Rhinoplasty

1. What Is Rhinoplasty (Nose Aesthetic Surgery)?

Rhinoplasty is a surgical procedure that aims to create a nose that is harmonious with the face, natural and functional by reshaping:

• The nose from the side and front view
• Dorsal humps (nasal bridge bump)
• The shape and angle of the nasal tip
• The width of the nostrils
• The relationship between the nose, lips and chin

The aim is not just to make a “small nose” but to provide:

• A nose that harmonises with the facial features
• A balanced profile (nose, chin and forehead harmony)
• Maintenance or improvement of breathing function
• A nasal structure that can remain stable in the long term

2. In Which Situations Is Rhinoplasty Preferred?

Rhinoplasty is generally preferred when:

• The nasal hump is prominent on side view
• The nasal tip appears wide, droopy, round or asymmetric
• The nostrils look wide or unbalanced from the front or from below
• The nose is perceived as too large or too small compared to the rest of the face
• The shape of the nose has changed after major trauma
• Curvature, enlarged turbinates and septal deviation that impair breathing are present together with aesthetic concerns

For many patients, because the nose is in the central part of the face, any change can have a marked aesthetic and psychological impact.

3. Can Functional and Aesthetic Nose Surgery Be Performed Together?

Yes, in most cases functional and aesthetic procedures are performed in the same session:

• Functional procedures such as
• Septoplasty (correction of a deviated septum)
• Turbinate (nasal concha) reduction
• Opening of narrowed airway segments

can be carried out together with aesthetic refinement of:

• Nasal bridge
• Nasal tip
• Nasal wings / nostrils

In this way:

• Breathing quality is improved
• A nose shape that harmonises with the face is obtained

If functional problems are ignored in a rhinoplasty performed for purely aesthetic reasons, breathing difficulties may increase in the long term. For this reason, a holistic assessment is very important.

4. Who Is a Suitable Candidate for Rhinoplasty?

Suitable candidates are generally individuals who:

• Are disturbed by the shape of their nose and/or by breathing problems
• Have a general health status that allows surgery
• Have largely completed nasal and facial growth (usually around 17–18 years of age in women and 18–19 in men)
• Have realistic expectations from rhinoplasty
• Can tolerate a short period of social isolation and recovery

In the presence of significant psychological expectation disorders, serious systemic diseases or conditions that contraindicate surgery, planning must be highly individualised.

5. Preoperative Evaluation and Planning

Before surgery:

• The patient’s medical history, current medications, allergies and smoking status are assessed.

The nose is photographed:

• From the front, side, from below and while smiling
• At rest and during facial expressions

Profile analysis is performed:

• Nasal tip rotation and projection
• Nasolabial angle (nose–lip angle)
• Chin projection
• Balance of forehead, nose and chin line

Breathing complaints are carefully evaluated; the following are examined:

• Septal deviation
• Turbinate hypertrophy (enlarged nasal turbinates)
• Narrowing of the internal and external nasal valves

At this stage, it is discussed:

• What kind of nose the patient imagines
• What will actually suit the facial structure
• What degree of change is realistically achievable depending on skin thickness (thin / thick skin)

The aim is not a “one type fits all nose” but a personalised result that suits the individual face.

6. Open and Closed Rhinoplasty Techniques

Rhinoplasty is generally performed using two main approaches:

a) Closed (Endonasal) Rhinoplasty

• All incisions are made inside the nose
• There is no visible external incision
• It is suitable for more limited changes in selected nose types

b) Open Rhinoplasty

• A small incision is made on the columella, the small column of tissue between the nostrils
• This incision is usually in an inverted V or straight-line shape
• The nasal skin is elevated in a controlled manner
• The cartilage and bone structures can be reshaped under direct vision

The open technique is especially preferred in:

• Revision cases (secondary rhinoplasty)
• Marked asymmetries
• Noses requiring detailed tip work
• Complex anatomies

Which technique is chosen depends on nasal anatomy, previous operations, skin type and the extent of change that is targeted and is decided by the surgeon.

7. How Is Rhinoplasty Performed?

In general terms:

Anaesthesia

• The patient is put to sleep under general anaesthesia in the operating room.

Incision and access

• Depending on whether an open or closed technique is used, incisions are made inside the nose and, if necessary, across the columella.

Bone and cartilage reshaping

• The dorsal hump is rasped or cut and reshaped
• When necessary, the nasal bones are carefully fractured (osteotomies) to create a narrower, more harmonious nasal bridge that fits the face

Tip plasty (nasal tip refinement)

• Tip cartilages are reshaped
• Nasal tip rotation, projection and width are adjusted
• If needed, grafts (cartilage support pieces) are used to strengthen tip support

Functional corrections

• If a septal deviation is present, it is corrected
• Enlarged turbinates can be reduced
• Narrow nasal valve regions can be opened

Closure and splinting

• Internal nasal sutures are usually placed with absorbable stitches
• Externally,
  1. a splint or cast is applied to the nasal bridge
  2. and silicone splints / internal nasal splints may be placed inside the nose if needed

The aim is to improve aesthetics while at the same time preserving or improving nasal support and breathing function.

