Deviated septum?

Written by Escobar MD     

People have asked me this question with relative frequency. To avoid complications, I will give you the following example: the nose will be like two conducts through where air flows, and the wall that separates these conducts is the septum.

In some cases this wall interrupts the flowing of air through one of the conducts, due to prior trauma or a birth defect. When the flow is interrupted it is logical that the breathing will not be good, and it will be necessary to set this wall in a position that allows good breathing. This is what is known as a septoplasty.

Nasal Tip Surgery in Colombia.

Written by Escobar MD    

In my opinion, the most important factor to obtain a beautiful, natural nose that works to breathe is the nasal tip.

The tip is made up of cartilage and the skin that covers it. Due to its location in the central part of the face, any slight defect can be very notorious.

Besides, if an adequate technique is not used, the changes that are performed on the nasal tip will not be stable long-term; this means that they will worsen in time, both aesthetically and functionally. An ugly tip has many possibilities of causing a nose that does not breathe well.

This technical difficulty is what has popularized the open technique (with external incisions), although, to my understanding, better results are obtained with a closed technique (without external incisions), obviously, with the adequate training.

Difficult rhinoplasty

Written by Escobar MD     

There are highly difficult rhinoplasty cases. They tend to be cases with several prior surgeries. A nose that is in a bad condition, with previous surgeries, will normally show that the reconstruction needs an expert surgeon and a technique that is capable of solving what was not possible previously.

There are many techniques to solve these cases nowadays. In many of these cases, given that there has been an important damage in the structure of the nose in prior surgeries, it is necessary to reconstruct what was lost or damaged.

Some surgeons use the patients' own tissues, or synthetic tissues, or a combination of both. If the patient's own tissues are used, they can be rib cartilage, septum cartilage or ear cartilage.

Personally, and due to the technique that I perform, I prefer (in a case needs a reconstruction of the support and structure of the nose) to use ear cartilage. It is strong, flexible and malleable enough to recreate most of the cartilaginous nasal structures (which are the ones that are most damaged by prior surgeries).

Nasal Base Surgery

Written by Escobar MD   

  

In some people the width of the base of the nose is somewhat greater that desired. The ideal value varies according to the patient's race, but we can say that the ideal value is equal to the distance between the eyes or up to 4 mm greater than this.

The treatment of the nasal base during a rhinoplasty is a complementary point of the surgery, but it is of great importance. If an adequate technique is not performed, there can be consequences such as asymmetries, breathing problems or visible scars.

"Mestizo" nose

Written by Escobar MD  

   

The racially mixed nose is defined as the nose that results from the combination of races that has happened mainly in Latin America. The racially mixed nose will therefore have the characteristics of the african-american, native, and white nose in greater or lesser degree, according to the degree of crossbreeding.

This type of nose needs a completely different treatment than that of a Caucasian or white nose. The racially mixed nose can have a wide spine and nasal base, weak cartilages and thick skin; these factors result in the lack of support and definition, which is characteristic of this type of nose.

Open or closed rhinoplasty?

Written by Escobar MD     

At the moment performing a rhinoplasty, there are two main types of techniques: the open and the closed rhinoplasty.

The open technique consists of making an incision on the skin of the area that separates the nostrils (columella), combined with other incisions on the inside of the nose. This way we can easily access the internal structures of the nose. 

The surgeon is the one who most benefits from this technique, because they can easily perform the necessary changes on the nose. Although the patient suffers more swelling, more recovery time, and can be left with a visible scar; without forgetting that the technique has less precision at the time of evaluating the changes that are being performed during the surgery.

On the other hand, the closed or endonasal technique avoids this external incision on the skin and only uses internal incisions to gain access to the structures susceptible to change. The one who most benefits from this technique is the patient, who avoids a scar that can be noticeable on occasions, and who will also have a faster recovery with less swelling.

This last technique, in expert hands, is the one that offers the best global results, and is the one that I recommend and perform.

