Rhinoplasty

DR ALI PIRAYESH

“For most people, a nose is crucial in perceived facial beauty. A carefully and artfully performed rhinoplasty can restore the nose to harmony with the rest of the face.”

Recovery

Treatment

Anaesthesia

Consultation

The nose is a central feature of the face, and many people are self-conscious about the shape of their nose: too wide or too small, they dislike bumps and irregularities on the bridge of the nose, or they experience difficulty breathing because of a displaced nasal septum. In addition, burns or cancer can disfigure the nose, and sporting accidents — e.g. a hockey puck in the face — can cause nasal fractures. A skilled plastic surgeon can transform the face with relatively minor changes. Not only the shape of the nose will be improved, but the harmony of the face and breathing will be significantly improved, with the bonus of no visible scarring.

Facts About Rhinoplasty:

A nose job or rhinoplasty can correct many different symptoms:

A nasal bridge that is too high, too wide, too narrow, or too low nasal
A nasal tip that is too low, too high, or bulbous
A bump on the bridge of the nose
The connection between the nose tip and the upper lip is too short
The nose is too big or hooked
The nose is askew, or the septum is displaced

Our philosophy is that we never use a photo of a beautiful nose as a starting point but instead look at how we can improve your nose — based on the structure of your face, bones, nostrils, and skin — and obtain the best possible result. This result will greatly benefit from the extensive attention Dr Pirayesh pays to the proportions of your face and your profile.

Reconstruction After Trauma, Burns, or Cancer

Dr Pirayesh has extensive experience reconstructing noses damaged by trauma, burns, or cancer. It gives him great pride and joy to restore the faces of patients dealing with these devastating afflictions.

Displaced Septum Causes Physical Complaints

Approximately 60% of all people have a displaced nasal septum. Although this doesn’t lead to physical symptoms for most people, some patients do suffer from one or more of the following symptoms:

Blockade of one or both nostrils
‘Stuffy’ nose
Frequent nosebleeds
Frequent sinus infections
Facial pain, headache
Snoring or noisy breathing during sleep

The nasal septum, or dividing wall, divides the nose into two chambers and is ideally located exactly in the middle of the nose. The front part of the partition is a flexible structure consisting primarily of cartilage and skin, covered with many blood vessels. Because cartilage continues to grow until the age of 18, a correction of the septum — also called septoplasty — is generally only performed on adults. Because a septoplasty takes place inside the nostrils, you won’t experience any visible bruises or scars.

A Unique Approach

For a surgeon, rhinoplasty is a highly complicated operation that requires a high degree of experience, skill, and aesthetic understanding. In less experienced hands, there is a real risk of under or over-correction. Also, a rhinoplasty impacts the nose's primary function—breathing— so we cannot be too careful. This is why Dr Pirayesh always performs rhinoplasties with a top otolaryngologist — an ear, nose, and throat specialist — to ensure optimal functionality of the nose after surgery. This approach is unique in The Netherlands and fits with our philosophy that only the best care is good enough for our patients.

It All Starts with a Consultation

No two noses are the same. The cosmetic needs and expectations of patients are unique. To ensure that you are happy with the result of your treatment, Dr Pirayesh develops a customised surgical plan for each patient. During the consultation, he will take the time to get to know you, discuss your requirements and help you make an informed decision.

He will ask about your general health and medical history, examine your nose, septum and nostrils, and will ask you about your complaints, olfactory sense, and ability to breathe. Naturally, Dr Pirayesh will ask you to point out the features you want to improve, after which he will indicate whether your wishes are realistic. He will explain which technique he will use for your surgery and which supplementary treatments will increase the result of your treatment. Sometimes, fillers can help to smooth a bump on the bridge of your nose, even though the effect is temporary. Dr Pirayesh will answer any questions, give instructions on how to prepare for the operation, and inform you about the cost.

