Rhinoplasty (nose job) involves a small alteration to your physical anatomy, but the results are huge. Your face can look softer and more refined. And when you like the way you look it affects the way you feel.
Goal of a rhinoplasty is to create a harmonic nose that also is in harmony with the rest of the face.
Mostly rhinoplasties are performed in women between 19 and 50 years of age, but sometimes teenagers, men and elderly patients are operated.
Aging changes may affect the nose in several ways: decreased skin elasticity, fragile bones and potentially calcified cartilages may lead to a hanging nose.
Among surgeons rhinoplasty is considered to be a difficult operation, primarily because of the limited predictability of the aesthetic result. The biggest challenge is to give enough stability to the nose so it looks the same or even better 1 year after the surgery and not worse. Failure to do this is the reason why revision rhinoplasty is necessary in 5% to 15% of the cases.
Dr van de Ven has a very low revision rate after rhinoplasties. Why is that?
Insufficient support to the tip of the nose is the indication in about 50% of all revision rhinoplasties. Deviations and irregularities are also frequent indications. Dr van de Ven will ALWAYS place a cartilaginous strut to give extra support to the tip of your nose, resulting in very stable results, even after decades.
After osteotomies during rhinoplasty (bone cuts) the nose is like a ‘bag of bones’. When these bones shift to one side and heal together in that position, the result of the rhinoplasty will be an oblique or even crooked nose. To prevent this a splint that keeps the bones aligned in the middle is necessary. Fluid collecting between skin and the underlying cartilages after rhinoplasty may lead to the body replacing that fluid collection with scar tissue, degrading the quality of the final result. Therefore Dr van de Ven has developed and patented a so called nose-moulder. It immobilizes the bone fractures and helps the skin adhere to the new framework by keeping fluid from collecting in a pool between the skin and the underlying cartilages.
Advantages of the nose moulder are:
• Real rigid fixation
• Less irregularities (straight noses)
• Real pressure
• Less fluid collection so less scar tissue
• Easily removed and put back on
• Intermittent doctor and patient control possible
• Little adjustments can be induced to the healing bones during checkups
• Patient can take it of for showering etc.
• Extended use possible—Patient can wear this device fulltime for 3 weeks after the operation and after that for months during the night
Indications for rhinoplasty can be:
• breathing problems
• disfigured nose after injuries
• congenital deformity
• masculine features in the nose of a woman
Breathing problems can be and should be corrected in the same stage with aesthetic rhinoplasty.
To begin with the cause of the problem needs to be determined: it can be a curvature of the septum, a hypertrophy of the turbinates or a weakness of the cartilages. In each case, an appropriate treatment should be performed as well as corrections of deformities of the external nose. If the reason is hypertrophy of the terminates Dr van de Ven will refer you to an ENT-specialist as he doesn’t deal with this kind of pathology.
The nasal septum is composed of a posterior bony portion and an anterior cartilage portion. Usually, a posterior deviation can be responsible of difficulty in breathing but doesn’t modify the shape of the nose. On the opposite, deformities of the anterior portion of the septum can also decrease breathing and are frequently the cause of visible deformities on frontal view and deformities of the nostril orifices.
Disfigured nose after injuries
Injuries to the nose frequently lead to displacement and/or damage to the bone and cartilage support. The appearance of the nose has changed and there can be deviations, asymmetries and sometimes airway problems.
Displaced bones and cartilages of the nose can be reset with a rather high success rate within the first week to 10 days after the trauma.
One should understand that after a significant injury to the nose it takes six months or more before an extensive rhinoplasty can be done safely. This is primarily because the tissues need to settle, become softer and less vascular. During the evaluation of the nose after an accident assessment of shape and possible airway problems are both very important. Sometimes a correction of the septum of the nose is necessary.
In order to restore a straight nose it is often necessary to re-fracture the bones and re-align the cartilages.
In general all extreme variations of a ‘normal’ nose that have appeared spontaneously during growth can be considered as congenital deformations.
They present with complex and asymmetric deformities of the cartilage framework. Their correction needs a wide experience of this type of rhinoplasty and will sometimes be very close to reconstructive surgery.
Cleft lip nose
Generally, the child already underwent several rhinoplasties during the early months of life but other rhinoplasty surgeries are often necessary around the adolescence in order to improve cosmetic and function of the nose. Restoring a strong support in the lower part of the nose and putting the philtrum (skin between the nostrils) and nostrils in a balanced and anatomic position will be the main goal of these rhinoplasties.
Masculine features in the nose of a woman
This type of rhinoplasty is the true specialty of Dr van de Ven. Over the years he has performed several hundreds of feminizing rhinoplasties. As almost always these are reduction rhinoplasties the support to the tip of the nose and the use of the nose moulder are of extreme importance. As cartilage and bone will be removed to make the nose smaller there will be an excess of skin. The skin resection during rhinoplasty can be only very limited as otherwise unacceptable scars of the skin would be created. Dr van de Ven performs alar base reductions in about 80% of his patients. The nose moulder will help prevent that fluid collections appear under the skin that would degrade the quality of the final result.
