DR. MATTIA COLLI SURGEON
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RHINOPLASTY

COSMETIC NOSE SURGERY

RHINOPLASTY

Rhinoplasty aims to redefine the correct balance between the various components of the nose (both bone and cartilage) and those of the entire face. To achieve this goal, Dr. Mattia Colli studies the different planes of the face very carefully in all their measurements and projections (for example, for example forehead-eye distance, mouth-chin, etc.) always taking into account the sex, personality and requests of the patient.

For many people rhinoplasty surgery means pain, nasal packing, general anesthesia and hospitalization of one or more days. In recent years by Dr. Mattia Colli the methods have changed a lot and in almost all cases the rhinoplasty operation is carried out under deep sedation and local anesthesia and without the use of nasal packing. The great advantage lies in the anesthesia that allows the patient to return alert immediately after the rhinoplasty operation, avoiding the discomfort related to the awakening of general anesthesia, and return home already after a few hours from rhinoplasty.

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The high level of cosmetic rhinoplasty surgery allows patients not to feel any pain during rhinoplasty surgery. In fact, even in the prescription of drugs a mild anti-inflammatory for swelling is suggested.

The elimination of annoying nasal packing makes Dr. Mattia Colli one of the few doctors in Europe in which the post-operative course becomes simple and clean, without migraines or headaches and suffering for their removal.

The timing of rhinoplasty surgery depends on whether the operating program plans to improve part or all of the nose; usually rhinoplasty surgery can last from half an hour to an hour and a half.

RHINOPLASTY: TO WHOM IT IS RECOMMENDED

If the shape of your nose does not reflect the symmetrical features of your face and the personality of the patient, so as to make one self uncomfortable to the point of being dissatisfied internally, rhinoplasty surgery concretely solves this difficulty.

The nose is divided into 3 fundamental portions: distal third (the tip), middle third (the central part characterized by the union of bone with cartilage, properly called back) and proximal third (the highest part, the one near the eyes characterized by the bone pyramid). Between the tip and the back there is a small angle that is called in the technical field “break-tip” and that allows an optical detachment between the back and the tip. Its loss configures an unnatural nose, without structural character, almost “drawn” and is one of the most common mistakes that can be noticed following a failed surgical intervention.

In most Caucasian and European breeds rhinoplasty is an operation to reduce nasal forms: in fact, the common characteristics in patients who undergo rhinoplasty surgery are aquiline nose, potato nose or fleshy tip, wide nose, saddle nose, deviated / crooked nose in proportion to the face.

Where a profile is modified, classically to soften and correct a hump (in technical terms hump), other times complete reductions of the shape, especially of the tip, reductions in the width of the base of the nose, or correction of a tip that tends to descend downwards, then rotating it slightly upwards, are required. In many cases rhinoplasty serves to correct a “long” nose where there is usually not only a tip rotated downwards, but all the nasal structure that comes out outside the profile of the face, that is, what in technical terms means an excessively projecting nose.

Along with these, there are augmentation rhinoplasty surgical interventions, as in the classic case of nose to saddle (nose “upwards”) that wants to be corrected to obtain a straight profile; usually in these cases cartilage grafts are used and much more rarely implants of synthetic or biocompatible material.

As for ethnic rhinoplasty for patients of African-American, South American or Caribbean origin who wish to correct typical characteristics of their nose, rhinoplasty surgery normally involves increasing the projection of the nasal pyramid, reducing the nasal base and the projection of the tip looking for aesthetic characteristics that are close to those of the European / Caucasian nose.

The feminization rhinoplasty in which some women with male characteristics, allows having a kinder and more harmonious profile and rhinoplasty is able to satisfy this request.

In the feminization of patients undergoing gender transition rhinoplasty can also be used to achieve a shape, volume, and nasal profile to match their changing facial features for surgeries that also address other anatomical areas of the face, such as cheekbones, chin, jaw,  and forehead.

