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Risks and precautions for nose formation and treatment that can be performed by nasal tip plasty

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Risks and precautions for nose formation and treatment that can be performed by nasal tip plasty

There are many treatments to shape the nose, and nasal tip plasty is one of them. The tip of the nose refers to the tip of the nose , and nasal tip plasty is a procedure to raise or narrow the tip of the nose .

There are multiple treatment methods for nasal tip plasty, and the recommended treatment depends on the fat at the tip of the nose, the shape of the nasal bone, and the desired design . However, due to the limitations of nasal tip plasty, it is not always possible to create the design you desire. If you try to force it, the risk of failure increases.

Before performing nasal tip plasty, it is important to be aware of the characteristics, risks, side effects, and precautions of each procedure . In addition, since the formation of the nose is a procedure that greatly changes the impression of the face, it is important to carefully select the medical institution and doctor who will perform the procedure .

Nose shape that can be expected to be formed by nasal tip plasty

Nasal tip plasty is a procedure to shape the tip of the nose . Therefore, this procedure is not suitable for those who want to pass through the nose, raise the entire nose, or lengthen the nose . The following people can be expected for nasal tip formation.

  • Those who want to make the dumpling nose smaller and thinner
  • Those who want to make the nose hole vertically long
  • Those who want a small, clean nose
  • Those who want to give height and sharpness to the tip of the nose

How to make an incision when performing nasal tip plasty

Open method that makes it easy to see the surgical field

The open method is a method of performing nasal surgery by making an incision in the nasal column between the inside of the nose hole and the nose to secure a wide field of view .

It is a method that allows the skin to be turned up from the incision to expose the surgical field, and it is said that the surgery can be performed while visually observing the surgical site, so that it can be closer to the desired design .

On the other hand, the wide incision leaves scars . However, the scar is difficult to see from the front .

References: Experience of rhinoplasty with an extranasal approach

Closing method where scars are less noticeable

The closing method is a method in which only the inside of the nose hole is incised and the nose is operated through the nose hole .

Compared to the open method, it is an incision method in which the surgical field is difficult to see and it is difficult to balance the suture position . In addition, it has been reported that the cartilage to be transplanted is broken if the nose hole is small.

However, it has the advantage of not being scratched in appearance .

How to perform nasal tip plasty with multiple combinations

For nasal tip plasty, the treatment to be performed is decided based on what kind of nose tip you want to have and how you want to shorten downtime . The treatment of nasal tip formation is roughly divided into three, and it is necessary to consult with a doctor along with the diagnosis of the condition of the nasal bone as to which combination to perform the treatment.

How to suture ala cartilage

The nose has nasal ala cartilage, which is arranged in an M-shape along the nose hole when viewed from below. In most Westerners, the two M-shaped tops of the nasal ala cartilage are separated, but in the case of Orientals, including Japanese, the M-shaped tops are separated but close in most cases.

When the distance is long like Westerners, it is said that the tip of the nose becomes thin and high by suturing the separated parts, but in the case of Orientals, it is said that a big change can not be expected because the original distance is short. I am. However, since the shape of the ala cartilage varies from person to person, there are cases in which even Asians can sufficiently prepare the tip of the nose by suturing the ala cartilage.

When performing nasal tip plasty for oriental people by suturing the nasal ala cartilage, the soft tissue (mainly fat) at the tip of the nose is often thicker than that of westerners, even if the M-shaped top of the nasal ala cartilage is It is said that there is very little change even if it is separated and the nasal ala cartilage is sutured. Therefore, when performing treatment on Asians, it is often the case that a part of the soft tissue at the tip of the nose is removed .

The method of suturing the nasal ala cartilage differs from person to person, such as the shape of the nasal ala cartilage and how to suture it depending on the doctor. Therefore, it is important to listen carefully to the doctor's explanation when receiving the treatment so that there are no unclear points or anxieties.

References: Changes in head morphology as well as external nose and face by region and their relationship with septal deformity

How to deform and suture the nasal ala cartilage

One way to suture the ala cartilage is to deform the ala cartilage and then suture it. It is also called the 3D method depending on the medical institution.

Cut both wings of the M-shaped ala cartilage to make four cartilage. Stand the two inner struts to make a strut, and sew the two outer struts to each of the inner struts. At this time, suture so that the top of the support is exposed. In most cases, the strength of the ala cartilage that has become the support is low, so it is reinforced with its own cartilage (autologous cartilage) or an artificial plate made of medical material .

