Rhinoplasty in Turkey

What is Nose Aesthetics (Rhinoplasty)?

Rhinoplasty is a plastic surgery procedure that provides both aesthetic and functional improvements. This surgery aims to aesthetically adjust the structure of the nose while also optimizing breathing function. Although it was described in 1887, methods and techniques have undergone significant changes over time.

The main focus of modern rhinoplasty is reshaping the nose to harmonize with the natural proportions of the face. The surgery aims to provide an aesthetic appearance by repositioning and, if necessary, adding to the nasal tissues. The procedure is planned considering both aesthetic and functional results.

The challenges of rhinoplasty include the unique facial structure and nasal anatomy of each patient. These variables require surgeons to develop a customized approach for each operation. Additionally, the recovery process after rhinoplasty varies for each individual. Therefore, patients’ expectations and outcomes should be clearly defined beforehand.

The evolution of the rhinoplasty process has been shaped by contributions from various surgeons. These surgeons have introduced significant innovations to the operation techniques. Their work forms the foundation of current rhinoplasty practices. Developments include:

• A better understanding of anatomical structures
• Integration of careful reduction and grafting techniques
• Methods to optimize functional and aesthetic results

Such innovations have made it possible to achieve more consistent and satisfactory results. Rhinoplasty not only improves appearance but also plays a critical role in maintaining or improving nasal functions. This is especially evident in cases where airflow is reduced due to obstructive processes.

The complexity of rhinoplasty is also one of the rewarding aspects of the surgery. Each successful operation enhances the surgeon’s skill and patient satisfaction. This shows that rhinoplasty is not just a technical procedure but also carries a high level of artistic direction.

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Anatomical Structures and Their Functions

Nose aesthetics operations require an understanding of the complex structure of nasal anatomy. Surgeons must have a good grasp of the function and structural features of each part of the nose before rhinoplasty. This understanding directly affects the success of the operation.

The nose is both an aesthetic and functional organ. It is divided into three main sections: the upper, middle, and lower parts. Each section has specific structural and functional features.

Upper One-Third:

• Consists of bony structures.
• Defined by paired nasal bones and the frontal process of the maxilla.
• This region determines the overall shape of the nose.

Middle One-Third:

• Formed by the upper lateral cartilages.
• These cartilages create a keystone area with the nasal bones.
• The aesthetic of the dorsal contour is shaped in this area.

Lower One-Third:

• Contains lower lateral cartilages formed by the medial, middle, and lateral crura.
• These cartilages determine the shape and size of the nasal tip.
• Supported by the external nasal valves.

The nasal muscles work integrated within the superficial musculo-aponeurotic system (SMAS). These muscles allow nasal movements and contribute to facial expressions. The nasal, levator labii aleque nasi, and depressor septi muscles are especially vital for nasal functions.

Nasal Muscles:

• Nazalis
• Levator labii aleque nasi
• Depressor septi

The skin and soft tissue envelope (SSTE) of the nose shows regional differences. The rhinon region is covered with the thinnest tissue, requiring careful handling during surgery. Factors such as gender, age, and ethnic background affect the thickness of this tissue.

Skin and Soft Tissue Envelope (SSTE):

• Thinnest region: Rhinion
• Moderately thick region: Upper section
• Thickest region: Lower section

The septum is a critical structure located in the midline of the nasal cavity. It separates the two nostrils and provides main support for the nose. The septum consists of cartilaginous and bony components and is a primary source for graft harvesting in nasal surgery. This structure regulates airflow within the nose through the internal nasal valve.

Septum:

• Cartilaginous component
• Bony component

The turbinates are bony protrusions inside the nose covered with mucosa. These structures function in humidifying, heating, and cleaning the air. They also regulate airflow and can lead to turbinate hypertrophy in conditions such as rhinitis or septal deviation.

Turbinates:

• Superior turbinates
• Middle turbinates
• Inferior turbinates

The nose has a rich blood supply. The main nasal arteries form an extensive anastomotic network, supporting extensive tissue reductions during surgery. Venous drainage mostly anastomoses with the facial vein, playing an important role in managing nasal bleeding.