With advancing age, often, it seems that the nose enlarges or loses the physiognomy that had characterized it until recently. In these cases, rhinoplasty allows to redistribute the proportions in a definitive way and to rejuvenate the image of the whole face.

RHINOPLASTY SURGERY IS RECOMMENDED TO ALL PATIENTS WHO:

  • wish to have an image of their face with a natural and harmonious profile
  • they want to enjoy their own admiration and that of others
  • realize pleasure in front of a mirror
  • consider self-esteem fundamental to succeed

THE CHARACTERISTICS OF THE PATIENT SUITABLE FOR THE SURGICAL PROCEDURE OF RHINOPLASTY ARE:

The characteristics of the patient suitable for this surgical procedure of rhinoplasty are:

  • good health (blood tests and ECG)
  • aquiline nose
  • potato nose or fleshy tip
  • big nose
  • saddle or upward nose
  • deviated/crooked nose
  • wide nostrils
  • real and concrete expectations

Realistic and concrete expectations are a fundamental element for complete patient satisfaction. It is perfectly known that a high-level rhinoplasty allows secondarily to improving the perception of oneself and the relationship with other people; for this reason, during the medical surgical visit, the patient’s face is analyzed in detail and numerous pre-operative programs are proposed to decide on the best shape and profile together with the Surgeon. The ideal and satisfied candidates are those patients who have real and concrete expectations and know that with rhinoplasty you can perfect the shape and size of the nose, modify and harmonize the profile of the face and improve the functionality of the nasal pyramid.

PRIMARY OR SECONDARY RHINOPLASTY: MEANING?

When we talk about rhinoplasty we can find references to primary rhinoplasty and secondary rhinoplasty.

Rhinoplasty is defined as primary, if performed on a “virgin” nose, that is, which has never been touched or operated; instead, we speak of secondary rhinoplasty for patients who have already undergone surgery.

This second case, in particular, requires extreme surgical skill precisely because it is first necessary to correct the results of the first rhinoplasty surgery and then shape the shape and size to give a natural and harmonious result with the face.

RHINOPLASTY: WHAT TO KNOW BEFORE SURGERY

RHINOPLASTY – MEDICAL SURGICAL EXAMINATION

During the visit for a rhinoplasty surgery, the plastic surgeon visits the patient collecting anamnestic notions on the imperfections and focal points of the nose that cause discomfort, discomfort and insecurity. A detailed study of the proportions and volumes of the face is carried out: to carry out this analysis, HD and 3D images will be made so as to be able to visualize the defects with the highest possible definition and precision. Subsequently, the surgical technique used, the type of anesthesia, the post-operative phases, risks and possible complications are illustrated and the final result will be proposed, the result of the union of the patient’s requests and the advice of the Surgeon.

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INCISIONS AND CHANGES OF THE NOSE: OPEN RHINOPLASTY OR CLOSED RHINOPLASTY

“Open” rhinoplasty involves both internal incisions and an external incision at the level of the columella, that portion of skin present between the two nostrils.

This type of procedure, even if it allows a greater type of view to access the cartilaginous structures of the tip of the nose, has the disadvantage of leaving a small scar, very well hidden and not visible.

The incision must be made in the shape of “z” or “v” and never linear; this is because the columella is an anatomical region of the nose that holds tension; its linear incision would result in a depressed scar reaction compared to the neighboring skin and therefore more visible.

“Closed” rhinoplasty does not involve incisions on the skin, because the shaping of the nose is carried out through the nostrils. The surgeon cuts the mucous membranes up to the cartilage or bone structures, preserving the columella and the skin entirely.

Closed rhinoplasty has an excellent aesthetic result because it does not leave scars on the skin, but great surgical skill is required. Closed rhinoplasty is used in patients who enjoy good breathing and have an aquiline nose, potato nose, saddle nose, while when it is necessary to correct a crooked or deviated nose, secondary or with a deviated tip, an open approach is necessary to be able to better visualize the modeling on the structures and obtain greater symmetry.