When autologous cartilage is used to reinforce the struts, auricular cartilage and nasal septal cartilage are used.

The auricular cartilage is collected by making an incision along the wrinkles behind the ear, or by making a small incision in the entrance of the ear hole called the tragus and collecting it from the ear canal. Since the auricular cartilage is also soft, it may be used to reinforce the columns by stacking multiple sheets. Auricular cartilage can be collected by incising a part that has little effect on the shape and function of the ear, so it is said to be less burdensome to the body.

The nasal septum cartilage is a hard, plate-like cartilage in the nasal septum that divides the nasal hole into left and right. If all of them are collected, the nose cannot be supported, so the collection is performed leaving the L-shaped part necessary to maintain the structure of the nose. Because of the cartilage in the nose, it is performed at the same time as the nasal tip plasty and does not cause any damage other than the nose.

When using artificial plates made of medical materials, PCL (polycaprolactone) and PDO (also referred to as polydioxanone / PDO), which are mainly absorbed in the body, are processed into plates. It is said that PDO is absorbed in the body in about 1 year and PCL in about 2 years.

References: Temporomandibular joint plasty combined with intermediate insertion and transplantation with auricular cartilage

References: Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians

How to transplant cartilage or medical artifacts

In nasal tip plasty, there are methods of using autologous cartilage, artificial cartilage, and artificial materials made of medical materials. This procedure is often used in combination with the method of suturing the nasal ala cartilage.

After suturing the ala cartilage, you can increase the height of the tip of the nose by inserting autologous cartilage or a medical artificial object on the sewn part and suturing it to the ala cartilage . In addition, the angle of the tip of the nose can be changed depending on the position where the autologous cartilage or medical artificial material is sutured.

When autologous cartilage is used, auricular cartilage is used in the same way as autologous cartilage used in the method of deforming and suturing the nasal ala cartilage. After collecting the auricular cartilage, shape it for insertion into the tip of the nose. Regarding the shape of the auricular cartilage, there are methods such as round shape, square shape, and L shape depending on the desired design of the tip of the nose . It may be used in layers according to the desired design.

When using artificial medical materials, PCL and PDO, which are absorbed by the body, are mainly used in the same way as the method of deforming and suturing the nasal ala cartilage. Unlike the method of deforming and suturing the nasal ala cartilage, it is not processed into a plate shape, but a dome-shaped or ball-shaped product made from thread-shaped PCL or PDO is used . The height is raised at the tip of the nose by inserting a medical artificial object.

Even when autologous cartilage or a medical artificial object is inserted after suturing the nasal ala cartilage, the strength of the nasal ala cartilage is often low. It is said that the stanchions for reinforcement need to be sewn.

It is a treatment method that is rarely used in combination with the method of deforming and suturing the nasal ala cartilage .

How to remove the ala cartilage

There are two ways to remove the ala cartilage. It is a method to decide whether to do it or not depending on the shape and size of the nasal ala cartilage. As a general rule, it is needed when the ala cartilage is large or overhanging . If a procedure is required, it is done before suturing the nasal ala cartilage or inserting cartilage or medical artifacts.

The ala cartilage is shaped like a heart when viewed from above. It is said that the effect of sharpening the cartilage of the nasal ala and narrowing the tip of the nose can be expected by cutting the heart-shaped two peaks to the central valley into a thin oval shape . However, it is said that the angle of the nose tends to be upward (up nose) because the ala cartilage shifts upward.

Another method is to make the tip of the nose thinner by cutting a part of the heart-shaped wings of the nasal ala cartilage vertically to make both wings smaller. It is said that this method is less likely to shift the nasal ala cartilage upward than the method of excising the heart-shaped peak to valley.

Depending on the size of the nasal ala cartilage and the desired shape of the nose, both the method of excising the heart-shaped peaks and valleys and the method of excising a part of both wings vertically may be used together .

Postoperative course and downtime of nasal tip plasty

On the day of treatment

There are swelling, swelling, redness, internal bleeding, and pain. Please avoid bathing. You can shower if you don't wash your hair or get your face wet. However, avoid long showers.

