RHINOPLASTY BARCELONA

I will personally attend to the patient at all times, so, in addition to carrying out the intervention, I will also provide care. The patient has my personal email, so they can consult anything that worries or bothers them at any time.

The price of the procedure also includes all necessary care and postoperative visits. Additionally, in the unlikely event that the patient is not satisfied with the result, I commit to intervening again at no charge; the patient only needs to cover hospital admission expenses.

The main advantage of my rhinoplasty technique over the closed technique is that it allows for a complete exposure of the entire anatomy of the nasal tip, making it easier to understand why the nasal tip has a certain shape. It helps in understanding which maneuvers to perform to address the problem. Additionally, we can immediately assess the aesthetic consequences of the procedure just by repositioning the skin, resulting in a much more symmetrical and harmonious nasal tip, ultimately appearing more natural.

As for external rhinoplasty, the primary advantage is that there is no visible scar. With just the repositioning of the skin, we can immediately see the results, whereas in external rhinoplasty, the results can only be appreciated at the end of the procedure when we close the columellar incision. It’s also worth noting that with my technique, the nose looks more natural and harmonious.

The patient has my personal email, so they can always proceed to inquire about anything that concerns or bothers them.

A rhinoplasty is a surgical procedure aimed at modifying the external shape of the nose. It can be performed under local anesthesia and sedation, although, from my point of view, it is strongly discouraged due to the discomfort it generates for the patient. The patient needs to be awake enough to swallow secretions but also at the right level of sedation not to be overly aware of the surgery. It’s important to consider the highly individual tolerance among patients, even with the same body weight. Therefore, the anesthetist must be well accustomed to this type of surgery and work in close collaboration with the surgeon. In case of any complications, immediate general anesthesia may be required, making it essential for an anesthetist to always be present.

Personally, I always perform rhinoplasties under general anesthesia because it is much safer and more comfortable for the patient since they are not aware of anything during the surgery, unlike when performed under sedation.

There are different techniques for rhinoplasty, namely the closed technique and the open technique. In the closed technique, there are no external incisions, but it presents the drawback of being challenging to control the surgery of the nasal tip, leading to a tendency for asymmetry or unnatural results.

In the case of open or external rhinoplasty, the procedure starts with an incision at the level of the nasal columella. Its main disadvantage is that this scar is always more or less visible.

Lately, there is much talk about ultrasonic rhinoplasty, which applies the Piezotome, designed by Italian maxillofacial surgeons some years ago to avoid neurosensory injuries that frequently occurred after mandibular osteotomies. It’s important to note that using this device in rhinoplasty always necessitates open rhinoplasty due to the impossibility of placing the apparatus. Ultrasonic rhinoplasty is only useful for osteotomy in the bony pyramid but does not serve to address the correction of nasal cartilages.

The effectiveness of ultrasonic rhinoplasty is debatable as nasal bones are very thin, requiring very small osteotomes for osteotomies. Whether to use ultrasonic rhinoplasty or not depends on the surgeons’ experience. More experienced surgeons who have been performing rhinoplasties for many years typically prefer osteotomes for osteotomies, while younger or less-experienced surgeons may prefer ultrasonic rhinoplasty for added confidence in performing osteotomies.

Although I occasionally perform closed or open rhinoplasties, in over 95% of my patients, I use my own technique presented at The American Academy of Plastic and Reconstructive Surgery Congress in Boston in 2010. This technique is more logical, leaves no scars, and results in more predictable and natural outcomes.

The main consideration in rhinoplasty is how to access the structures that need correction and what maneuvers to perform to achieve it. It’s crucial to keep in mind that each maneuver has a margin of accuracy and a margin of error. Nasal sutures or the placement of a graft must be done carefully because the margin for error is limited, and incorrect execution can worsen the aesthetic outcome.

Rhinoplasty is considered a very challenging surgery as no two cases are alike, and achieving highly predictable results often requires many years of experience. In cases where rhinoplasty is combined with septal surgery to address breathing problems, it is called septorhinoplasty, which is even more challenging as it further disrupts or weakens nasal anatomy. The goal of the intervention is not only to improve breathing but also to achieve a natural-looking nose.

A rhinoplasty is a type of surgery aimed at correcting nasal aesthetic irregularities. The most common goal is to address deformities of the nasal dorsum, such as a hump or a wide or asymmetrical nasal tip.

While some surgeons perform rhinoplasty under sedation and local anesthesia, I personally always practice it under general anesthesia. The duration of the operation depends on the difficulty of each case, typically ranging between a minimum of 90 minutes and up to 3 hours in very challenging cases, such as revisions.

The advantage of performing rhinoplasty under general anesthesia is that the patient is intubated, and vital signs are continuously monitored throughout the procedure. In cases of sedation, where the patient is not intubated, the airway is not isolated or protected by an endotracheal tube. Sedation requires careful consideration of individual variability in the doses needed to ensure the patient is adequately sedated or asleep, making them comfortable with the maneuvers performed by the surgeon. Simultaneously, the patient must be able to swallow secretions or manage any bleeding to prevent it from reaching the lungs since the airway is not isolated.

In sedation-based rhinoplasty, an anesthetist must always be present to shift to general anesthesia through endotracheal intubation if necessary.