When Should Nose Aesthetics Be Performed?

Nose aesthetics is a significant decision point for many individuals. The timing of this surgery is critical for both aesthetic and functional outcomes. The ideal time is when the individual has reached physical maturity and the nasal structure has completed its growth. This ensures the nasal form remains stable post-surgery.

The maturity age varies for males and females. Women generally reach this maturity at an earlier age, while men mature slightly later. These differences can be decisive for the timing of surgical intervention.

• Ideal age for women: Approximately 18 years old.
• Ideal age for men: Approximately 20 years old.

These ages indicate that the nasal structures have largely completed their development and will not undergo significant changes. Rhinoplasty performed at an early age can lead to undesirable outcomes as growth continues. An underdeveloped nasal structure may prevent the surgery from achieving its aesthetic and functional goals.

Comprehensive evaluations conducted before surgery allow the surgeon to determine the patient’s nasal structure’s developmental status and whether they are suitable for the operation. The patient’s medical history, genetic factors, and physical development are integral parts of this assessment process.

When the decision for surgical intervention is made, it must be ensured that the patient is both physically and psychologically ready for this operation. Individualized planning for the timing of the surgery should consider the patient’s expectations, lifestyle, and social environment.

The timing of nose aesthetics is not only limited to physical suitability. The patient’s emotional maturity and ability to adapt to the postoperative process are also of great importance. Therefore, in-depth consultations with patients before making a surgical intervention decision are an indispensable part of this process.

In Which Situations Should Nose Aesthetics Not Be Performed?

Rhinoplasty may not be suitable for some individuals. Certain conditions and health issues constitute contraindications for this surgical procedure. Firstly, patients who show emotional instability or have unrealistic expectations are not suitable candidates for this operation. Patients with Body Dysmorphic Disorder (BDD) are also included in this group. This disorder causes individuals to become excessively fixated on minor or imagined flaws. The presence of such a condition increases the risk of dissatisfaction after rhinoplasty.

Contraindications:

• Unstable emotional state or unrealistic expectations
• Body Dysmorphic Disorder (BDD)

A second significant contraindication is obstructive sleep apnea. This respiratory disorder is characterized by recurrent airway obstruction during sleep. It is known that individuals with this disease have a high risk of perioperative complications before rhinoplasty. Therefore, necessary precautions should be taken for such patients before the operation.

Contraindications:

• Obstructive sleep apnea

Thirdly, individuals with active cocaine use are not suitable candidates for rhinoplasty. Cocaine use can cause severe damage to the nasal mucosa. Chronic use resulting in mucosal inflammation and septal perforation increases postoperative complications and hinders healing.

Contraindications:

• Active cocaine use

Fourthly, some medical conditions that can increase the risk of complications related to surgical intervention exist. These include bleeding disorders. Issues related to clotting can cause serious problems during and after the surgery.

Contraindications:

• Bleeding disorders

Lastly, patients who have previously undergone rhinoplasty and are dissatisfied with the results should wait at least one year before considering another operation. This period allows the tissues to heal completely and for a new intervention to be planned more healthily.

These contraindications must be considered for the safe and effective performance of the rhinoplasty procedure. It is important for patients and surgeons to take the necessary precautions to minimize these risks. This way, both the quality of surgical outcomes can be enhanced, and patient satisfaction maximized.

What Anesthesia Methods Are Used in Rhinoplasty Surgery?

During closed rhinoplasty, patients are usually treated under general anesthesia or local anesthesia with sedation. These options maximize the patient’s comfort while ensuring a painless experience during the surgical intervention. Before the procedure begins, infiltration anesthesia is applied; this step both numbs the nasal area and makes the operation field bloodless.

• The solution used for anesthesia contains 1% lidocaine diluted with epinephrine.
• 5 ml to 10 ml of the solution is injected into the nasal area.