3 to 5 days after the procedure

There are swelling, swelling, redness, internal bleeding, and pain. For pain, a medical institution will prescribe a pain reliever. The cast to fix the affected area can be removed in 3 to 5 days.

About 7 days after the procedure

Remove the thread. Symptoms such as swelling, swelling, redness, and internal bleeding continue. Makeup is possible after thread removal.

1 to 3 weeks after the procedure

Symptoms such as swelling, swelling, and internal bleeding subside. The redness of the scars also begins to subside, but in most cases it does not disappear completely.

1 to 3 months after the procedure

The tip of the nose becomes stiff. The redness of the scar subsides and becomes slightly whiter than the surrounding skin.

3 to 6 months after the procedure

The tip of your nose becomes softer and your nose becomes more familiar. However, the hardness of the tip of the nose may be harder than before the procedure.

Outpatient visit after nasal tip plasty

After a nasal tip plasty, you will need to go to the hospital to remove the cast and remove the cast. The cast can be removed in about 3 to 5 days after the procedure , and the thread is removed in about 7 days after the procedure .

In addition, it is said that it is necessary to check the condition regularly even after thread removal in nasal tip plasty. Although there are differences depending on the medical institution, it is said that it is usually done after 1 month, 3 months, and 6 months .

Precautions for nasal tip plasty

Smoking cessation before and after surgery

Oxygen carried by blood and blood vessels plays an important role in healing wounds. However, it is said that smoking causes blood vessels to constrict, resulting in insufficient blood and oxygen, resulting in poor healing of wounds . Therefore, smoking cessation is recommended from 2 weeks before surgery to at least 1 month after surgery .

Avoid acts of excessive blood flow after surgery

Blood and oxygen play an important role in repairing wounds, but excessively active blood flow has the detrimental effect of excessive internal bleeding and prolonged swelling . Therefore, avoid behaviors such as drinking alcohol, strenuous exercise, and saunas that cause excessive blood flow for about a month after the procedure .

Do not give shock or pressure to the nose

After the treatment, the nose is fixed with a cast for about 3 to 5 days, but if impact or pressure is applied, the nose may be deformed . Avoid hitting your nose, wearing glasses for a long time, or lying down .

If you have allergies such as rhinitis or hay fever, consult a doctor.

A runny nose contains germs that can cause infections after surgery . In addition, a strong nose blow may cause strong inflammation of the surgical site. If you have allergies such as rhinitis or hay fever, and you have a runny nose or a strong nasal blow , tell your doctor before the procedure and discuss the appropriate treatment .

Risks and side effects of nasal tip plasty

  • Infection
  • Necrosis of the skin
  • Tactile transplanted cartilage

Infection

Although nasal tip plasty is performed in a sterile condition, it is very rare that bacteria can enter and cause an infection .

In addition, it is possible that bacteria may enter the affected area and cause an infection in the life after the procedure, not during the procedure. After the treatment, keep the affected area clean and try to prevent infections .

If you have symptoms such as redness that does not go away easily, swelling continues, or pus appears after the treatment, you may have an infection, so please consult a medical institution immediately.

Necrosis of the skin

The skin may become necrotic if the blood flow at the treatment site is blocked or if there is too much blood due to internal bleeding .

It is said that the possibility of skin necrosis is extremely low, but if you feel any discomfort at the treatment site, immediately consult a medical institution to confirm that there is no problem.

Transplanted cartilage tactile (Ishoku Nankotsushokuchi)

Cartilage transplant palpation is a risk that can occur when cartilage is transplanted by nasal tip plasty. Cartilage transplanted by ala nose plasty may come into contact with the skin or lift up, and may occur months to years after the procedure.

If the transplanted cartilage is palpable , it may be necessary to remove the cartilage, so please consult the medical institution that performed the procedure .

Nose plasty other than nasal tip plasty

Ryubijutsu

Rhinoplasty is performed using meltable threads made of materials that are absorbed by the body such as PCL and PDO used for nasal tip formation, autologous cartilage, medical grade silicone called prosthesis, and hyaluronic acid.

It is said that the nose can be raised as a whole by inserting a thread that dissolves in the nasal muscles or autologous cartilage . Nasal tip plasty can be performed at the same time.

Septal extension (bichukakuenchojutsu)

The nasal septum extension technique is to adjust the length and angle of the nose by inserting a thread that melts into the nasal septum (the wall that divides the nasal hole into left and right) and transplanting its own cartilage. It is a treatment .

