Many of us cannot have rhinoplasty, which is the dream of many people, because of our fears. Our biggest fear is that the result is not what we want, but in our subconscious we are actually afraid of the pain and the healing process that we think will last for months. Pain is one of the most difficult complaints for every living thing. Of course, the biggest factor here is the bad surgical results we see or hear from the environment. Frankly, almost every patient has a bad rhinoplasty story to tell from his/her environment. Unfortunately, if some surgical rules are not followed, bad results and healing processes that last for weeks can be seen in rhinoplasty that is performed so frequently. Worst of all, after this bad process, patients have to undergo surgery again and a new challenging process awaits the patient.
So why do some surgeries heal and look flawless within 10 days, while some surgery results can be so problematic. Why do some patients have swelling and bruises that go away in 4-5 days, and there are patients who have been dealing with swelling for months, and as a result, they have problems that will require surgery again. Although the only explanation for this is rhinoplasty surgery is expressed as a single name, it is performed by each physician with different techniques and approaches, and more importantly, with different tools and perspectives. In other words, these surgeries are not the same surgery. Patients actually encounter very different surgical steps under the name of rhinoplasty. The skill of the surgeon is of course important. But which technique, which tools he uses and his artistic point of view are much more important.
Now let’s look at the results of what is done during the surgery one by one. Let’s take the skin incision first. As we know, open surgeries are performed by cutting the skin under the nose. Actually, this is not just a skin incision. Along with the skin, the connective tissues, vessels and lymphatics under the skin are also cut. Cutting the connective tissues reduces the resistance of the nose and requires extra supports, and artificial supports harden the nose. Cutting the vessels causes malnutrition in the tissues and long-lasting swelling occurs, especially in the tip of the nose, until new vessels are formed. The pitungay ligament system is the main support connective tissue of the tip and lateral part of the nose, and many vessels and lymphatic networks pass through it. Cutting it will both disrupt these structures and reduce the blood supply and absorption of tissue edema, and the resistance of the nose will decrease and its naturalness will deteriorate. In particular, the scroll line, which is described as a wing, will lose its naturalness and resistance. In closed technique rhinoplasty, this system is not opened, the skin is not cut, and the vascular structures in the unopened system are preserved. Since the lymphatic flow is not impaired, the collecting system works faster after the surgery and the edema quickly regresses.
The second part of the nose when you go up is the cartilage part. The main dorsal cartilage structure, known as the upper lateral cartilage, continues into the nose as the septum (nasal midline cartilage). In many aesthetic surgeries, the nasal back cartilage is obviously broken down and removed during belt removal, and its deteriorated structure is tried to be repaired by using many cartilages. Even in the most skilled hands, it is not possible to reconstruct the original structure of the nasal ridge in the same way. In the protective (preservation) rhinoplasty technique applied in addition to the closed technique, the nasal ridge structure is never removed. Its integrity is intact. How is this region that is not opened and whose integrity is not compromised to be operated on? As a result, this area forms the anterior lower arch structure of the nose and if it is not to be removed, it must be lowered. This is where the “PUSHDOWN” technique comes into play. With the interventions made inside the nose, this structure is emptied and the underfilled tissue goes down. While preserving its original perfect anatomy. The unopened ridge of the nose will of course heal much faster. Skin edema will be very little, the result will be much more natural and the back lines will be smooth.
Let’s come to the most feared part, bone structures. Most patients think that their nasal bones are broken during surgery with rough blows. Unfortunately, there are surgeries performed in this way. However, even without a single drop of blood, bone structures can be shaped. piezo
Surgical instruments cut bone structures with ultrasonic waves and do not interfere with soft tissues at all. Sometimes, in cases where piezzo devices cannot be used, bone areas can be intervened with very fine 2mm or 1mm bone cutters. The thinner, the less swelling and quicker healing. However, you will appreciate that it requires a great deal of surgical experience and hand control to use such thin instruments by feeling inside the bone without seeing it. The difference will also emerge here.
In nose surgeries performed with the appropriate technique, the duration of the surgery has no effect on swelling and healing. However, considering the opposite, tissue edema will increase with each passing minute, blood will fill between the tissue, and rough healing areas will occur that last for months and sometimes, unfortunately, do not go away. The ideal is to use the right technique and to finish the operation at reasonable times.
Postoperative nosebleeds are mostly caused by nasal midline cartilage. The more this segment is opened and joins the surgical field, the greater the risk. The midline of the nose is often opened for curvature, but sometimes for cartilage support. In protective PUSHDOWN surgery, the need for cartilage support is very low, because the nasal support is intact and there is no mandatory area for repair. For this reason, the midline of the nose is also slightly opened. The risk of bleeding is much lower. The buffer residence time is limited to 1-2 days and the tampons are thin and small.
As a result of all this, the recovery period of the CLOSED PROTECTIVE PUSHDOWN technical nose plastic surgery is limited to 5 days, and patients not only recover quickly, but also rarely need a second surgical intervention.