Deviated nose

Written by Escobar MD     

In the case of the deviated or crooked nose, if look at yourself in the mirror and observe your nose from the font, you can divide it into 3 parts. The first one is bone, next is the cartilaginous part (it is the part after the bone that is softer and, as opposed to the previous part, can be moved).

Finally there is the nasal tip, which is the lowest part and is also made up of cartilage. Normally, if all this is well, these 3 parts or portions are perfectly aligned on the central axis of the face, in such a way that the nose will have a straight appearance.

WHAT IS IT ABOUT? Every alteration in the position, whether traumatic or congenital, of any of the portions that make up the nose in regards to the central axis of the face. Therefore, if this happens your nose will be deviated or crooked.

Doctor, I look weird...

Written by Escobar MD     

Some times after a rhinoplasty some patients tend to say this phrase. The truth is that after a rhinoplasty there is a period of adaptation to the new image. In some people this can take longer than usual, although they finally end up getting used to their new nose.

This period of adaptation happens usually on the 2 or 3 weeks after finally removing the nasal dressing and the splint. At this point there will still be some swelling of the nose and the around the lower eyelids, which makes the patient feel scared about not looking as well as expected. It is the surgeon's job to calm the patient down and explain the normal process that they are going through.

The sun in the rhinoplasty

Written by Escobar MD     

There are some things that you should keep in mind after a rhinoplasty so that your recovery is as quick as possible, and one of them is the exposure to the sun. Solar radiation will affect your recovery in two ways: the first one is that it causes heat, and the second is that its UVA rays pigment the skin.

A fair amount of sun is beneficial for our health and improves our mood; it helps us create vitamin D which is basic for the maintenance of our bones, among other things. But after a rhinoplasty, and especially in the cases of people with thick skin (negroid or racially mixed noses) or revision rhinoplasties (more than one previous rhinoplasty), the exposure to the sun is not recommended at least during the first two months after surgery.

Does the Rhinoplasty hurt?

Written by Escobar MD     

This question is very frequent, and I always say the same thing: NO

A rhinoplasty does not hurt. Fortunately it is one of the best post operatives in the facial plastic surgery field, and you can begin your normal activities in just a few days.

The main symptoms are nasal congestion that is similar to that of a light cold but that will disappear little by little, and in some 3 or 4 days your breathing should be practically normal. Nevertheless, this congestion can cause a slight migraine or headache sensation, but that easily disappears by taking a soft analgesic.

As days go by these small inconveniences will disappear, and two weeks later they will not exist anymore. Therefore, if you follow the doctor's recommendations like an obedient and collaborating patient, the entire rhinoplasty experience will be positive.

The nasal dressing

Written by Escobar MD     

If you are going to get a rhinoplasty in Bogotá or in Madrid, you are perhaps thinking about the famous cast and the noticeable dressing...

This point is necessary (very necessary, I would say), but it has particularities, in my experience.

I believe that the use of a cast in a rhinoplasty is something completely anachronistic, out of date and useless.

The ideal thing is to use a metallic splint that adapts easily to the shape of the nose, that does not become loose as the nose's swelling goes down, and that is in place for at least 10 days.

This splint is fixed and covered with Micropore, which is a type of paper bandage that will allow the splint to be held in a stable position. It will be better if it is flesh toned, because it will be more aesthetic.

Swelling

Written by Escobar MD  
   

WHAT IS SWELLING? It is your body's reaction to the surgery's aggression. Swelling is, in fact, somewhat necessary for any injury or trauma to be cured.You are going to get surgery, and there is something that I believe is important for you to know about the swelling

Through the increase in blood flow produced by the swelling, the substances that help heal the nose will arrive at the area and do their job in the months following the surgery.

TYPES OF SWELLING We can divide the swelling into 3 types: acute swelling, sub-acute swelling and chronic swelling.

Deciding

Written by Escobar MD     

On some occasions I have seen that the patient is the last one to decide to get the surgery or not. I believe that this is a point that deserves special attention. The patient should be the one to have the initiative to get the surgery, the one who searches for a surgeon, and above all, they should be totally determined to go through with everything that a surgery implies.

Only by being fully determined will the process be satisfactory for the patient, and everything will be easier.