BEFORE AND AFTER E DOPO RHINOPLASTY’S SURGERY

RHINOPLASTY: WHAT TO KNOW BEFORE SURGERY

PREPARATION FOR RHINOPLASTY SURGERY

Before rhinoplasty surgery, all the blood and ECG tests listed and proposed during the first visit must be carried out. In some cases of crooked/ deviated nose, CT scans should also be performed with axial and coronal projections of the nasal pits and pyramids to identify the degree of deviation of the cartilaginous septum that does not allow or limits breathing.

Numerous pre-operative images will be made for the planning of an increasingly personalized therapeutic path.

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How should I prepare for rhinoplasty?

You should inform the surgeon of any treatment with drugs (especially cortisone, contraceptives, antihypertensives, cardioactives, anticoagulants, hypoglycemic agents, antibiotics, tranquilizers, sleeping pills, stimulants, etc.) and stop taking medicines containing acetylsalicylic acid (eg Alka Seltzer, Ascriptin, Aspirin, Bufferin, Cemerit, Vivin C, etc.) at least a couple of weeks before rhinoplasty.

It is absolutely necessary to eliminate or reduce smoking at least a week before rhinoplasty surgery and report the onset of colds, sore throats, coughs, skin diseases.

MATURE THE DECISION TO PERFORM RHINOPLASTY

Deciding to undergo a rhinoplasty surgery should not be an impactful and instinctive choice but must instead be the result of a decision-making process matured and meditated over time. It is appropriate and advisable to mature the decision for some time before proceeding definitively to the pre-operative program.

RHINOPLASTY – INFORMED CONSENT

When the patient has clarified all doubts and decides to have rhinoplasty surgery, he or she is guided in filling out the informed consent document, which is drawn up according to his or her clinical case.

RHINOPLASTY – CLINICAL INVESTIGATIONS

Before rhinoplasty surgery, the patient must carry out the clinical examinations prescribed by the Surgeon to certify and demonstrate the suitability of the state of health for the total safety and tranquility of the patient, which must always be the first concern. In the event that any pathologies are discovered or the examinations record abnormalities, it will be the surgeon’s concern to inform about the state of health and to be able to plan the surgical intervention  with other anesthesiological techniques to avoid any risk related to them.

HOSPITALIZATION OF THE PATIENT

The patient is admitted in the morning fasting from midnight the night before. The preoperative program is again reviewed and validated a second time, as are the clinical examinations (double check). The patient is prepared in his or her own dedicated room, and when everything is ready, he or she is transferred to the operating block.

ANAESTHESIA

Dr. Mattia Colli has decided to abandon general anesthesia  with the relative dangers:  surgical interventions are performed with the most modern anesthesiological techniques of deep sedation (local anesthesia + intravenous anesthesia), so that fear and the sensation of pain are completely canceled while the unconscious is invaded by dreams and pleasant images.

For rhinoplasty, local anesthesia is carried out at the level of the nose through small infiltrations that allow to effectively eliminate the sensation of pain. The insertion of this solution, called tumescent, also takes place with a vasoconstrictor (adrenaline) to avoid bleeding, because it reduces the blood supply in the area to be treated allowing the operating surgeon to work at his best and in a delicate way, managing to eliminate a greater amount of fat.

Another advantage is to have an immediate return to social life without having to endure classic situations of fatigue, dizziness and exhaustion typical of the disposal of general anesthesia drugs.

RHINOPLASTY – SURGERY

Rhinoplasty surgery begins with incisions of the mucous membrane at the level of the nostrils, which allow the surgeon to access the structures of the nose. Depending on the pre-operative program agreed with the Surgeon, we proceed to the next phase of modeling of the wing cartilages, triangular, nasal pyramid, nasal septum, etc.

The incisions inside the nostrils are not visible and at the end of the rhinoplasty surgery dissolvable sutures are inserted; these have the great advantage of making internal surgical wounds heal first and detach themselves, so they avoid the discomfort and pain of removing the stitches in the post-operative period, an unpleasant sensation unfortunately due to inflammation of the nostrils.

