Nose is the most protruding part of ones body and so it is easily get injured. Nasal injuries can result in damage to the skin, bone, cartilage or any combination. If the skin is cut this requires cleaning and then closing using either sutures or self adhesive strips. An injection to prevent tetanus is advisable if your vaccination is not up to date (every 10 years). Bony fractures of the nose account for nearly 50% of all facial fractures. Fractures to the nasal bones cause a lot of swelling and it may take about five days for the swelling to settle down enough for the bones to be checked.

Treatment

X-rays do not contribute to the clinical management of nasal fractures, as the majority are simple and uncomplicated. Only when more serious injuries have taken place are they important and should include the skull and face.

Most of the time when the swelling has settled down and there is either no or little change in the shape of the nose.

If the nose is deformed after the swelling has subsided (five to seven days after the injury), manipulation under anaesthesia is performed. Manipulation must take place before 14 days after the injury and the patient made aware that the deformity may not be corrected completely. Any residual deformity even after manipulation may require more surgery (Rhinoplasty)say 12 months or more after the injury.

Complications

Nosebleeds (epistaxis)

Nosebleeds are common and usually settle on their own with simple first aid by gently pinching the lower half of the nose for 15 minutes. Nasal packing or cautery in hospital is reserved for nosebleeds that do not stop of their own accord.

Septal haematoma

Blood collecting (haematoma) under the lining (mucosa) of the central partition wall of the nose (septum) is stripped off either side causing a purple swelling inside the nose. If this occurs it will give you nasal obstruction and pain and need treating by draining the blood away soon after it happened.
If the blood is left and not drained it can become infected or cause damage to the underlying support destroying cartilage and then leave a ‘saddle nose’ deformity. (explanation please) Treatment is by surgical drainage and a course of antibiotics.

Deviated Nasal Septum

Nasal blockage usually occurs after the injury due to swelling inside the nose and this may take a few days to settle. If the nose is still blocked after three weeks it may be due to the septum being deviated . Septal deviation may require surgical correction if the blockage is significant.

Rare complications

Cerebrospinal fluid leak

Severe nasal trauma can push the nasal bones into the face, giving the face a pug-like appearance. The thin cribiform plate at the roof of the nose may fracture causing the cerebrospinal fluid that bathes the brain to leak out.

Small fractures seal spontaneously with conservative management (95% within two weeks). Antibiotics are not given unless infection is proven to be present. If fluid leak continues , more treatment may be required. Loss of sense of smell The smell organ in the roof of the nose can also be damaged. Loss of sense of smell very rarely returns

The demand for aesthetic surgery continues to grow, and an objective means of assessing the patient is required. Proper patient selection and facial analysis is very important before attempting the operation of Rhinoplasty.
First and foremost the surgeon must understand the motivation of the patient. The patient may mask their true desires, applying a fake reason for surgery. Occasionally, the patient suffers from a psychiatric illness.
The goals of aesthetic surgery are a satisfied patient and surgeon. There should be a rapport between the surgeon and patient. Discuss the details and explain the chances of having improvement.

Unrealistic expectation- step ladder principle
One cannot climb more than one step at a time. One cannot make an ugly nose to a very beautiful Nose. The nose ladder is ugly, bad, normal, and pretty, very pretty. One cannot make an ugly nose to very pretty. Often patient has some cine star type nose in their mind and if they don’t achieve that they get depressed.
It is important to have several views of preoperative digital images of face and nose views. This will be useful after surgery to evaluate the result.
Preventing patient dissatisfaction depends upon proper patient selection. Any patient that makes the surgeon uncomfortable should at the minimum have surgery delayed, and perhaps referred for psychiatric evaluation. The most commonly diagnosed psychological conditions which should make the surgeon concerned include: neurotic disorders, personality disorders, psychotic disorders, and depression/mania.
Cosmetic surgery is not a game. It should be taken seriously by both patient and surgeon alike.

Postoperative Instructions after Rhinoplasty

First 12 hrs after Surgery

once fully awaken in the theatre, you will be shifted to the ward. You can expect to have cool compresses on your eyes and cheeks to reduce any swelling or bruising that may occur following surgery. Your nose will be blocked as a result of swelling from the surgery and from the thermoplast that are placed in your nose to assist in maintaining its new shape and function. For this reason, you must remember to breathe through your mouth.
The nurses will be checking your vital signs frequently- Pulse, BP Temperature etc.