Who should decide?

Written by Escobar MD     

In some occasions I have seen that the patient is the last one to decide to get the surgery or not. I believe that this is a point that deserves special attention.

The patient should be the one to have the initiative to get the surgery, you should be the one who searches for a surgeon, and above all, you should be totally convinced of going through everything that a surgery implies.

Only when you are fully convinced will the process be satisfactory, and everything will be easier to overcome.

Do not let anybody influence you to get surgery, it is clear that an important part of the motivation to get the surgery are the people that surround us, but to a certain extent. Never go into an operating room forced by someone, but do not keep yourself from going in due to an external opinion either, or due to fear of what people will think of you...

The opinions from the people that surround you will help you decide, but in the end you are the most important; if you are an adult, it is your choice. Do not forget!

It is frequent to see how at times a surgery is cancelled due to the opinion of a boyfriend, of friends or relatives

When the patient seemed determined. We also tend to see people coming to a practice looking to get a surgery forced by criticism from their environment, to the extent that they believe that getting the surgery will solve all their problems (a rhinoplasty only fixes a nose, not an entire life).

Therefore I reiterate, think about it a lot, gather information, be clear about what your main motivation is, and never let anybody force you to do something that you do not want to do, whether in one or sense or another. A good surgeon must be aware of these situations and give you advice in the best way possible, from an honest point of view, without putting their interests before yours.

Choosing a surgeon

Written by Escobar MD     

You have had this idea in your head for a long time: getting nose surgery. You have taken pictures in all angles and positions, and you realized long ago that you did not look good on pictures, and after analyzing it...

yes, the nose is to blame.

Once you decide that you need surgery to improve your self-esteem and to gain self-trust, the most important thing is to choose a good specialist.

GATHERING INFORMATION A first step tends to be surfing the internet in search of information (Google, YouTube, even Facebook are nowadays the best sources).

You find videos, photos, specialized forums, opinions... some recommend one thing or another. Another way is talking to someone who has already had surgery, ask about their experience with their surgeon, etc...

I want a natural nose!

Written by Escobar MD   

It is very usual for me to hear this a lot on the first consultation. The artificial-looking results that are often associated to a nose surgery or rhinoplasty are mainly due to old techniques that sadly are still performed today by many surgeons.

Fortunately for the patient, the current tendency is to avoid every sign of surgery, for nobody to find out that they have had surgery, for the results to be natural and proportional to the result of your face. To my understanding, good results are the ones that keep the surgeon in anonymity.

The best techniques to achieve good results are the ones that are conservative at the moment of removing cartilage or bone, so we not only obtain natural results, but also maintain a good breathing function. What is most important is that we will achieve results that are predictable at long-term.

Recovery Time

Written by Escobar MD   

  

In my experience, this point is the one that worries the patients the most, obviously, after the final results. We would generally be able to divide the recovery process of a rhinoplasty into two parts; the first would be the one immediately following the surgery, which is from 9 to 14 days.

After this time, the patient has practically no swelling or hematomas, the nasal dressing will have been removed, and he/she will be able to begin their daily activities without anybody noticing that they just had surgery. Even though this depends on each patient and each surgeon, this is the typical scenario.

On the days following this initial period, the patients will continue the process of bringing down the swelling, day by day they will notice that their nose improves continuously, until around 6 months after the surgery, when the changes become minimal. All this can vary, and in some patients it can take up to a year or a year and a half.

What influences this? Mainly the type of surgical technique, the surgeon's experience, the patient's skin type (if it is thin or thick), the patient's age, among others.

All in all, I could say that you will be practically 85% recovered from the surgery one month later. The remaining 15% will continue improving from 6 months to a year.

Are you a candidate for a rhinoplasty?

Written by Escobar MD     

This question is very interesting. There are people with noses that would not fit the beauty standards, who are still happy with them or have never had any problems.

The point is that if your nose is an aesthetic problem that has discouraged your full personal development, or has affected to your self-esteem, you are probably a candidate, although it is also true that it is not necessarily the solution to all your problems.

