Rhinoplasty

A rhinoplasty reshapes the bones and cartilages of the nose so that the skin then re-drapes over its new framework. This procedure may be aesthetic or functional, to address breathing difficulties. It harmonises the appearance of the nose while preserving or improving nasal breathing.

This operation can remove a hump, narrow the nose, refine or lift the nasal tip, correct a deviated nose, shorten a nose that is too long, or reduce the width of the nostrils.

It is a maxillofacial and aesthetic procedure that has seen many technical advances. Today, almost every surgical step is performed in a controlled manner under direct or indirect vision. The anatomical structures are preserved (“preservation rhinoplasty”) in order to achieve a natural result and optimal long-term stability.

This procedure involves several stages (skin, bone, cartilage). It is in fact made up of several operations: the tip, the hump, and the nasal septum.

Major advances have shaped rhinoplasty in recent years:

– The way the structures are approached has changed: the “2.0” closed approach, known as “preservation rhinoplasty”, which respects the ligamentous and anatomical structures, now stands alongside the more traditional open approach, which provides a better view of all the structures and allows the use of piezosurgery.

– The use of new motorised instruments for rhinosculpture, and of ultrasonic rhinoplasty with piezosurgery (piezoelectric instruments), brings greater precision to the bone work and limits swelling and pain

– More precise control of the reshaping of the bony pyramid is now possible, either segment by segment or as a single block (dorsal preservation technique).

– Reshaping and support of the nasal tip are better controlled and more stable over time: resections are more conservative and combined with cartilage sutures and supporting cartilage grafts (Teorhinoplasty).

– Treating a deviated septum, correcting nasal valve function, and targeted treatment of the turbinates improve nasal breathing and prevent it from deteriorating after a rhinoplasty.

THE “PRESERVATION RHINOPLASTY” TECHNIQUE

Doctors Dujoncquoy and Laurian have a special interest in this procedure. They are renowned for their natural results and operate exclusively on the face. They trained with international experts and perform “Preservation Rhinoplasty”, also known as “Smart Rhinoplasty” (or the anterior marginal closed approach), as well as Teorhinoplasty. These techniques minimise scarring and respect the ligamentous structures. They make it possible to reshape the nasal tip without any scar, with excellent results and long-term stability. Dr Dujoncquoy trained during a fellowship with Dr Baris Cakir, the world-renowned surgeon who developed the Preservation Rhinoplasty technique.

There is sometimes debate as to whether a rhinoplasty should be performed through an open or a closed approach. The open (or external) approach requires a skin incision under the nasal tip, between the nostrils. The closed approach avoids this incision, with scars located only inside the nostrils and therefore completely invisible. Some noses require a closed approach, while others are better corrected through an open approach. Doctors Dujoncquoy and Laurian use both techniques and choose the most appropriate one for each situation.

WHAT A RHINOPLASTY INVOLVES

How should you prepare for a rhinoplasty?

– It is important to have thought things through before “taking the plunge” and to have discussed the expected result with your surgeon over several consultations. All necessary questions should be asked before setting a date for surgery.

– It is advisable to stop smoking at least 4 weeks before surgery so that the tissues are well oxygenated and heal properly.

– Aspirin should be avoided in the days leading up to the operation.

– Do not undergo surgery if you use recreational drugs (mainly cocaine), as this is far too risky.

– If you have thick or oily skin, you will need to see a dermatologist to treat your skin before the procedure. This operation is sometimes not recommended when the skin is too thick.

Two consultations, spaced 15 days apart, are required before scheduling surgery. This interval is mandatory and allows time for reflection. The quality of the preoperative consultations is important. These consultations help build a relationship of trust and establish the best possible surgical plan. A third consultation is often offered for a final review.

The hospital stay is 12 hours (outpatient) or 24 hours (one night spent at the clinic).

You will be asked to arrive at the clinic with an empty stomach. You will be put to sleep under general anaesthesia. Once the operation is over, you will spend one to two hours in the recovery room before returning to your room.

A splint is placed on the nose for 7 days to protect and support the tissues. Ointment-coated packing or soft silicone tubes are positioned in the nostrils for 24 hours to protect the nasal lining and limit bleeding.

– Splint: a splint is placed on the nose. It is kept in place for one week, then worn at night for a further two weeks or so.

– Nasal packing: removed the next day or after a few days

– Recovery time after general anaesthesia: varies from person to person (6 to 24 hours).

– It is advisable to sleep with your head slightly elevated to limit the swelling and bruising that may appear under the eyes.

– It is advisable to take it easy in the days following surgery without remaining completely still. Strenuous effort should be avoided, but it is important to get moving from the day after surgery. This helps minimise oedema (swelling). Bruising fades within 7 to 15 days. You can use Helichrysum (an essential oil sold in pharmacies) to speed up its disappearance.

– Make-up can be worn again a few days after the procedure.

– Work can be resumed one to two weeks after surgery. For a purely aesthetic procedure, not covered by the French national health insurance, no sick leave certificate is issued.

– Sports activity should be limited for 4 to 6 weeks.

– Wearing glasses: in some cases you will need to wait 1 month before wearing glasses. This depends on the technique used.

– Very slight swelling persists for a few weeks or months. It generally goes unnoticed by those around you.

– Sun: it is advisable to wait one to two months before exposing your nose to the sun

Results and follow-up after a rhinoplasty

The result is visible at 7 days, when the splint is removed. The final result is achieved within 4 to 12 months, as the skin and cartilage continue to remodel and a very slight oedema persists during the first year.

You will see your surgeon again 7 to 10 days after your rhinoplasty, then 6 weeks after the operation. However, Dr Dujoncquoy and Dr Laurian can see you before these appointments and remain available and attentive to any questions or concerns.

Risks:

– Risk of aesthetic imperfection: in 10% of patients who undergo surgery, a slight imperfection or asymmetry is acknowledged to remain. If necessary, the result can be refined during a second operation, but sometimes a minor flaw simply has to be accepted. Any revision must be performed at least one year after the initial procedure, as the skin and cartilage remodel slowly and remain inflamed for several months after surgery.

– Risk of haematoma (blood under the skin): most often harmless.

– Risk of infection: very rare.

– Risk of an inflammatory reaction in the weeks following the operation: uncommon and usually easily treated.

– Risk of anaesthesia-related complications: exceptional if you are in good health and have a healthy lifestyle.

PRACTICAL INFORMATION:

  • Consultations take place at 15 rue Chateaubriand, 75008 Paris (George V metro station – line 1) and at 22 rue d’Orléans, 92200 Neuilly-sur-Seine (Sablons metro station – line 1)
  • The operation is performed at the Ambroise Paré – Hartmann private hospital group in Neuilly-sur-Seine
  • Hospital stay: outpatient or one night spent at the clinic
  • Anaesthesia: general anaesthesia
  • Duration: 1 to 4 hours
  • Social downtime: 7 to 15 days
  • Splint: 7 days
  • Time off work: one to two weeks
  • Stitches to be removed: sometimes

    You can also explore our other orthognathic surgery treatments, such as mandibular osteotomy in Paris, 3D orthognathic surgical planning in Paris and maxillofacial surgery in Paris, to learn more about our full range of techniques and indications.