Nasal Packing

There will be a nasal pack to prevent any bleeding after surgery. We use Merocel pack with or without an airway.
If the nasal septum is straightened (Septoplasty), thin silastic splint will be sewn inside the nose to assist in keeping the septum straight while it is healing. These silastic sheets are removed by in the OPD one week after surgery. Removal of the splints is usually painless.

Columellar incision

Inverted V shaped incision on the columella should be taken care of.Keep moist with applying Neosporin ointment, avoid rubbing.

Avoid sneezing

Take antihistamine(loratidine) as prescribed by the surgeon.

Swelling and Discoloration

Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more dramatic in the face. We suggest that you keep your head elevated as much as possible.
Your nose and eye area may remain swollen with varying amounts of discoloration for several days. The most important thing to remember is that these conditions always subside.

Remember

1. Stay vertical. Sit, stand and walk around as much as is comfortable beginning on your second postoperative day. Of course, you should rest when you become tired but keep your upper body as upright as possible.
2. Apply ice packs frequently for a minimum of 24 hours after your return home from surgery.
3. Avoid bending and lifting heavy things for one week. In addition to aggravating swelling, bending and lifting may elevate blood pressure and start bleeding.
4. Avoid hitting or bumping yur Nose. It is wise not to pick up small children and you should sleep alone for one week after your operation.
5. Sleep with head end up for 1-2 weeks following your surgery. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of the mattress. It is recommended that you sleep on your back for 30 nights. Some patients find a reclining chair placed at a 45-degree angle to be more comfortable than a bed.
6. Avoid straining while in Toilet. If you need a laxative, take Dulcolax or Creamalax tablet one at night. Proper diet, plenty of water and walking are strongly recommended to avoid constipation.
7. Avoid direct sunlight on your face for one month.
8. Avoid heavy exercise for one week following surgery.

It is not unusual to have varying amounts of discoloration in the nose and eye area. Like the swelling, it may become more pronounced, especially in the eye area, after the first day or so. Remember this is normal and temporary. It usually lasts no more than two weeks, all the while decreasing in intensity. The measures previously described that help the swelling to subside will also help diminish discoloration; however, there is no medication that will cause it to disappear rapidly - only the natural course of time.
If you have external incisions, do no apply make-up over the incisions themselves until one day after the sutures have been removed; however, you may bring make-up to the line of the incisions.

Nasal Drainage or Bleeding

You should expect some blood-tinged drainage from your nose following any nasal surgery. The hospital nurses will place a nasal pad under your nose when you are discharged from the hospital. This pad should be changed whenever it becomes soiled. If you develop active bleeding from the nose, spray each nostril 4 to 6 times with a decongestant nose spray such as Otrivine and ice pack over the Nose .You may repeat this maneuver every 10 minutes for up to 30 minutes. If bleeding continues despite these steps, call the doctor.

Cold compress

This provide the simplest and most effective cold compresses to reduce swelling, bruising, and discomfort following surgery. During your waking hours, apply the packs to the cheek and eye area around your nose for 20-30 minutes each hour for at least 48-hours following surgery.

Pain killers

Even though you may not feel much initial discomfort following your surgery, pain medication should be taken as prescribed, every 4-8 hours for the first 24 to 36 hours after surgery. We find that many patients initially feel very well following surgery and are reluctant to take any medication for symptoms of pain. Unfortunately, the patients who “tough it out” often develop discomfort 18 to 24 hours after the procedure, which may then last for 3 to 4 days. Those patients who take their medicines faithfully, as instructed, have very little, if any, discomfort. Beginning 36 to 48 hours after surgery, Diclofenac and Paracetamol is usually adequate for any discomfort you may still experience.

Antibiotics

You will take an oral antibiotic for 7 to 10 days following your surgery. All antibiotics should be taken with food or liquids to prevent nausea and promote proper absorption of the medication (do not consume milk or dairy products when taking your antibiotic as they can inactivate many medicines). Take your antibiotic as instructed by your physician until medication is completely gone. Do not forget to take your antibiotic and do no stop taking it because you feel better.

Gastric acidity

Gastric acidity develops following many types of surgery and is not uncommon after nasal surgery. You may be given a prescription medication, Rabeperazole and Domperidone capsule to be taken once daily.

Fever

Generally, the body temperature does not rise much above 100 degrees following nasal surgery. If any high fever, call the doctor.

Feeling dizzy

It is not unusual for a patient to feel weak, have palpitations, break out in “cold sweats,” or get dizzy following any type of surgical procedure especially when anesthesia has been administered. Within a few days these feelings will generally disappear without medication. Returning to a normal diet and light activity will shorten the duration of these feelings.