Surgery Overview and Timeline

Duration of the operation: 1 to 3 hours
Anaesthesia: light general anaesthetic administered by a specialised anaesthetist
Length of stay: outpatient; you may go home after about 4 hours. You will need to be picked up, and it is preferable if someone is with you for the next 24 hours.
Post-operation: there may be swelling around the nose and eyes. A splint is placed over your nose, and your nostrils are packed with soft tampons, which are removed after one day.
You will receive pain medication and instructions on using a nasal spray to keep your airway open.
Complications: rare: swelling that can last for several months, a reduced sense of smell, allergic reaction.
Recovery time: after one week, the splint will be removed. After a week, you can resume your normal activities. After six weeks, you resume heavy physical work and heavy lifting.
Results: the swelling around your nose and eyes will slowly settle in the weeks after the operation, showing a hint of what your new nose will look like. It will take about six months before you can enjoy the result: a harmonious shape and a beautiful profile.
Scarring: although a rhinoplasty scar is only 3 millimetres long and almost invisible, tucked away under the nose tip, it will be treated with the utmost care. Dr Pirayesh has developed a program, APS Scar Care, including aloe vera-based creams, laser treatments, and (if necessary) injections to ensure that your scars heal in the best possible way.

Rhinoplasty in Six Steps

On the day of your surgery, Dr Pirayesh will mark the surgical field and take pictures of your nose and your profile for your medical record.

Step 1. Anaesthesia

If you're nervous, we can give you a mild sedative. A specialist anaesthesiologist will inject a light general anaesthetic into a vein through a cannula (a thin, plastic tube) in your arm or hand. The anaesthesiologist and his team will monitor you closely throughout the operation, ensuring you are comfortable and safe. The anaesthesiologist will discuss the anaesthesia with you before your surgery and will answer any questions.

Step 2. Different techniques

There are two types of rhinoplasties: open and closed rhinoplasty. If your nose tip needs adjusting, the surgeon will make a 3-millimetre incision between the nostrils: the open procedure. With a closed procedure, the incisions are made on the inside, in the nasal mucosa, and are invisible. The closed procedure is suitable for patients who only need minor adjustments to their noses. In some cases, the bridge of the nose needs to be rebuilt with synthetic implants or, ideally, with cartilage harvested from your ear, rib, or septum.

Step 3. The incisions

After the general anaesthesia is administered, Dr Pirayesh makes small incisions in or between the nostrils.
A piece of cartilage or bone is removed to attain the desired shape.
If your septum is displaced, it will be straightened.
If needed, the bridge of your nose is rebuilt with synthetic implants or your cartilage.
The nose of your skin remains intact and will fall tightly around your new nose.

Step 4. Suturing and bandaging

Once the nose has been given the correct shape, the incisions are closed with tiny, dissolvable sutures. Internal splints and/or tampons are put into your nostrils, and an external splint is placed on the bridge of your nose.

Step 5. Recovery and aftercare

You will remain in our surgery clinic for the next few hours, in the care of Dr Pirayesh and his team, until he feels it is safe for you to return home. You will need to be picked up, and it is preferable if someone is with you for the next 24 hours. You will receive pain medication and instructions on using a nasal spray to keep your airway open.

You must not drink alcohol or take blood thinners like aspirin painkillers (paracetamol is allowed) for ten days before and ten days after surgery.
During the first 48 hours after surgery, you may experience swelling and discolouration, usually lasting for seven to ten days.
You must rest for a few days and refrain from bending, lifting, or blowing your nose.
You must hold your head upright as much as possible and sleep upright, propped up on pillows.
The swelling will make breathing through your nose difficult for the first two weeks. This will, in turn, make your mouth feel dry, so it is important to drink enough liquids, even though the swelling makes it a little bit problematic.
Avoid the sauna, solarium, and warm baths to reduce the chance of further swelling.
The tampons in your nostrils will be removed one week after your surgery.
As a rule, you can resume your normal activities after a week: you can do light cardio workouts, but you must refrain from contact sports for the first six weeks.
You can perform heavy physical work or heavy lifting after six weeks.
You will experience reduced sensitivity of your nose, but this will return to normal after some time.

Step 6. Wound healing and scars

Although a rhinoplasty scar is only 3 millimetres long and almost invisible, tucked away under the nose tip, it will be treated with the utmost care. Dr Pirayesh is very savvy when it comes to promoting rapid healing. He has developed a customised regimen, APS Scar Care, including aloe vera-based creams, laser treatments, and (if necessary) injections to ensure that your scars heal in the best possible way. This regimen has ensured that many of Dr Pirayesh’s patients have hardly noticeable scars. However, it is impossible to pre-determine if patients will have problems with their scars healing.