As with nasal tip plasty, we use meltable threads and auricular cartilage made from PCL and PDO. In addition to auricular cartilage, nasal septal cartilage and costal cartilage may be used. It can be performed at the same time as nasal tip plasty.

Ala of nose plasty

Ala of nose plasty is a procedure to reduce the size of the ala of nose (small nose), and is also called ala of nose reduction.

It is said that the ala of nose can be reduced by cutting a small amount of the roots of the nose holes on both sides and suturing them. Ala nose plasty can be performed at the same time as nasal tip plasty.

Price of nasal tip plasty

The market price for nasal tip plasty varies widely from 200,000 yen to 800,000 yen .

  • Do you make an incision by the open method?
  • Do you make an incision by the closed method?
  • Is it just suturing the nasal ala cartilage?
  • Do you make an incision in the nasal ala cartilage?
  • Do you transplant autologous cartilage etc.
  • Is it a medical institution's own technique?

Costs tend to be determined by various factors such as. The incision method and surgical procedure will be decided after consulting and counseling the doctor . If you would like to know more about the price, please consult a doctor and receive counseling.

Flow of nasal tip plasty

1) Perform medical examination, counseling and design

Tell your doctor what nose design you want for consultation and counseling. At this time, it is important to convey the desired shape of the nose in detail and adjust the finish. Depending on the medical institution, the simulation may be possible on a PC. If you neglect to match the finished design, it will lead to disappointing treatment. Other treatments may be suitable depending on the desired nose shape, so it is important to listen to the opinions of the doctor before deciding on the treatment. Please refrain from performing the procedure until you are satisfied with the examination and counseling.

2) Wash your face

Dirty makeup and skin increases the risk of postoperative infections. Therefore, remove makeup and wash your face to keep it clean.

3) Anesthetize

Local anesthesia, intravenous anesthesia, and general anesthesia are often used in nasal tip plasty. Which anesthesia to use depends on the surgical procedure and the policy of the medical institution, but as a general rule, if the anesthesia works, you will not feel any pain. If you have a desired anesthesia method, please check with your medical institution in advance.

4) Nose tip formation treatment

When using autologous cartilage, first collect the autologous cartilage. It depends on whether or not to collect autologous cartilage, the surgical procedure, and the medical institution, but it is said that it takes about 1 to 3 hours throughout. It is said that there is pain when you wake up from anesthesia, but as a general rule, medical institutions prescribe pain relief.

How to choose a medical institution to receive nasal tip plasty

Nasal tip plasty is a procedure that narrows or raises the tip of the nose, but it is necessary to select the surgical method depending on what kind of nose shape you want . If you choose the wrong treatment, there is a risk that you will not get the desired shape, so it is important to convey your hope firmly when consulting and counseling a doctor. If you are a medical institution that can perform simulations using PC software, it will be easier to convey your desired image .

In addition, the detailed surgical procedure such as the suturing method, how to make the shape of the autologous cartilage to be inserted, and the incision position of the nasal ala cartilage differs depending on the doctor in charge. It is also important to consult with various medical institutions and doctors without deciding the treatment by receiving medical examination and counseling from only one medical institution and one doctor .

Furthermore, if there is an excess or deficiency in the procedure, such as insufficient peeling after incising the affected area by the open method or closed method, insufficient strength of the support, or excessive excision of the soft tissue at the tip of the nose, the procedure will fail. It's more likely. Possible failures due to excess or deficiency of treatment include polybeak deformation, which causes the tip of the nose to rise slightly above, and pinch nose deformation, which creates a dent between the tip of the nose and the nose that looks like it is pinched with a clothespin. .. It is important to choose a doctor with a large number of cases to avoid the risk of failure due to excess or deficiency of treatment.

Anesthesia is used for nasal tip plasty, but anesthesiologist is required for general anesthesia and intravenous anesthesia . Anesthesiologists include anesthesiologists stipulated by law by the Ministry of Health, Labor and Welfare and certified doctors of the Japanese Society of Anesthesiology. Both are anesthesiologists who are recognized as having sufficient experience and considerable knowledge in performing anesthesia. If the medical institution that receives the treatment has an anesthesia doctor or a certified doctor of the Japanese Society of Anesthesiology, you can receive the treatment with peace of mind.

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