Beforehand, oxymetazoline, a local vasoconstrictor, is applied to the nasal mucosa to encourage vasoconstriction. This application helps reduce bleeding during the operation. Infiltration usually starts from the nasal root and extends to the lateral nasal walls. During this process, major vessels and nerves are preserved, minimizing structural disruption to the nose. Care is also taken with the mucosal areas during infiltration.

Areas for Infiltration:

• Lateral nasal walls
• Columella
• Maxillary arch

In more advanced procedures, such as septal reconstruction or cartilage harvesting, infiltration into the septal mucosa prevents bleeding and allows more effective dissection. Subsequently, nasal hairs are cleaned, and the nasal mucosa is disinfected with an antiseptic solution. This preparation phase ensures that the surgical area remains sterile and minimizes the risk of infection.

What Incision Techniques Are Used in Rhinoplasty Surgery?

The incision techniques used during rhinoplasty allow the surgeon to precisely adjust the nasal structure. Techniques used, especially during nasal tip reshaping, vary. There are two main incision techniques:

• Trans-cartilaginous incision
• Intercartilaginous incision

Trans-cartilaginous incision is generally applied in cases where a fuller appearance of the nasal tip is required. With this method, the lower lateral cartilage is incised, providing the desired aesthetic appearance after the operation. The mucosae are carefully turned around to better manipulate the tissues, and unnecessary cartilage tissue is removed. A certain amount of cartilage is preserved to support the nasal tip structure and prevent collapse.

Intercartilaginous incision is applied to the region between the upper and lower lateral cartilages. This technique is preferred more for fine-tuning the nasal tip. Marginal and intercartilaginous incisions are combined for more precise adjustments of the nasal tip. Stripping soft tissues from the incision sites facilitates the removal and reshaping of the cartilages. Changes made to the cartilage after the procedure help maintain the natural appearance of the nasal structure.

How is the Management of the Nasal Dorsum Area Handled?

The evaluation and reshaping of the nasal dorsum area are critical in the rhinoplasty process. If a dorsal hump is present, it is typically a combined structure of cartilage and bone. Treatment methods are determined accordingly. Various techniques come into play when reducing the dorsum:

• When reducing bony structures, the surgeon may use rasping, osteotomy, or ultrasonic tools. After the procedure, the dorsum should be smooth and straight.
• Cartilaginous dorsums can be excised regardless of their connections. During this procedure, the surgeon should avoid excessive tissue removal to prevent complications like dome collapse.

Dorsal augmentation procedures are especially applied to correct structural deformities. These procedures are frequently preferred methods during rhinoplasty. Materials used for augmentation and contour correction include:

• Autologous or homologous bone and cartilage tissue
• Synthetic implants; materials like silicone and Gore-Tex can be preferred.

Although synthetic implants are useful in some cases, autologous tissue, if available, is a safer choice. There are risks such as infection and tissue loss with implants. Therefore, each treatment step should be meticulously planned and executed. Rhinoplasty procedures aim not only at aesthetic but also functional improvements.

What is the Role of Lateral Osteotomies in Rhinoplasty Surgery?

Lateral osteotomies are important surgical techniques applied to improve nasal aesthetics during rhinoplasty. These procedures are especially utilized when the nasal vault is wide or when natural curvatures of the nasal structure need correction. If the patient has an open roof deformity, the surgeon may resort to lateral osteotomies to correct this deformity. This technique preserves the aesthetic dorsal lines of the nose while ensuring symmetry and functionality.

Lateral osteotomies can be performed in the following ways:

• Internally through the nasal mucosa
• Externally by cutting the skin and using a thin osteotome

These methods are preferred to reshape the nasal bone and achieve a smooth facial profile. The pressure applied during the procedure creates a greenstick fracture, helping to reposition the nasal bones in their new positions. Lateral osteotomies are typically performed where the bone is thin at the junction between the maxilla’s frontal process and the nasal bone.

Some contraindications exist in the application of these techniques. Lateral osteotomies can be risky, especially in patients with thin or short nasal bones. The surgeon must be particularly careful considering these situations. When performed on suitable patients, lateral osteotomies provide effective results and can significantly improve the aesthetic of the patient’s face.

