The purpose of rhinoplasty (also known as nose correction, nose reshaping, or simply nose job) is to create correct aesthetic proportions of the nose and face. It is the most frequently requested cosmetic surgery procedure for face beautification. In 1/3 of all cases we only work on the tip of the nose, to reduce it’s length, refine and project it. Rhinoplasty requires accurate and precise movements with excellent knowledge of the anatomy.

As a central part of the face, the nose has a major role in defining aesthetic proportions. It has an individual structure and has to fit in the overall aesthetic proportions, volume and angles of the face.

Rhinoplasty can only correct the outer appearance of the nose! If there is an impairment of the nasal function (ex. deviated septum, polyps, deviation of ethmoid bones, mucosal edema etc.), we work ENT specialist, when necessary, prior to a cosmetic nose job.

Attention!

A surgeon cannot make your nose like it looks on the face of another person. Your bones, cartilages, skin, individual characteristics and proportions are different!!!

Many patients ask whether Michael Jackson’s nose should be considered as an ideal. Such thinning is impossible without removing bone structures, which disturbs the function of the nose. However, nose’s function is much more important than its appearance! Not everyone can afford to buy and use a hyperbaric oxygen chamber at home to saturate the body with oxygen.

The goal of rhinoplasty is to beautify without disrupting the function!

What are the correct proportions of the nose?

The aesthetic standards for correct proportions of the nose are: 1/3 the length of the face (golden section rule), straight or slightly curved dorsal line, 90 degree angle at the tip, possibly thinner dorsum and tip, narrow alar base.

Why do we use Closed, instead of Open Rhinoplasty?

We practice closed rhinoplasty to perform the necessary correction of the nose, and more specifically – Dr. Serdev’s author techniques. This approach prevents the traumatic “opening” of the nose, it is mini-invasive and without bloodloss. Instead, the manipulation and sutures are made inside the nose. In addition, casts, plasters and intranasal packings become unnecessary. There is no swelling, no “black eyes” and no scars.

In open rhinoplasty the surgeon would make an incision across the columellar area (the skin-covered barrier between the nostrils) and pulls the skin upward. In this way he can see the cartilages and bone structure of the nose. Then, he reconstructs the cartilage to alter the shape and size of the nose. In the end, the surgeon puts sutures in place to close the incision and inserts intranasal packings for a few days. A cast would be set on the nose for a week so that the new shape stabilizes. The real shape of the nose becomes visible only after one year. However, the scar on the underside of the nose will remain visible.

In our clinic we do not like the open rhinoplasty, due to a lot of negatives (loss or necrosis of cartilage, great percentage of secondary corrections, etc.) and visible scars. Therefore, we use closed rhinoplasty techniques, without visible scars.

Patient Testimonial

“I am coming out of surgery just now. For me, the anxiety before the operation was very big, I had fear. But it actually it was not an intervention, according to me – as if I was going to the dentist. There was no pain, it was very quick to me. The difference before and after is so huge… exactly what I wanted! Most importantly, I am not dizzy, there is no pain,  I feel very good. Such a painless surgery, after all others that I’ve had… [3 days after surgery] I don’t have any problems. In short, I can say that the feeling cannot be better. As if there hasn’t been a surgical intervention.”

Results

Many of the rhinoplasty procedures used in our clinic are done using the so called “Serdev Rhinoplasty Techniques“. These techniques help us achieve the correct proportions of the nose using a closed approach, without trauma. Thanks to the developments made by Dr. Nikolay Serdev in the field of nose correction, our patients leave the clinic with their new desired look, without plasters, casts or intranasal packing.

Read more – journal review of the book “Serdev Techniques in Rhinoplasty”

Serdev Rhinoplasty Techniques

The methodology is based on the achievements of the first president of the American Academy of Cosmetic Surgery – Dr. Julius Newman, surgeon in Hollywood, called “Dr. Nose” and improved by Dr. Serdev.

The internationally recognised scarless Serdev techniques in rhinoplasty are:

– T-zone Excision – for shortening the length of the nose. Protects cartilages from separation/cutting/shortening during surgery, which in older methods often resulted in necrosis (after their separation, processing and returning back to place, cartilages do not always get well vascularised);

– Nasal Tip Rotation by suture – shortens the length of the nose (alternative of the T-zone Excision);

– Columella Sliding by suture – used to correct the tip projection (decreases or increases the height of the tip). The aim is to obtain the aesthetic 30 degree angle of dorsum to profile line;

– Nasal Tip Refinement (narrowing) by suture – narrows and makes a finer tip;

– Alar Base Narrowing by suture – narrows the width of the nostrils;

– Digital fracture instead of lateral osteotomy – closes the open dorsum roof after medial osteotomy (humpectomy) without visible step deformity;

– Medial and/or lower dorsum narrowing by suture.

Patient Testimonial

“I am coming out of surgery just now. For me, the anxiety before the operation was very big, I had fear. But actually it was not an intervention, according to me – as if I was going to the dentist. There was no pain, it was very quick. The difference before and after is so huge… exactly what I wanted! Most importantly, I am not dizzy, there is no pain,  I feel very good. Such a painless surgery, after all others that I’ve had… [3 days after surgery] I don’t have any problems. In short, I can say that the feeling cannot be better. As if there hasn’t been a surgical intervention.”

