What are the correct proportions of the nose?
The proper aesthetic proportions of the nose are: 1/3 of the length of the face (golden section rule), straight or slightly curved dorsal line, an angle of 90 degrees at the tip, possibly thinner dorsum and tip, narrow alar base.
The nose is located in and occupies the middle of the face - it is the most visible part and aesthetic proportions mainly depend on it. The nose is an individual entity and when needed it has to be corrected in relation to the aesthetic proportions of individuals' face.
What is the purpose of Rhinoplasty?
The purpose of rhinoplasty is to create aesthetic proportions of the face. Cosmetic surgery of the nose is the most frequently requested procedure in the face. In 1/3 of all cases we only work on the tip of the nose, in order to reduce it’s length and to design the narrow peak. Rhinoplasty requires accurate and precise movements with excellent knowledge of the anatomy.
Why do we use Closed, instead of Open Rhinoplasty?
In open rhinoplasty nose procedures the surgeon would make an incision across the columellar area of the nose and reconstruct the cartilage to alter the shape and size of the nose. Sutures would be put in place to close the incision and a splint would be set on the nose for a week so that the new shape stabilizes. When the swelling subsides, the new shape of the nose would be visible. However, in open rhinoplasty, a small scar would be visible on the underside of the nose.
In our clinic we do not like the open rhinoplasty, due to a lot of negatives (loss or necrosis of cartilage etc.) and visible scars. We use closed rhinoplasty techniques - the stitches inside the nose are not visible. There are no casts, no intranasal packing, no bruises around the eyes, no external scars.
The techniques used in our clinic can be used for primary, as well as for secondary rhinoplasty.
- Humpectomy - for hump removal. Create a straight or slightly concave dorsum depending on patient preferences.
- T-zone Excision - used to rotate (lift) the tip for shortening the length of the nose;
- Columella Sliding – used to correct the tip projection (decreases or increases the height of the tip). The method is used to obtain the aesthetic 30 degree angle dorsum to profile line;
- Nasal Tip Refinement (narrowing) by suture - narrows and makes a fine tip;
- Alar Base Narrowing by suture - narrows the width of the nostrils;
- Nasal Tip Rotation by suture - shortens the length of the nose (scarless aleternative of the T-zone Excision);
- Digital fracture vs. lateral osteotomy - the methods is used to close the open dorsum roof after medial osteotomy (humpectomy) without visible step deformity;
- Medial and lower dorsum narrowing.
The most common causes of secondary nose job are:
- Disproportionately long nose and hanging tip or columella after the first operation;
- Loss of alar cartilage due to excessive work on the extracted cartilages, trauma, loss of blood supply and necrosis;
- Curved tip;
- Regrowth of hump fibrotic tissue, growth of the bone spikes from the medial osteotomy area.
In our clinic, rhinoplasty is one of the most tolerable procedures for patients, without postoperative pain. It is an outpatient procedure with local anesthesia, combined with contemporary venous analgesics and anesthetics. Many of the stages of the operation are Bulgarian patent, bearing the name of Dr. Serdev. The operation is relatively short at his hands but can last for hours with other surgeons, which causes too much trauma to the tissues.
When we only correct the tip, there is no necessity of swabs or plaster, no bruising can appear, and swelling is not visible to the uninitiated observers. The patient can return to social life almost immediately, without scars and no one will know that the nose has been operated. Notably, most of our TV presenter patients work on the next day - the team and TV viewers do not even realize that there has been an intervention.
No Trauma, No Casts, No Intranasal packing
Due to the minimal trauma in our operations, bruises are minimal and only appear in about 30% of cases of hump removal. In rare cases, a minimal stripe bruise can appear under the eyes but it only runs for about 5 days. After the operation and only in cases where the hump is removed, a skin-color tape is worn for three days. Intranasal packing is not necessary (and even traumatic) 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.
After surgery the patient has the obligation to appear at the designated check-ups, which usually are: the day after the operation (to clean the nose), on the third day (to take the tape off), and in two weeks (to remove the sutures, which are not absorbed, if any).
Operations before the legal age are not recommended, but in rare cases of severe generated complexes an operation can be made upon request and signatures by both parents. In such cases, minor adjustments could be necessary after the completion of nasal growth, usually after 21 years of age.
Serdev Methods in Rhinoplasty
Rhinoplasty is one of the most effective operations and using the methodology of Prof. Dr. Serdev it is also one of the lightest in cosmetic surgery, with very short recovery period. In some cases patients may wear a tape for only 3 days after surgery. Furthermore, there are no visible operation signs - no casts and no tampons, no "blue glasses" bruising and return to social life can happen in the first days after surgery.
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 through basic techniques known in the world as methods of Dr. Serdev - " T-zone excision", "columella sliding", as well as the well-known Serdev Suture® methods for nasal tip refinement (narrowing) and alar base narrowing.
The T-excision rotates the tip upwards and the columella sliding gives projection. If a hump is presented, a hump medial resection is performed to the bone and cartilage pyramid. A very atraumatic methodology exists - the digital fracture - created by Dr. Hernandez from Ecuador. It is used to prevent from bleeding and formation of bone steps on the side of the nose, and the three "crow's foot" lines (as in lateral osteotomy).