Rhinoplasty and Septoplasty Surgery Processes

Rhinoplasty and septoplasty treatments provide aesthetic and functional improvements to the nasal structure. The procedure begins with septoplasty; the correction of septal deviation is essential. During this process, bilateral mucoperichondrial flaps are elevated to allow a clear view of the septum. The anterior septal angle is identified, and an incision is made on the cartilage to expose the subperichondrial plane. Following this step, the mucoperichondrial flaps are separated from the septal cartilage using a Cottle elevator. The cartilage removal process is completed using a scalpel and a Ballenger rotating knife. To minimize the risk of septal collapse, a certain amount of septal cartilage is preserved during the procedure.

After septoplasty, rhinoplasty is performed. Here, the goal is to create a wider area between the septum and the upper lateral cartilages. Spreader grafts described by Sheen are used for this purpose:

• Placed between the septum and the upper lateral cartilages.
• Provides width to increase the angle of the nasal valve.
• Can improve aesthetic dorsal lines.

A septal “tunnel” is prepared using a Cottle elevator before placing the spreader grafts. Following this tunnel, the grafts are fixed under and above the uncut septum for correct positioning. This procedure requires meticulousness for accurate placement, and incorrect placement can lead to aesthetic and functional issues. After the procedures are completed, mattress sutures are used to close any dead spaces. These processes aim to improve both nasal function and appearance.

How Are Nasal Tip Modifications Performed in Rhinoplasty Surgery?

Nasal tip adjustments hold significant importance in rhinoplasty. They provide aesthetic and functional improvements. A series of techniques are used during the procedure, including projection and rotation adjustments. These techniques optimize the aesthetic appearance and functionality of the nasal tip.

Projection reduction or augmentation procedures are applied to ensure the nasal tip harmonizes with the facial profile. The lateral and medial crura are shortened to reduce projection, while various grafts are used to increase projection.

• Columella strut placement supports the medial crura, increasing projection.
• A graft made from the septal cartilage is placed between the medial crura to enhance tip projection.
• Septal extension graft is placed between the lower lateral cartilages to increase both projection and rotation.

Tip rotation adjustments contribute to the harmony of the patient’s face. Upward or downward movement of the nasal tip changes the nasolabial angle, significantly affecting facial expression.

• Cephalic trimming of the lower lateral cartilages aids in natural elevation of the tip.
• Caudal trimming of the septum adjusts the nasolabial angle and can reduce projection.

Suture techniques used for tip shaping improve the contour and balance of the nasal tip.

• Transdomal suture narrows the tip width and increases projection by bringing the domes closer together.
• Interdomal suture is placed between the domes of the lower lateral cartilages, narrowing the tip width and enhancing projection.

Turbinectomy Treatment in Rhinoplasty Procedures

Inferior turbinate hypertrophy is a common issue inside the nose that can obstruct the airway. The treatment varies depending on the level of obstruction. Various surgical techniques are preferred to manage this problem:

• Submucosal turbinectomy,
• Turbinoplasty,
• Radiofrequency,

If other nasal internal structural problems, such as valvular issues or septal deviation, have been previously resolved, the turbinate outfracture method may be sufficient to increase the airway size. This can significantly improve the patient’s breathing capacity.

Post-Rhinoplasty Closure and Dressing Techniques

Post-rhinoplasty, the closure of mucosal incisions is of great importance. Absorbable sutures are used to speed up the healing process. These sutures facilitate faster tissue fusion and keep the operation area stable. After the procedure, septal support is necessary, which is provided by Silastic splints. These splints are placed on both sides of the septum and carefully sutured. These splints:

• Enhance septal support,
• Encourage mucosal healing.

After the operation is completed, the nasal dorsum is covered with paper tapes. These tapes:

• Protect the structure,
• Control swelling.

These tapes are carefully removed after seven days. This process supports both aesthetic and functional healing.

What Complications Can Arise During Rhinoplasty Surgery?