Benefits

Dr. Serdev’s rhinoplasty techniques reduce operation time to 15-40 minutes, depending on the difficulty and number of procedures. Due to the minimal trauma in our operations, small linear bruises under the eyes appear in only about 30% of hump removal cases. The lack of trauma and blood loss make intranasal packing unnecessary. Packings are placed in the inner nose, while cosmetic corrections deal with the external nose. Full return to social life is possible from the first to the 5th postoperative day, depending on the presence or absence of minor bruises.

When we only correct the tip, there is no necessity of plaster or cast. No bruising can appear and swelling is not visible to the uninitiated observers, there are no scars. Therefore, patients return to social life almost immediately, without signs of surgery. No one will know that the nose has been operated. Most of our TV presenter patients work on the next day – the team and TV viewers do not even realise that there has been an intervention. The presenter only looks refreshed, rejuvenated and more beautiful.

Of course, the patient has the obligation to appear at the designated check-ups after surgery.

In combination with Serdev Suture Lifts for face and body, we can achieve an overall aesthetic beautification and rejuvenation, without trauma and without scars.

Serdev Techniques Explained

Results

Removing the hump of the nose (nose straightening or humpectomy) requires cutting the convexity of the back (roof) of the nasal bones. Nasal hump removal aims to create a straight line on the back of the nose. However, removing the hump creates an opening, i.e. the two nasal bones remain separated and must be brought together to form a narrow back of the nose.

No Trauma, No Intranasal Packing, No Casts

We practice closed rhinoplasty to perform the necessary correction of the nose. This approach prevents the traumatic “opening” of the nose. Instead, we make the manipulation and sutures inside the nose.

Due to the minimal trauma in our operations, a minimal stripe bruise can appear under the eyes in only about 30% of cases of hump removal but it only runs for about 5 days. After the operation and only after humpectomy, the patient wears skin-color tape for three days. Intranasal packing is not necessary and is even traumatic. This is because it is placed in the inner nose, while cosmetic corrections deal with the external nose. Full return to social life is possible from the first to the 5th postoperative day, depending on the presence or absence of minor bruises.

The nasal hump removal can be done as a standalone procedure orin combination with other Serdev techniques for atraumatic nose correction or with complete rhinoplasty. For the purpose of beautification and thanks to the atraumatic nature of the methodology, rhinoplasty can also (if necessary) be combined with different liftings using scarless Serdev Sutures methods  or VASER ultrasonic liposculpture on face and body.

See more: Narrowing of the nostrils; Narrowing of the nose; Nose tip correction (narrowing, shortening)

Results

When narrowing the nose, besides working on the tip and the nostrils, we often have to narrow the dorsum (back of the nose) – the upper half (after removing the hump), as well as its lower or middle part. We perform these procedures using Dr. Serdev’s bloodless and atraumatic techniques.

Narrowing of the nasal dorsum (back of the nose)

This procedure requires closing the open roof of the nasal bones after humpectomy. Removing the “roof” of the nose leaves it open. The standard approach for narrowing the nose requires additional lateral osteotomies of the nasal bones on the side of the base and moving the bones inwards. This leads to bleeding and bruising around the eyes (“black eyes”). This method often forms visible “steps” (known as “crow feet”) of the nasal bones in the middle and on both sides.

To avoid this malformation, as well as trauma and bruising, Dr. Serdev introduced the technique of digital fracture (breaking) of these bones. This technique leads to their tilting towards each other to close the open “roof” (the back of the nose) and its narrowing without bleeding and trauma. This technique is atraumatic, does not cause soreness and bruising after surgery. In addition, it does not require casts or intranasal packing. The postoperative period is minimal. Minimal bruising can appear in about a third of all cases, in the form of lines on both sides of the nose. Patients tolerate this technique very easily, due to lack of pain. Swelling is minimal. Return to social life is immediate or, in the case of minimal bruises, within a few days.

Narrowing of the lower and middle part of the nose

This technique is done by passing the nose either through the mucous membrane (leaving no scars) or through needle punctures of the skin to collect the tissues on the back of the nose. The latter applies also when narrowing the middle part of the nose. The goal is to suture the cartilages on the back of the nose and narrow it.

As with every injection, the signs of punctures disappear within 1-2 days. The procedure is bloodless and atraumatic.  Patients can resume their daily activities on the day after surgery or rest for a few days if they wish.

Narrowing the back of the nose can be done as a standalone procedure, in combination with other Serdev Techniques for Atraumatic Nose Correction or with complete rhinoplasty. Thanks to the atraumatic nature of the methodology, rhinoplasty may, if necessary, also be combined with different scarless Serdev Sutures lifts or ultrasonic liposculpture of the face.

Raising concavities to straighten the line on the back of the nose

By using Dr. Serdev’s suture techniques, we can also raise the back of the nose or get rid of irregularities. Sutures are performed through skin punctures. The technique is atraumatic and mini-invasive. No patches, casts or intranasal packings are necessary. The skin punctures disappear within two days.