The surgeon, from an honest point of view, should be the one to confirm this and help the patient decide if surgery is adequate or not, and what type of surgery is best.

Regarding the age as of which a person can get a rhinoplasty, women can have it as of 15 and men as of 17. At this age the growth of the nose stops, and therefore a rhinoplasty will offer reliable results.

Tips before a rhinoplasty

Written by Escobar MD   

 

If you are reading or visiting this page, it is because you are interested in having nose surgery in Colombia or Spain.  You will have thought about this for a long time, and even though you are very determined, you will have to have gotten the courage to take the step.

A rhinoplasty is a big process that begins at the moment in which you realize that the surgery is necessary to improve and solve something that has been limiting your personal development. Regardless, you must remember that this is not the solution to all your problems.

The anesthesia

Written by Escobar MD     

The rhinoplasty is the most difficult plastic surgery of all, not only due to its technical difficulty, but also because the results are influenced by various factors. One of them, and which is a key aspect for me, is the anesthesia.

I prefer general anesthesia to operate, mainly due to the security that it gives to the patient (compared to local anesthesia). With general anesthesia we can control the patient's airway during the entire procedure, in such a way that there will not be any problems with the oxygen supply if anything unexpected were to happen. It also offers the surgeon a more comfortable way of working, in such a way that he will be able to operate in a calm environment and obtain more precise results.

In all the various types of general anesthesia, the one that I recommend is the intravenous general anesthesia. This anesthesia does not use gases to make the patient sleep, only medication that is given through the veins.

This type of anesthesia is safer than the anesthesia with gases, because just stopping the flow of the medication will cause the patient to begin to awake, as opposed to the anesthesia with gases, with which we must wait longer. This makes waking up very comfortable, it feels as if you are waking up from a nap.

Additionally, we can control blood pressure better during the entire surgery, maintaining it at a level that avoids excessive bleeding.

All of this will have an influence on a faster recovery, because if you do not bleed, you will not have hematomas or so much swelling, and in my experience I can tell you that, with this type of technique, you can begin your social and work activities within 10 days without any problem.

The only inconvenience that intravenous anesthesia has is that it is more expensive that the classical general anesthesia, and you need an anesthetist with enough experience to perform this technique adequately.

Rhinoplasty for men

The rhinoplasty, as well as the other facial plastic surgeries, was traditionally considered as something that was only for women. Fortunately the world has been changing a lot, and men are currently interested in improving their image, being conscious of the fact that a better aspect will result in greater confidence and more possibilities of success in their personal and professional life.

As for the rhinoplasty, a man has some typical facial proportions, which are what define their face as a male face. For this reason, the changes that we must perform in a man will be, logically, different than those in a woman.

A Custom Nose

Written by Escobar MD     

An important aspect to obtain good results in a rhinoplasty is a good facial analysis. For this, it is important to take photos of the patient in frontal, base and profile projection. Analyzing the photographic images, and logically observing the patient live, we will be able to study the shape of the nose in detail and its relation to the other elements of the face.

FRONTAL ANALISIS We will do this observation from the frontal vision, mainly to asses if the nose has a well-proportioned length to the face, if the width of the nose is adequate according to the distance between the eyes and the width of the mouth. And, of course, to assess if the nose is aligned with the facial axis; this axis divides the face into two theoretically equal halves. If the nose does not coincide with this axis it can be deviated, and therefore we must plan a surgical technique to solve it.

The price of a rhinoplasty

Written by Escobar MD     

Planning a rhinoplasty is something that takes time, for the patient as well as for the surgeon. The patient has to adapt his agenda to have at least 7 free days to recover from the intervention, besides going to the checkups, which will be twice a week for the first month. But perhaps one of the fundamental aspects will be the financial part, to be able to pay the expenses related to the surgery.

This point, especially nowadays, is what slows down patients the most. I tend to get a lot of mail asking for the price of a rhinoplasty in Madrid (Spain) or in Bogotá (Colombia).

I always answer personally, saying that each case is different and that it is honestly difficult to be able to give a real diagnosis or budget until I have personally assessed their case at my office.