues like bone and its covering layer periosteum, cartilage and its covering layer perichondrium, mucosa, skin and fat are not always under the control of the surgeon.

An unfavourable result of rhinoplasty is clearly visible as everybody is an expert. The patient very often blames the operating surgeon for the unfavourable result while the surgeon tends to call it a complication. In principle, both are possible.

Few problems however are in fact a mistake in surgical planning. Choosing and opting for a surgeon who has good experience in rhinoplasty will help in mitigating this problembecause an earnest analysis is essential for prevention. Sometimes very minor subtle flaw or correctionpeople demand to be rectified ontheir nose may not look good when done. Dr Amit Agarwal believes that the nose should look harmonious on the face and should be in balance with your facial profile.

Other complications are effects of the individual reaction and the healing process. They are not under the control of the surgeon. In this case the surgeon has to identify the complication early enough and react adequately.

The complications and aftermaths of the surgery vary from person to person and their physical well-being. The factors which affect are poor circulation, a history of blood clots, diabetes or heart, lung or liver infection. Nose job usually gives desired results but there can be some risks involved which include:

• Risks related to General anaesthesia which are very rare. Anaesthesia is very safe in present times and with best machines and a qualified anaesthetist, chances of encountering any complication is less than 0.1 percent in a healthy individual. We at Kayakriti Plastic Surgery and Dental Centre are equipped with world class anaesthesia workstation, other equipments and two very qualified intensivists for the surgical procedures to be very safe and smooth.
• 10% of the patients after rhinoplasty complain about residual or new breathing problems. Rhinoplasty can reduce the cross-sectional area of the nasal airways due to deep bone cutting, alar resections or valve problems.All should be aware that scars inside the nose and loss of mucosal sensation can give the feeling of a "blocked nose". Of all the patients who undergo revision-rhinoplasty, breathing disturbances are reported in 70%.
• The main risks of cartilage or bone implants are dislocation and resorption, while artificial materials can cause infection and extrusion. Silicone implants are reported to have a complication rate between 5-20%.
• Skin and soft tissues can have persistent swelling, collection of blood, infect, fibrosis, can have numbness, develop small cysts originating from displaced mucosa. In rare cases skin can develop necrosis or atrophy.
• Persistent post-ostoperative swelling is more often due to the osteotomy (bone cutting).Percutaneous osteotomies cause less traumabut may result in visible scars. Osteotomies can also cause injuries of the or bital region.
• Infections are rare but can happen in less than 1% of cases. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases.
• Rare event of Deep Vein Thrombosis, pulmonary or cardiac complications, lidocaine toxicity can occur or precipitate in patients with multiple pre-existing diseases diagnosed or undiagnosed by routinely available standard tests or if multiple procedures are done in the same sitting. Kindly do not force your surgeon for combining multiple surgeries in one sitting which is never recommended by Dr Amit Agarwal and might turn a very safe procedure to an unsafe one. For example, combining sinus surgery with rhinoplasty is usually not recommended as it can increase the chances of infection around the face

These are the risks and possible complications which should be discussed by you with Dr Amit Agarwal before the procedure.

Independent of the indication, success of rhinoplasty should be based on patient's satisfaction. Assessment of the result by patient and surgeon can sometimes be different. Patients with mainly functional problems will rate a rhinoplasty successful when the breathing function is improved. The more aesthetic demands are involved in the surgery, the more patient's satisfaction will be based on multiple factors. A perfect result immediately after surgery may be totally different one year later and a not so perfect result may look better after a year. This can result in overall decreased satisfaction rate with the surgery. The dynamic healing process of bone, skin and soft tissues is unpredictable and out of control of the surgeon. Sometimes, patient's expectations can be unrealistic and beyond the capacity of the surgeon and can be a major reason for multiple revision rhinoplasties.

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