Not able to sleep

If you experience excessive difficulty in sleeping during the postoperative period, take mild sedative and pain killer at night. It should be remembered that such drugs also tend to make some people feel light-headed and weak and should be taken only if absolutely needed.

Resuming Activities

1. DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 3 weeks. Both of these activities significantly slow the healing process.
2. WEARING GLASSES AND CONTACT LENSES. Eyeglasses should not be supported by the nose for at least one month after surgery. Eyeglasses may be taped to the forehead or a device called a “cheek rest” may be purchased to clip on to your glasses. (These steps are taken to avoid any external forces being applied to the nose which may result in a change in its new shape and function). Contact lenses may be inserted the day after surgery, if no eyelid surgery was performed.
3. HOUSEHOLD ACTIVITIES. On your second postoperative day, you are encouraged to be up and around the house with your usual activities; however, no bending, no heavy lifting, and no strenuous activity for 1 week.
4. PULLOVER CLOTHING. For 1 week following surgery, you should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head.
5. EXERCISE. No strenuous athletic activity or exercises that involve straining or heavy lifting for 1 week following surgery.
6. RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES. When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop; the average person is ready to return to work or go out socially 1 week after surgery.
7. DO NOT DRIVE A CAR for one week. Also, do not drive while taking any sedative or prescription pain medications.
Follow up Appointments
Your first postoperative appointment will occur 5-7 days after your surgery .Your second postoperative visit will be 2-3 weeks after your surgery

Nostril piercing was first thought to originate in the Middle-East almost 4000 years ago. From there it spread into India in the 16th century, where it was quickly adopted into the noble castes. The kind of jewellery worn could distinguish the wearer by caste and social standing, much like a title, or even an identity card!

Body piercing usually refers to the piercing of a part of the human body for the purpose of wearing jewelry in the opening created. Body piercing is a form of body modification. Some people practice piercing for religious or other cultural reasons, while many individuals, particularly in the modern West, choose to be pierced for spiritual, ornamental, or sexual reasons.

Evidence suggests that body piercing  including Nose and ear piercing has been practiced by peoples all over the world from ancient times. Mummified bodies with piercings have been discovered, including the oldest mummified body discovered to date, that of Otzi the iceman which was found in an Austrian glacier. This mummy had an ear piercing 7­11 mm in diameter.

Nose piercing and ear piercing are mentioned in the Bible. In Genesis 24:22, Abraham’s servant gave a nose ring and bracelets to Rebekah, wife of his son Isaac. In Exodus 32, Aaron makes the golden calf from melted earrings. Deuteronomy 15:12-17 dictates ear piercing as a mark of slavery.

Nose piercing was practiced among the nomadic Berber and Beja tribes of Africa, and the Bedouins of the Middle East, the size of the ring denotes the wealth of the family. It is given by the husband to his wife at the marriage, and is her security if she is divorced.

Nose piercing has been common in India since the 16th century. Nose piercing was bought to India in the 16th Century from the Middle East by the Moghul emperors. In India a stud (Phul) or a ring (Nath) is usually worn in the left nostril, It is sometimes joined to the ear by a chain, and in some places both nostrils are pierced. The left side is the most common to be pierced in India, because that is the spot associated in Ayuvedra (Indian medicine) with the female reproductive organs, the piercing is supposed to make childbirth easier and lessen period pain. Some women in India pierce their noses to induce a state of submissiveness. They claim this happens by proper placement in a marma or acupuncture point.

Nose Piercing Using Laser

After cleaning the nose with betadine, laser beam can make a precise hole without any bleeding. We don’t encourage this much, but if some one want to wear a diamond Nose stud, why not spend a bit on getting it done by laser?

Complications of nose piercing

Both ear and nose piercing for decorative purposes are widely practiced the latter being particularly popular among Asian women.

Since Nose harbor Staphylococcal bacteria. It can lead to Perichonditis and necrosis of Nasal cartilage thus causing Alar collapse. The use of smaller butterfly clasps increases the risk .Maintaining hygiene must be more difficult in the nose, particularly as so many people are nasal carriers of staphylococci.

Stud placed through the lateral wall of the nose may penetrate the lateral

Nasal cartilages, with the possibility of inducing perichondritis and necrosis

of the cartilage. This might lead to  the nasal alar collapse

Bat Ear Surgery - Otoplasty- Pinnaplasty

Some people’s ears stick out more than normal. This condition is sometimes referred to as “bat ears”. Ears that stick out do not cause any physical problems, but they can make people feel self-conscious and can lead to children being teased. Prominent ears can be corrected with an operation.

