Rhinoplasty before – after, Dr Bellity
In France cosmetic surgery on the nose is not covered by social security; the state will only pay for this procedure if there is nasal obstruction caused by a crooked septum and you will need the X-rays to prove this. You may also be covered if your nose is clearly deformed or blocked due to an injury but you will have to apply for this specifically and your application will need to be accepted.
Rhinoplasty is certainly the trickiest area of all when it comes to cosmetic surgery. Aside from technical skill, the surgeon’s artistic sense is important in obtaining a harmonious result that does not scream « nose job ».
ASSESSING THE REQUEST
To me, there are two parts to the consultation: the first is the « assessment of the request » and the second is « the technique and information”. The patient’s motivation and requests are carefully considered. Don’t forget, we are not operating on a nose but a patient, and the best work in the world will only be properly appreciated if the patient is psychologically prepared for it and accepts it. The way a patient presents, the language used, assessing how long the patient has wanted the procedure, to what extent they are influenced by their entourage, their friends (or so-called friends) and family can tell us much about how great the expectations are and how important the result is to the patient.
Most of the time, the request is clear and precise and the motivation is strong. In this case the patient is looking for surgery that will give satisfaction from a morphological point of view.
With adolescents, the request is often urgent and carries overtones of major teen angst. A caring attitude, and a neutral one regarding the family, consists of talking to the patient alone about their motivations, trying to play for time without refusing to operate. This can enable the surgeon and the patient to take the « right decision » at the right time. If in doubt, the surgeon should seek a psychological opinion on the appropriateness and the timing of the procedure.
TECHNIQUE AND INFORMATION :
I ask my patients to « describe » their nose in words as they perceive it. The nose is basically made up of three parts: The « bridge » (also called the nasal dorsum), the « tip » (also called the lobule) and the nostrils. When it comes to the bridge, we look at whether there is a bump or not, the width of the bone, whether it is crooked or not, the angle in relation to the forehead (the naso-frontal angle), the length of the nose and its projection, in other words its forward dimension.
With the tip, we talk of a slim or bulbous tip, we describe the skin as thin or thick, we say the tip points upwards (retroussé) or downwards (hanging), and we measure the angle in relation to the lips (the naso-labial angle).
With the nostrils, we measure the size of the nostrils and whether they are drawn and narrow or, on the contrary, flared. An in-depth clinical examination of the nasal cavity for signs of a crooked septum or a turbinate hypertrophy determines the respiratory capacity of the « nasal valve”. This is made up of cartilage which should ensure the sturdiness of the nasal opening. This is important to avoid the procedure having a negative effect on the patient’s breathing.
It is also important to put words to all these elements and note them down on file. The use of digital photos with a morphing feature aids this work enormously. The possibility of showing the modification using computer tools enables the patient to grasp the morphology of their nose and of those parts they wish to alter. It also enables the patient to understand the change that is about to take place and to get used to it or not.
For the surgeon, it is a way of understanding what the patient wants, finding out whether it is realistic and feasible and preparing the procedure that will effect this change. It is important to use this computer tool for what it can offer both parties, but it must not be seen as a promise or an exact commitment.
The before/after « simulation » is given to the patient marked with the words « NON-CONTRACTUAL simulation” and a new consultation is arranged to confirm all the details discussed during the first consultation.