Rhinoplasty is a complex surgical procedure performed to achieve aesthetic and functional improvements in the nasal structure. The recovery period plays an important role in this process, as various complications can arise. These complications are generally unpredictable and can show different reactions in each individual. Undesirable outcomes can sometimes occur in ways that even the surgeon cannot foresee. These situations are generally categorized under the following headings:

• Hemorrhagic complications
• Infectious complications
• Traumatic complications
• Functional issues
• Aesthetic problems

Although the likelihood of leading to serious health problems is low, such complications can cause social and psychological difficulties for the patient. Additionally, surgical interventions, especially those performed for aesthetic concerns, carry the risk of not meeting the patient’s expectations. This situation can lead to legal problems for the surgeon. Therefore, the postoperative period requires careful monitoring.

How Are Bleeding Complications Managed After Nose Aesthetics?

One of the common issues encountered after nose aesthetics is bleeding. This complication is usually mild. Elevating the patient’s head, applying a decongestant to the nose, and compression methods can control the bleeding. If these measures are insufficient, the use of anterior packing may be necessary.

In the case of continued bleeding, a more careful examination is required:

• If anterior packing is insufficient, the possibility of posterior bleeding should be evaluated, and if necessary, posterior packing should be applied.
• For severe and uncontrolled bleeding, endoscopic intervention or angiographic embolization methods may be employed.

Another condition that requires attention is septal hematoma:

• This is a sensitive mass in the nasal septum that requires urgent intervention.
• It presents symptoms such as pain, fever, loss of smell, and difficulty breathing.
• Early intervention is essential to prevent infection risk and permanent damage.

Steps applied in the treatment of septal hematoma:

• Draining the hematoma,
• Placement of anterior packing after the procedure,
• The patient should be re-examined after 24 hours.
• If there is a suspicion of septal abscess, antibiotic treatment should be initiated.

Finally, studies are ongoing on the use of antifibrinolytic drugs like tranexamic acid to reduce bleeding complications:

• This drug has the potential to reduce bleeding when administered intravenously before surgery.
• It can also prevent the formation of edema and bruising around the eyes.

What Are the Infection Risks After Nose Aesthetics?

Infections rarely occur after nose aesthetics but can vary. Infections can range from mild skin issues to more serious health problems. For instance, cellulitis encountered in the early period usually responds well to antibiotics. However, the patient’s condition should be continuously monitored to prevent the progression of cellulitis.

Early Period Infections:

• Cellulitis: It manifests with redness and swelling on the skin.
• Septal abscess: Typically occurs as a result of an untreated hematoma and requires antibiotics along with surgical drainage.

Septal abscesses can be seen in the septum, nasal tip, or dorsum. The antibiotics and drainage used in the treatment process are crucial to prevent the infection from escalating into larger health problems. Severe infections occur in less than one percent of cases. In such situations, serious complications like tissue necrosis or toxic shock syndrome can occur. Rapid and effective intervention is necessary to prevent these complications.

Severe Infectious Processes:

• Tissue necrosis: Can cause the death of tissue.
• Toxic shock syndrome: A life-threatening condition.

Early intervention, intravenous antibiotic treatment, and rapid tissue debridement play vital roles in preventing these serious health issues. Prophylactic antibiotic use can be beneficial in reducing postoperative infection risk. However, there is no definitive consensus on the duration of antibiotic use. The WHO does not recommend antibiotic use for more than 24 hours after surgery due to the low infection risk. Careful observations made within this period are important to detect any signs of infection early and apply appropriate treatment methods.

What Are the Traumatic Complications After Nose Aesthetics?

Some traumatic complications may occur after nose aesthetics. Among the most noticeable are:

• Damage to the L-strut region. This can lead to septal deformities and collapse.
• Intracranial injuries. Although very rare, such injuries can have serious consequences.

Septal injuries typically manifest over time if not detected during surgery. These deformations often require secondary interventions. If the injury is diagnosed during surgery, it should be repaired before the tissue is closed. Intracranial injuries can cause cerebrospinal fluid leakage, leading to nasal discharge and headaches. Such a complication requires urgent medical intervention, and the patient should be hospitalized immediately, with a neurosurgical evaluation performed. These situations should be carefully handled and treated as soon as possible.

