Introduction Plastic surgery for the nose is considered as the most difficult form of aesthetic surgery. It requires wide experience, imagination, passion and artistry from a surgeon. Only proper plastic surgeons have the knowledge, skills and experience necessary for performing this type of operation, however, but not all like carrying them out. We are proud to say that all surgeons working with us are highly qualified specialists in rhinoplasty who join medical technical excellence with the sensibility of genuine artists. There are two trends in contemporary aesthetic surgery of a nose. They differ from each other in "philosophy" of approach to surgery. The first, based on traditional techniques, is dependent mainly on a surgeon's experience. The surgery is made through small invisible cuts inside the atrium of the nose. When sculpting the "scaffolding", a surgeon does not see much through his eyes but through his additional sense - "eyesight located in his fingers". The virtue of these techniques are the invisible scars, and their disadvantage is imperfection, which in the opinion of some people make them more natural. The second trend stresses the necessity for perfection often expected by patients. This technique consists of operating by an "open" method in which cartilage and bone skeleton are exposed to be better seen. This requires, however, a tiny cut through the skin of the nose column, (the vertical post dividing the nostrils). The scar is very small and visible only when you look at the patient's nose from the bottom with your head placed against his chest. The advantage of these techniques is the extreme precision which cannot usually be achieved in traditional methods. In Melilot we use both of the above "philosophies". The choice depends on our assessment and the patient's preferences.

We are most often asked to make smaller or straighten a nose, or remove a "hump", but one can do almost anything to the shape of one's nose. As from the point of view of an artist, the shape of a nose should fit the face, the number of details we want to change is genuinely large. A patient's request to make his nose smaller can vary sometimes with our opinion. A surgeon always explains his plans and adjusts to a patient's expectations. You should talk to your physician about any queries you have. If a decision on whether or not to go through with an operation is still difficult for you, visit our clinic several times. With pleasure we spend time on planning your operations to ensure that the outcome will be satisfactory both for you and us.

Anaesthesia Rhinoplasty is conducted in Melilot under general anaesthesia. During an operation the patient is asleep and he awakes to find himself back in his room.

Operation The nose skeleton shaped during an operation is built of cartilage and bone parts. The cartilage part consists of the tip, upper part of the nostrils and front part of the nasal septum dividing the two nasal canals. The bone part consists of the middle and upper part of a nose reaching a forehead. An operation only on the tip is often sufficient to improve the shape of nose. Correction of a cartilage can result in, among other things:

• narrowing of an excessively wide tip;
• shortening of a tip in the shape of "hook";
• shifting up and lifting a tip making it slightly "snub".

Usually, apart from an imperfect tip, a nose has some other extra defects. Then the bone part has to be operated on. Consequently:

• the curve of a nose can be straightened;
• a too wide nose can be narrowed;
• a hump on the flat of the nose can be removed.

During plastic surgery a nasal septum can be straightened. The nasal septum sometimes becomes curved after an injury. A curved septum makes breathing difficult and is often the cause of a permanent cold.

After putting a patient to sleep, an operation commences with the separation of a nose skeleton from subcutaneous tissue. In an open method the skin from above the nose is lifted up. First the surgeon models the tip and then the bone part. It is necessary to break curved or badly shaped bones and very often to cut a hump. After breaking a bone, a surgeon models it and places in a new position. To achieve an optimum shape, sometimes it is necessary to add sculpted parts of cartilage or bone in some places. This is referred to as a "transplant". If we do not remove any part of the cartilage, the transplant cannot be modelled. Then it is necessary to take a piece of cartilage from another place, for instance from behind an ear.

After the skeleton of the nose is modelled, the skin is returned to its previous position. It very quickly "joins" the separated hard parts and "contracts" on its new scaffolding, like elastic clothing on a dieting person. As this requires a few days, a nose immediately after an operation does not look like as it will eventually.

Healing While still on the operating table the surgeon places small pads in the nose. These are a part of the dressing. A plaster cast properly shaped is placed on the outside of the nose. A patient wakes up with a nose which feels clogged and squeezed from the top.

The first 24 hours or 48 hours after an operation, the patient stays in the clinic. It is not a pleasant period and requires patience. His/her face can get very swollen. Apart from swelling, "bruises" are formed around the eyelids. One does not feel any pain. Tiredness and weakness worsen patients' mood. Some feel depressed and discouraged. All these symptoms disappear on the third day.

The internal pads are removed from the nose on the second day. Sometimes they are replaced with short dressings for the next day or two. A plaster cast remains on the nose for a week. After its removal a patient is able to see his "new" face. As this operation changes their appearance radically, many patients are surprised at the first moment. The following days bring more satisfaction, but the final shape of nose can be seen only after about 6 months when the swelling disappears and skin becomes soft and elastic.