The main treatment for prominent ears is an operation called pinnaplasty or otoplasty, that reshapes the cartilage (gristly tissue) in the ear and uses plastic stitches to pin the ears back (or sometimes just by using the stitches alone).

Otoplasty or ear surgery is the procedure used to modify the size and shape of your ears in order to give them a more pleasant look. If your ears stand out prominently or are too big, this is your chance to stop being ashamed of them and harmonize your face

What does Otoplasty do?

It reduces the projection of prominent ears. The angle between the head and the ear is about 35°. Many people consider a greater angle to be unaesthetic. Do people talk about your ears? Were you laughed at in school? Then this surgery may be the right thing for you. It reduces the size of big ears. It corrects irregularities in the outline of the ear, such as the outline of ‘pointy ears’ or of ‘lop ears’. It may also help correct earlobe problems such as lacerations due to heavy earrings, enlargement of the earlobe due to aging and scars from previous face-lifts.

What does an Otoplasty NOT do?

Even though it will make your face look more beautiful and harmonious, and it will probably also improve your self-esteem, it will not be enough to make you look perfect. We must be realistic and accept that that kind of perfection does not exist.

How is Otoplasty performed?

The surgeon makes a vertical incision on the back of each ear exposing the cartilage that is under the skin (this cartilage is what gives the ear firmness and defines its shape). There are two possible procedures, according to the particular characteristics of each case: a) The surgeon sculpts the cartilage and folds it towards the head to reduce its projection, then he sutures with permanent stitches that will hold it in the desired position. b) The surgeon removes part of the cartilage to achieve a larger reduction before folding it towards the head, then he sutures with permanent stitches that will hold it in the desired position.

The pictures above show the location of the external incision for a rhinoplasty, a dotted line shaped like an inverted “V.” Other incisions are hidden up inside the nose, but when an “external” incision, meaning an incision on the outside skin, is used, the operation is called an “open” rhinoplasty. A “closed” rhinoplasty is when no incision on the outside skin is made. This open rhinoplasty incision is placed across the part of the nose called the “columella.” The columella is the central column of tissue that separates the nostrils. The columella is wider above and below the position of those red arrows. The skin of the columella is very thin, and the incision is short, so the resulting scar is all but invisible after healing. Making the incision in the shape of an inverted “V,” rather than a straight line from the left to the right edge of the columella, also helps make an invisible scar

‘Sushrutha Samhitha’ is considered to be the most advanced compilation of surgical practices prevalent in India around two thousand millennia ago. In‘Sushruta Samhita’, Sushruta emphasized all the basic principles of plastic surgery and vividly described numerous operations in various fields of surgery with significant contributions to Plastic Surgery.

Rhino (Latin for nose) and plasty (Greek for molding or forming) is a medical procedure that reshapes the nose for cosmetic or reconstructive purposes.

Rhinoplasty can reduce the size of the nose or alter the shape of the tip for a more pleasing result. It can even change the angle between the nose and upper lip. It can also restore proper functioning of the nose in the case of injury or abnormalities of the nasal cavities.

Rhinoplasty and Septoplasty ensures that a patient will be able to breathe through both nostrils. Both men and women are candidates for Rhinoplasty, but most surgeons will caution against the procedure for girls under 15 or boys under 17, pending full maturity.

External Rhinoplasty is performed as an open technique by making a small inverted V shaped incision at the columella .The skin is separated and adjustments are made to the bone and cartilage. Bones may be broken or chiseled depending on the patient’s desired result. Cartilage may be trimmed. The nasal passages are then packed and an external splint is applied. The packs are removed in 24 hours but the splint is worn for about a week.

The operation normally takes 1-2 hours and can be done under general or local anesthesiaPost-op bruising and swelling around the nose and eyes is normal and peaks about three days after surgery, lasting a total of 2-3 weeks. Other temporary side effects can be a dull headache, an aching nose, or numbness of certain areas on the nose. If bones were broken, healing will take longer.

Most people who undergo Rhinoplasty return to work after two weeks, giving the bruising and swelling time to disappear. It’s usually recommended that sports and activities that could result in injury be avoided for six weeks or longer.

Clear results from Rhinoplasty can be seen a week after surgery but the final results will take 4-6 months to see, or until the nose is fully healed.