How Is Damage to the Lacrimal Canals Addressed in Nose Aesthetics?

One of the issues that may be encountered after nose aesthetics is damage to the lacrimal canals. This type of injury can occur, especially during lateral osteotomies. Postoperative edema pressing on the lacrimal canals can cause epiphora, known as tear overflow. This condition usually heals on its own within the first few weeks. However, in some cases, additional interventions may be required:

• Canal intubation: Can be applied for persistent tear problems.
• Medical follow-up: To wait for the edema to subside and evaluate the situation.

Being aware of these complications and early intervention is critical to prevent permanent damage.

What Functional Problems Are Encountered After Nose Aesthetics?

Septal perforation is a complication that can occur after nose aesthetics operations. It may arise due to tears in the mucoperichondrial flaps or a septal hematoma. Perforations vary from small to large, and the severity of symptoms varies with the size of the perforation. Small perforations usually do not cause noticeable symptoms, while large perforations can lead to serious airflow issues. These situations can trigger problems like epistaxis and rhinitis.

• Small perforations generally do not require treatment.
• Large perforations require surgical intervention and carry a risk of recurrence.

Nasal adhesions are another functional problem encountered after aesthetic operations. They occur due to abrasion of the mucosal surfaces, and the use of Silastic splints during septoplasty procedures can prevent them. If adhesion is detected postoperatively, it should be surgically separated.

Rhinitis is generally considered a temporary complication. It can occur after resolving airway obstruction. The most common symptoms are nasal discharge, dryness, and difficulty breathing. This condition can usually be controlled with topical treatments. If nasal discharge persists, the possibility of cerebrospinal fluid leakage should be considered.

What Aesthetic Problems Arise After Nose Aesthetics?

Some patients may experience late complications after nose aesthetics. The tip area is particularly at risk. Asymmetry and deformities can develop as a result of grafting procedures. These issues are related to various factors such as skin thickness. The amount of graft used and fixation techniques are also influential. It is recommended to wait at least one year after the initial surgery, as early intervention can negatively affect the healing process.

Complications seen in the dorsal area are more varied:

• Problems arising from excessive or insufficient resection of septal cartilage
• Residual hump
• Middle vault collapse
• Pollybeak deformity

Pollybeak deformity is characterized by a convex structure formation in the supratip area, usually developing as a result of excessive removal of the cartilaginous dorsum. Scar tissue formation can lead to pollybeak deformity in this area. This condition is generally treated with Triamcinolone injections and taping, but if unsuccessful, surgical intervention may be required.

Additionally, if scar tissue does not form, the soft tissue envelope may contract. This can lead to the collapse of the nasal vault and saddle nose deformity. In such a situation, general findings include:

• Collapsed middle vault
• Tip projection and over-rotation
• Columella retraction
• Alar base widening

These can also cause breathing problems. Treatment is usually performed with the necessary grafting to restore septal integrity and dorsal support. These grafts are often carried out with autologous material obtained from the patient’s own tissue. In rare cases, rib grafts may be used.

How Much Does a Rhinoplasty in Turkey in 2024 ?

The cost of a Rhinoplasty in Istanbul, Turkey, typically ranges between €5,000 and €7,000. The price can vary depending on several factors, such as the surgeon's experience, the complexity of the procedure, the clinic's reputation, and additional services included in the package.

Average Rhinoplasty  Cost (in Euros) in 2024
United Kingdom	€16,600 – €19,000
United States	€14,200 – €23,400
Canada	€16,000 – €19,000
Australia	€23,800 – €37,800
South Korea	€9,400 – €17,200
Ireland	€13,000 – €15,000
Germany	€11,000 – €13,000
Netherlands	€11,000 – €13,000
France	€11,000 – €13,000
Turkey	€5,000– €7,000

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One of the Best Clinic Team for Rhinoplasty in Turkey

Dr. Alev Camcıoğlu is considered to be one of the best Rhinoplasty  surgeon in Turkey. You can check Rhinoplasty reviews here.

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