See more: Humpectomy (hump removal); Narrowing of the nostrils; Nose tip correction (narrowing, shortening)

Results

The nose is positioned in the middle of the face and the aesthetics of proportions essentially depend on it. In at least half of all cases there is no hump and only have to correct the tip of the nose. The correction consists of narrowing the tip, shortening (reducing the length of the nose), and projecting it.

Shortening the Nose (reducing the length of the nose)

One of the procedures for aesthetic correction of the tip of the nose is its shortening. There are two variations of this procedure, both of them created, described and published by Dr. Serdev. They are mini-invasive, atraumatic, without blood loss, without casts and intranasal packings. Due to the lack of scars from surgery, patients can return to work and social life on the day after surgery. Alternatively, they can rest for 1-2 days.

1. T-Excision at the tip: this is an ambulatory, bloodless procedure. Skin-color tape (as the one used when we remove the hump) and intranasal packings are not necessary. There is no bruising. Since we do the procedure using a closed approach and do not open the nose, the postoperative recovery is fast and the swelling is not noticeable. There is no post-op pain except by touch. During the first hours after surgery, there is a slight dripping from the nose, which patients only  need to clean gently. We remove the formed crust during the follow-up session on the day after surgery. Breathing is undisturbed, there is no visible scarring and bruising. Patients are free to return to their daily lives without an “operated on” appearance.
2. Suturing the cartilages to the nasal bones, which shortens the nose. It is done using Serdev Sutures method. This method has received worldwide recognition and is being applied worldwide as a mini-invasive and atraumatic technique, without cuts and bleeding. Patients’ return to their daily routines is almost immediate. To our patients, this is a better alternative to classical methods. Classic rhinoplasty, especially when opening the nose, reversing the skin with invasive corrections leads to a long postoperative period and long lasting swellings. Results come late and complications are common.

Projecting the Tip of the Nose (Columella Sliding)

Nasal tip projection, according to aesthetics, should be approximately 30^o to the facial profile line. In some cases, this angle is larger and the tip protrudes, while in others it is smaller and the nose is low. Both cases present a small deviation from aesthetics. To correct the projections, we apply the columella sliding technique.

This is a nasal tip correction method, created by Dr. Serdev. It is a simplified technique for fixation of the skin-cartilaginous part of the columella to the septum (the stable cartilage, which divides the two halves of the nose and provides stability to the tip). We can slide the columella up or down to adjust the projection of the tip. In this way, we achieve the aesthetic angle of the nose to the profile line, described above. We do not use implants or transplants. During the follow-up session on the day after surgery, we clean the nose to remove crusts. Patients can immediately resume their social activities.

The intervention is mini-invasive, atraumatic and bloodless. There are no visible signs of surgery and no hospitalisation.

Narrowing the Tip of the Nose

This is a suturing (sewing) procedure, which tightens and narrows the cartilage on the tip of the nose. For this purpose we either pass through the mucosa or through needle punctures of the skin (no scars remain in either approach). Like with every injection, puncture traces disappear within 1-2 days. Because we do not open the nose, the procedure for narrowing the nose tip is bloodless and traumatic. There are no plasters or intranasal tamponade. As with all other Serdev techniques, patients can be socially active immediately after their rhinoplasty.

All nasal tip correction procedures – shortening, projection, or narrowing can be performed independently (in the absence of a hump) or in combination with other Serdev rhinoplasty techniques or as parts of complete rhinoplasty. Thanks to the atraumatic nature  of  these methods, they may be combined with different scarless Serdev Suture lifts or ultrasonic liposculpture of the face.

Read more: Humpectomy (nasal hump removal); Narrowing of the nostrils; Narrowing the back of the nose

Results

Thanks to Dr Serdev’s author’s techniques in rhinoplasty, we can do non-invasive and atraumatic nostrils narrowing without scars. The nose sits in the middle of the face and aesthetics proportions largely depend on it. Therefore, when narrowing the nostrils we have to take into account the aesthetic 30 degrees deviation of each nostril from the center line. It is important that the correction des not interfere with breathing, because the function of the nose is more important than its shape.

There is also a method for narrowing the nostrils, where the surgeon has to cut off a part of the nostrils. This is an invasive approach and more or less visible scars may remain. This is why we do not recommend this approach and practice it only in select special cases. In addition, cutting the nostrils requires more healing time.

When using Dr. Serdev’s suturing technique, there is no downtime and no visible scars remain. Patients can immediately resume their daily routines.

The procedure for narrowing the nostrils can be done as a standalone procedure, in combination with other Serdev Techniques for Atraumatic Nose Correction or with complete rhinoplasty. For the purpose of beautification and thanks to the atraumatic nature of the methodology, rhinoplasty can also (if necessary) be combined with different liftings using scarless Serdev Sutures methods  or VASER ultrasonic liposculpture on face and body.

See more: Hump Removal; Narrowing of the nose; Nasal tip correction (narrowing, shortening)

Results