The safety advantages of rhinoplasty under general anesthesia are evident from the above, and it is also more comfortable for the patient as they remain unaware of anything during the procedure.

There are different rhinoplasty techniques, namely the closed and open techniques. The closed technique has the advantage of internal incisions, making scars invisible. However, it is challenging to control the symmetry of the nasal tip. Since most cases require some modification of the nasal tip, results in this aspect can be unpredictable, often resulting in asymmetric nasal tips with this technique.

The external or open technique requires an incision at the level of the columella, which is always visible. The main advantage is excellent visibility of the anatomy of the alar and triangular cartilages, aiding in understanding the maneuvers needed for correction. However, the results tend to be unnatural, especially when combined with functional septum surgery or septoplasty, where nasal packing exerts pressure on the columellar scar, posing a risk of necrosis.

Personally, although I started with closed rhinoplasties 35 years ago and later began incorporating open rhinoplasty 6 years later, I rarely use these techniques. Instead, I have designed my own technique that achieves similar exposure to open rhinoplasty but without external scars.

It’s crucial to consider that rhinoplasty aims to achieve harmony within the facial structure, striving for a natural-looking nose that doesn’t appear operated. The current trend differs from that of a few years ago when nasal corrections were exaggerated, resulting in similar-looking noses that clearly showed signs of surgery. Overcorrected aesthetic noses often lead to airflow collapse, drawing attention for their unnatural appearance.

The lack of natural aesthetics in nasal surgery is often due to excessive resection of the lateral crura of the alar cartilages and occasionally the triangular cartilages, resulting in airflow collapse. Every year, patients with such issues seek consultation, and thanks to advances in rhinoplasty surgery, solutions are possible through grafts at the nasal valve level.

Rhinoplasty is a procedure that has a much more significant impact than the patient is initially aware of. Most patients come to the consultation very excited, seeking information on how to address their aesthetic concerns. Many of them are self-conscious about various issues such as a large nose, a wide nasal tip, a nasal hump, or a deviated nose. However, they all desire a natural appearance that doesn’t make them feel self-conscious in photographs.

In my case, as my basic training is as an otolaryngologist, most patients also want to address nasal breathing insufficiency (difficulty breathing through the nose). Some also mention headaches or persistent rhinorrhea (mucus).

The initial impression of a nose is crucial to me, as it is what attracts my attention the most. A nose with a wide nasal tip, deviation, or a dorsal hump can significantly draw attention, hindering the appreciation of the beauty of the rest of the face, whether viewed from the front or the side.

Interestingly, after a rhinoplasty, the beauty of the eyes or mouth becomes more noticeable because the nose is better integrated into the face, enhancing facial symmetry and allowing for a better appreciation of overall beauty.

From an aesthetic standpoint, rhinoplasty improves confidence and self-esteem. However, we must be cautious with certain types of patients who expect that the changes brought about by rhinoplasty will make them more attractive and consequently change their lives, such as finding a better job or a more appealing partner. When these anticipated changes don’t occur, some may start doubting the results, even if objectively they are good or very good.

From a functional perspective, the improvement achieved through septorhinoplasty, which combines correction of a deviated nasal septum with rhinoplasty, significantly enhances the patient’s quality of life. After septorhinoplasty, patients often report less fatigue during exercise due to improved nasal breathing.

Normal human breathing occurs through the nose, ensuring that air reaches the lungs with the proper humidity and temperature, regardless of external conditions. Mouth breathing is less efficient, leading to inadequate gas exchange between the pulmonary alveoli and the blood.

Nasal breathing also serves to filter impurities and allergens in the air properly. Recent studies have demonstrated the role of nasal breathing in the production of nitric oxide through the sinus mucosa, a gas with significant health implications, including antiviral properties.

It has long been known that people who breathe well through their noses tend to have fewer illnesses. The nasal mucosa shares similarities with the bronchiolar alveolar mucosa, so patients with rhinitis often exhibit asthma to varying degrees, and vice versa.

In patients with asthma, nasal breathing is crucial. If contaminated or very cold air, or air with many allergens, directly reaches the bronchi without passing through the nose, it can easily trigger bronchospasm.

In a young patient with poor nasal breathing, the impact on health may not be excessive, and they may not be very conscious of it. However, as we age, difficulty breathing through the nose can contribute to or exacerbate bronchitis, significantly affecting health.

I always perform a nasal fibroendoscopy (which is painless), allowing the patient to see on a monitor the internal image of their nasal cavity, helping us understand better why they may experience breathing difficulties or headaches.

After septorhinoplasty, many of my patients not only experience a considerable improvement in aesthetics but also report the disappearance of headaches that they have suffered from for years. Headaches related to significant deviations of the septum that contact the middle and/or lower turbinates can often be relieved by correcting the septum.

I have also observed some cases of anxiety that significantly improve in situations of severe difficulty breathing through the nose. This is logical because having a constantly blocked nose and not being able to breathe properly through it can cause significant emotional distress, which disappears when proper nasal breathing is restored.

In conclusion, rhinoplasty contributes to emotional well-being by making individuals feel more comfortable with themselves. Septorhinoplasty is more challenging than rhinoplasty because it aims for both functional and aesthetic improvement, but the benefits and satisfaction are often higher because it also improves health.