Click here for a more in depth description of the rhinoplasty procedure.
- General anesthesia—Rhinoplasties are usually done under general anesthesia. In certain minor cases, local anesthesia and sedation may be used. The operation generally lasts between one and two hours.
- Incision—For almost all rhinoplasties we prefer the ‘open method’ because it gives the surgeon more operational space. In the ‘open’ approach one small incision is outside the nose across the columella (the skin between the nostrils). After a couple of months the scar is generally extremely difficult to see.
- Incision for an open rhinoplasty
- The real job—According to your individual needs following actions may be done:
- Giving support to the tip— A cartilage ‘strut’ is taken from the septum or ear and sutured into the columella (part of the nose between the nostrils) to give support to the nasal tip.
- Refining the tip— Sutures are placed to achieve refinement or ‘narrowing’ of the nasal tip.
- Shaping the profile—The bone-cartilage hump is removed. A surgical file or rasp is commonly used to smooth the bony hump, in order to achieve more precise results.
- Reconstruction rhinoplasty— In case the nose structurally lacks cartilage to give shape to the tip, the wings or the vault of the nose, cartilage may be taken from the septum, or ear(s) reshaped and sutured in place in the part of the nose that needed support. Of larger volumes are needed to augment the dorsum a roll of Mersilene mesh is a good option.
- Narrowing the nasal bone— If the bridge of the nose is wide, it can be narrowed by fracturing the nasal bone on each side and moving it closer to the centre.
- Narrowing the nostrils— The volume of the nostrils can be reduced by an alar base excision
- Sutures—Small sutures will be used to close the incisions. The sutures are not absorbable, and have to be removed 8 days after the surgery.
- Nose moulder—A nose moulder will be put on your nose to keep the bones and cartilages in their proper position and prevent fluid collecting between skin and the underlying cartilages that may lead to scar tissue which degrades the quality of the final result of the rhinoplasty.
Recovery after rhinoplasty
- Breathing— Most people find it very difficult not being able to breathe through their noses after the rhinoplasty. We will give you some nose drops to open up the nose during your preoperative consultation.
- Stiches—The stitches underneath the nose need to be removed ten days after the surgery.
- Bleeding—Some sporadic bleeding could be expected during the first couple of weeks, which is normal and should not be a cause of concern.
- Bruising— Most people get bruising around the eyes and cheeks. The bruises under the eyes will intensify during two or three days before they begin to vanish. 15 days later, only you and your surgeon will be able to notice any traces of the surgery.
- Appearance—Your nose will regain its normal appearance very soon, but the definitive results of the rhinoplasty will be fully appreciated after six months. The tip is the area that takes the longest to acquire its new shape.
FAQs before rhinoplasty
That is a very difficult one. It depends very much upon your healing and we can’t give you any guarantee about how long it takes before you look good enough for a photoshoot.
It could be 4 months, but it could also be a year. Of course it also depends on the amount of work that has been done.
If you want you can send us good pictures together with your ideas so we can send you a financial and operative proposal. To receive a proposal, please fill in the proposal request online
and pay the proposal fee of 50 euro through Paypal.
Of course you are always welcome for a consultation.
In a normal nose the respiratory route is critical at just one point which is the internal valve. By the use of spreader flaps or spreader grafts Dr van de Ven will make sure that there the nose doesn’t become smaller.
Rhinoplasty is considered to be an operation with high risks, primarily because of the limited predictability of the aesthetic result. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. What are the reasons? A perfect result immediately after surgery may be totally different one year later. Limited predictability is mainly due to the dynamics of the healing process. Many different types of tissues are involved: bone, cartilage, mucosa, skin, fat, fascia, muscles, nerves, vessels, perichondrium and periosteum. The individual reactions of these tissues are not always under the control of the surgeon. This is especially true for cartilage, the main supporting structure of the nose.
The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake. Dr Bart van de Ven has build up a decent experience with noses during his carrier. To help the healing process he developed a device called ‘nose moulder’ that drastically decreases some of the aesthetic complications after rhinoplasty. Because of the real pressure possible with this splint less fluid collection between skin and underlying tissue is the result. Fluid can be replaced by the body by scar tissue, compromising the aesthetic result. The real pressure also gives a real fixation of the bone cuts. This results in significant straighter noses.
FAQs after rhinoplasty
You should try to wear the nose moulder as much as possible during the first 3 weeks after surgery. Please make sure the nose moulder is placed in the middle. If it hurts you should make the elastic band wider and/or leave the nose moulder completely off for a while.
After the first 3 weeks we advise to wear the nose moulder every night until the check-up 4 months after the surgery.
After a rhinoplasty you have to be really patient. During the first 3 months it can be very swollen. Especially if you have a thick type of skin it can take more than a year for all the swelling to disappear. The nose can continue to change until 1 – 2 years after surgery.
The tape helps partly to avoid the swelling from forming. Once the swelling is there, the tape will not let is disappear. Only waiting….Also the nose moulder is not useful for the swelling, this is only to keep the nosebones in place.
You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.