A thermoplastic brace will be positioned on the nose in order to maintain the shape until its removal: it is a kind of rigid cast that rests on the nasal pyramid, assists in the healing of bone tissues in the correct position,  and allows to protect the operated area from any accidental impacts.

At the end of rhinoplasty surgery, nasal packing is not used and this makes Dr. Mattia Colli one of the few doctors in Europe to make the post-operative course simple and clean: the patient avoids those annoying sensations of migraines or headaches due to the placement of the nasal packing that occlude the airspaces and does not have to bear the pain for their removal.

Another advantage is to have an immediate return to social life without having to endure classic situations of fatigue, dizziness and exhaustion typical of the disposal of general anesthesia drugs.

POST-OPERATIVE RHINOPLASTY

In the healing of rhinoplasty surgery, the patient is advised not to wear glasses so that the frame cannot weigh on the shaped nasal pyramid; in this phase of healing, contact lenses are recommended in case the patient needs them. The patient is advised particular behaviors and ideal positions to be able to hold the first days in order to promote healing and limit swelling; for example, it is recommended to sleep with two pillows under the head, so as to raise it to a higher plane than the body (in fact, the lying position at night redistributes the accumulated fluids in the legs, inflating the face. Avoiding this phase in the first few days allows the face not to swell too much).

The application of ice inside sterile gauze provided to the patient to help contain post-rhinoplasty edema.

After about a week the rigid cast is removed and surgical tape is then placed to counteract the tension of the swelling and allow for faster healing.

A few hours after the end of rhinoplasty surgery it is normal to see some swelling of the eyes, forehead and cheekbones; very often there are visible bruises under the eyes that improve and vanish within weeks. The patient is prescribed all the pharmacological treatments dedicated to them, from antibiotic to anti-edema prevention.

Even though most of the swelling has vanished after 3 weeks, it should be remembered that the type of tissues treated in rhinoplasty surgery are multiple and different and have completely different definitive healing times, for example the bone tissue of the nasal structure has a very slow healing that ends about 6 months after rhinoplasty surgery.

The suggestion and medical prescriptions tend to emphasize and reiterate that the nose should not suffer bumps or trauma at this stage of healing, so it is recommended to avoid sports in which this risk can be predicted. In the case of competitive sports or clubs, a tailor-made and completely personal mask will be designed and built in order to protect the nose and release the pressure tension or any impacts on the frontal and zygomatic area. Work and social life can already be resumed the day after rhinoplasty surgery.

RHINOPLASTY – RESULTS

A high level of surgery in rhinoplasty surgery significantly improves the harmony and proportions of the face. For this purpose, Dr. Mattia Colli abandoned old surgical techniques and adopted modern methods: rhinoplasty surgery must respect the naturalness of the face, the modeled nose must not take on recognizable features of a surgical intervention , neither from afar nor from close.

A nose modeled and harmonious in its shape and projection is the one that presents delicate and soft osteotomies (bone shaping lines) that respect the angle of the maxillary profile: narrow Michael Jackson like noses, noses too hollowed out and the excessively upward tips with recognizable profiles and that followed a fashion that has long been outdated.

A balanced nose that reflects the characteristics and physiognomies of the face is the one imperceptible to the eyes of others but that forms contours and lines of the face soft and graceful, without escaping from the symmetries with a proboscis and attracting the attention of others.

Rhinoplasty surgery is one of the main requests by patients because the degree of satisfaction is very high, always taking into account that the results that are planned and obtained must reflect realistic expectations of patients.

RHINOPLASTY: TYPES OF SURGICAL INTERVENTION

SECONDARY RHINOPLASTY

 

Secondary rhinoplasty is a new rhinoplasty surgery on top of a previous one to correct defects that have not improved with the first surgical intervention , or modify the aesthetic outcomes that have not reflected the agreed upon surgical plan or that no longer satisfy the patient.