8. Anaesthesia Process and Surgery Day

Before surgery, the anaesthesiologist evaluates the patient:

• Necessary tests are performed
• Medications, allergies and previous surgeries are reviewed

On the day of surgery:

• Eating and drinking must be stopped after a certain time (fasting duration is specified by the anaesthesia team).

Although the operation itself takes on average 2–3 hours:

• The total time spent in the hospital is longer when preparation and wake-up phases are included.

After surgery:

• The patient is monitored in the recovery room
• Nausea and pain are controlled
• The patient is then transferred to the ward

9. The First Postoperative Days: Splints, Cast, Swelling and Bruising

In the first days:

If silicone splints / internal supports are used:

• The nose may feel blocked
• The patient may need to get used to breathing through the mouth

The splint / cast and nasal tapes on the nasal bridge:

• Support the new shape of the nose
• Help to control swelling

Complaints

• In the first 2–3 days, there may be swelling of the nose and around the eyes and mild to moderate pain
• Bruising can appear under the eyes;
  1. it usually decreases significantly within 7–10 days
  2. swelling resolves more slowly

Position

• Sleeping with the head slightly elevated
• Avoiding bending forward in the early days
• Taking care not to hit or bump the nose are important.

Pain is usually well controlled with prescribed painkillers; many patients report that “the feeling of congestion is more bothersome than pain itself”.

10. Staying in Istanbul, Follow Ups and Returning Home

For international or out-of-town patients, a typical process is:

Day 1–2

• Discharge from hospital if 1 night was spent
• First dressing change and general condition check

Day 3–5

• Removal of silicone splints / internal supports if used
• Instructions on nasal cleansing and use of sprays and ointments

Day 5–7

• Removal of the external splint / cast and sutures
• First assessment of the nasal shape
• Explanation of taping and care recommendations for the following weeks

Therefore, most patients are advised to stay in Istanbul for 6–7 days for rhinoplasty. Before flying, swelling, risk of bleeding and general condition are evaluated by the surgeon.

11. Returning to Social Life, Work and Sports

At home

• For the first 1–2 days, rest and swelling control are the main focus.

Return to work

• For desk-based work, most patients can return within 7–10 days.
• After the external splint is removed, mild swelling and colour changes can be camouflaged with make-up.

Social environments

• Bruising usually decreases significantly within 7–10 days
• Although swelling lasts longer, many patients start to feel more comfortable socially from the second week onward.

Return to sports

• Light walking: from the first days (with doctor’s approval)
• Brisk walking / light exercise: around 3–4 weeks in most patients
• Swimming, weight training, running and sports with a risk of impact: generally 6–8 weeks

Avoiding direct trauma to the nose during this period is extremely important.

12. Nasal Tapes, Massage and Follow Up Process

After the splint / cast is removed:

• Tapes placed on the nasal bridge and sides help:
  1. control swelling
  2. the skin adapt to the new nasal framework

Taping duration

• In the first weeks, taping may be recommended at night and/or for certain periods during the day
• In thick-skinned noses, longer taping protocols may be used

Massage

• In some cases, especially in areas with pronounced swelling, gentle massage techniques as demonstrated by the surgeon may be recommended.
• These massages must be performed carefully and in a controlled manner; strong pressure that could distort the nasal structure should be avoided.

Follow ups

• Several visits are scheduled within the first month
• Then follow ups at around 3, 6 and 12 months are commonly planned

13. Possible Risks and Complications

As with any surgical procedure, rhinoplasty also carries certain risks:

• Bleeding, haematoma (collection of blood within the tissues)
• Infection (rare)
• Wound-healing problems, issues along the suture line
• Asymmetry, irregularities at the nasal tip or bridge
• Shape changes over time related to tissue healing
• Need for revision (secondary surgery)
• Incomplete improvement of breathing problems or occurrence of new breathing difficulties
• Very rarely, problems due to impaired skin circulation

To minimise these risks, the following are crucial:

• An experienced surgeon
• Correct indication and detailed planning
• Compliance with pre- and postoperative instructions on smoking, medication and care
• Not missing control visits

Revision rates vary depending on nasal anatomy, skin thickness and healing characteristics, but a certain revision rate exists worldwide in all rhinoplasty series.

14. Results, Expectation Management and Healing Differences by Nose Type

The aims of rhinoplasty are to obtain a nose that:

• From the front, harmonises with the other facial features
• From the side, maintains a balanced profile
• Looks natural when smiling
• Has good breathing function

Points to remember:

• In the first weeks the nose is very swollen and oedematous, so it does not reflect its final shape.
• Nasal contours become more defined within 1–3 months
• Fine details and residual swelling resolve within 6–12 months

Nose type

• In thin-skinned noses:
  1. details appear earlier, but small irregularities can also be more visible
• In thick-skinned noses:
  1. swelling lasts longer
  2. the final result appears later, so patience is very important.

The goal is not a “fashionable one type nose” that may go out of style but a nose that is timeless, natural and looks like it truly belongs to your face.