Secondary rhinoplasty presents the goal of restoring the architecture modified by the primary rhinoplasty surgery and subsequently give a balanced nose shape with the remaining proportions of the face through the modeling of the structural components of the nose. Compared to primary rhinoplasty surgery, secondary rhinoplasty presents itself with greater surgical difficulty, precisely because the surgeon must first reorganize the structures and then be able to shape them. If respiratory function has also been impaired or reduced since the first rhinoplasty surgery, it must be restored efficiently.

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Secondary rhinoplasty has a type of anesthesia and operating times similar to the primary one, but very often the surgical approach is carried out with open technique, just to allow the surgeon a better view to restore the anatomical portions of the nose. Therefore, secondary rhinoplasty is very variable from patient to patient, precisely because it is linked to the different type of correction provided and the type of tissues that the patient presents after the primary rhinoplasty surgery.

Compared to primary rhinoplasty, in which the patient complains of lack of results or who does not like the outcome different from the one agreed and planned, secondary rhinoplasty allows to obtain more satisfactory results.

 

AQUILINE NOSE

 

The aquiline nose is the one that has a morphology such as to resemble the beak of an eagle. The high profile with the prominence of the hump, due to the particular protrusion of the nasal and cartilaginous pyramid, is the focal point where the eye impacts and tends to draw attention to that point. In this regard, the eyes lose their relevance and will never be deservedly appreciated.

The aquiline nose derives from a genetic component, in fact when one of the two parents presents this imperfection it is very likely that the same will be transmitted to the children. In other cases, however, the hump can form as a result of a strong trauma. The cosmetic surgery that allows you to redefine the profile and eliminate the hump is rhinoplasty. The purpose of making the back of the nose softer involves  removal of the cartilaginous portion and a shaping of the bone pyramid.

When harmonizing and softening the back of the aquiline nose; a straight profile of the nose must never lose the break-tip, or that small change of angle that faces the tip. If these elements are respected, the profile of the nose will become straighter and more harmonious while maintaining its natural characteristics.

 

 

POTATO NOSE

 

The potato nose is configured with a rounded and coarse tip. The imperfection is due to the particular size of the wing cartilages and the presence of adipose tissue that make up the tip of the nose. The potato nose manifests an “ironic” expression of the patient, bringing the focal point of the eye right to the distal third of the nose, namely the tip.

The cosmetic surgery that corrects the defect of the potato nose is rhinoplasty. If during the medical examination the surgeon fulfills the patient’s desire to reduce only the tip of the nose, it will be possible to perform a faster and reduced technique than a complete rhinoplasty. Succesful rhinoplasty is the set of very high surgical quality in the three components that make up the optics of the nose; it is clear that if potato nose surgery corrects the tip but after correction it would be to the detriment of the other two components, then it is better to do a full rhinoplasty surgery.

 

CROOKED/DEVIATED NOSE

 

The crooked nose identifies a non-straight nasal pyramid and differs from the deviated nose in that this affects the functional part of the nose, obstructs one or both of its airways and creates a serious obstacle to breathing.

In the case of crooked nasal pyramid and deviation of the septum from the same side it is possible that the patient still breathes well enough.

The crooked nose usually involves a complex pre-operative planning that improves almost all the anatomical areas of the nose. The deviated nose instead provides for a general revision of the structure of the nose regarding the internal architectures.

 

WIDE NOSTRILS

 

The wide nostrils are characterized by an excessive extension of the wing cartilages, such as to attribute to the nostrils an excessive opening. This predominant  feature is more commonly seen in people of   African and some Oriental races. The wide nostrils are therefore not considered an imperfection in the latter, but represent typical anthropological characteristics.

In the West Caucasian race, however, the possible presence of wide nostrils represents an aesthetic defect that can be corrected with the surgical intervention  of rhinoplasty. However, if the nose initially configures only the wide nostrils, these can be corrected and perfected individually without involving other anatomical parts of the nose.

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