Rhinoplasty

The nose is not a rigid block: it is an articulated biomechanical unit of bone, cartilage, ligaments and lining under constant dynamic tension. Surgical rhinoplasty is one of the most complex procedures in facial plastic surgery.

Dr Yousefpour’s approach is based on structural and preservation rhinoplasty: sculpting an elegant bridge and a defined tip while strengthening the cartilage framework, in order to preserve breathing function for life.

Nasal surgery is a high-precision discipline subject to the uncertainties of biological healing, tissue contraction and cartilage memory. The surgeon has a heightened duty of care, but no perfect aesthetic or functional result can be guaranteed.

The protocol, step by step.

1. Step 1

   Functional analysis

   Clinical and internal examination of the nasal passages, septum, turbinates and nasal valves, as part of an overall analysis of the facial skeleton.

2. Step 2

   Planning

   Photographic analysis of the profile and of the nose-forehead and nose-chin proportions, then confirmation of anatomical limits and the tailored aesthetic plan.

3. Step 3

   Surgery

   Open or closed approach depending on anatomy, reshaping of bone and cartilage, shaping sutures and supporting grafts if needed.

4. Step 4

   Follow-up

   Moulded splint for 7 to 10 days, 80 % of swelling resolved at 2 to 3 months, final result between 9 and 18 months.

Primary rhinoplasty, Dr Yousefpour’s preferred procedure

Dr Afshin Yousefpour favours primary rhinoplasty, the first operation on a nose that has never been operated on. The bone and cartilage are intact, allowing more predictable surgery and reconstruction of the nasal framework in the best conditions.

As a maxillofacial surgeon, he approaches the nose as part of the architecture of the face, in relation to the forehead, jaws and chin, rather than as an isolated feature. Preserving breathing function for life remains his priority.

Primary rhinoplasty (first operation)

• Hump reduction: millimetre-precise removal of excess bone and cartilage without collapse of the upper lateral cartilages.

• Tip work: refining, increasing or decreasing projection, or rotating the alar cartilages using shaping sutures and autologous cartilage supports (columellar strut).

• Functional septorhinoplasty: straightening a deviated septum (septoplasty) and treating the turbinates to restore symmetrical, smooth airflow.

• Open or closed approach: chosen according to the patient’s anatomy, to hide the scars inside the nostrils or under the columella.

Secondary and tertiary rhinoplasty (complex revisions)

Secondary rhinoplasty is for patients dissatisfied with the aesthetic result or suffering from nasal obstruction after one or more previous operations performed elsewhere.

The technical challenges are specific: fibrous scar tissue, loss of the natural anatomical planes and lack of cartilage support due to excessive resection (inverted-V deformity, saddle nose, pinched tip, alar retraction).

Reconstruction uses autologous grafts from the remaining septum, the ear concha or rib cartilage (spreader grafts, tip grafts, alar extension grafts) to rebuild the vaults and restore the structural integrity of the nose.

It is essential to wait at least 12 months, ideally 18 months with thick skin, before considering a revision: this allows inflammation to settle, the skin to soften and internal healing to stabilise completely.

Possible complications and their management

• Post-operative bleeding and nosebleed: removal of clots, haemostatic packs and agents; a return to theatre to stop bleeding remains exceptional.

• Septal haematoma: immediate drainage under local anaesthesia, compressive packing on both sides and antibiotic cover to prevent chondritis or perforation.

• Post-operative infection: targeted antibiotics, local antiseptic care and drainage of any collection. It remains very rare despite the nose’s natural flora.

• Healing problems and subcutaneous fibrosis: draining massage, compressive night-time strips, micro-doses of long-acting corticosteroids or late revision if fibrosis persists.

• Residual asymmetry and palpable irregularities: monitoring until stable (12 to 18 months), then bone rasping under local anaesthesia, a camouflage graft or a micro-injection of hyaluronic acid.

• Intranasal adhesions and persistent obstruction: division of the adhesion at the practice and temporary placement of a septal splint.

• Septal perforation: saline rinses and healing ointments; if symptomatic, closure with mucosal flaps or a medical silicone septal button.

• Altered sensation of the nasal tip, upper lip or incisors: spontaneous recovery over 6 to 12 months in almost all cases.

• Displacement or visibility of a cartilage graft, skin injury from the splint, temporary changes in smell and taste, and exceptionally injury to the tear ducts or leakage of cerebrospinal fluid requiring immediate treatment.

• These risks should not be overestimated: in expert hands, rhinoplasty remains surgery with a low complication rate, but every operation carries some uncertainty.

Non-surgical rhinoplasty with hyaluronic acid

Non-surgical rhinoplasty reshapes the nose with injections of advanced hyaluronic acid, without general anaesthesia, incision or time off. It works by strategic filling and optical illusion: softening a hump by filling the hollows above and below it, projecting or rotating the tip, correcting asymmetry and fine touch-ups after surgical rhinoplasty.

The session lasts 20 to 30 minutes: facial and photographic analysis, disinfection, drop-by-drop injection of micro-boluses in the deep planes (sub-aponeurotic and supra-periosteal), then manual shaping and immediate review in the mirror. The result is instant and lasts 12 to 18 months on average.

Limits: the technique does not reduce the overall size of a large nose, does not act on a deviated septum or nasal obstruction, responds less precisely on very thick skin and requires regular maintenance. It is, however, reversible with hyaluronidase.

Essential, mandatory information: because of connections between the vessels of the nose and the arteries behind the eye, nasal injection carries exceptional but very serious vascular risks: local skin necrosis and severe visual disturbance, up to irreversible blindness in one eye. Dr Yousefpour uses high-safety techniques (aspiration before injection, slow micro-boluses in the deep planes) and keeps hyaluronidase at hand to dissolve the product immediately if needed.

Aftercare: do not massage or press on the area for 48 hours, avoid heavy glasses resting on the bridge of the nose for 48 to 72 hours, and avoid sauna, steam room, strong sun and intense sport for 48 hours. Contact the practice immediately in case of abnormal pain, mottled pale skin or sudden visual disturbance.

Costs, tax and reimbursement

When clinical and internal examination confirms an obstructive septal deviation or a documented consequence of injury, the functional part (septoplasty, fracture reduction) may be partly reimbursed by the Belgian national health insurance (INAMI/RIZIV) and your health insurance fund or hospital insurance. The purely aesthetic part is paid by the patient.

Under the Belgian VAT Code (art. 44, § 1, 2°), any procedure or part of a procedure with a purely aesthetic purpose is subject to 21 % VAT. Only the strictly reconstructive or functional part, documented and coded according to INAMI criteria, may be exempt.

Internal healing of the nose continues for 12 to 18 months: no definitive touch-up is undertaken before then. If revision surgery is needed, all costs (clinic, anaesthetist, consumables, theatre equipment and surgical fees) are paid entirely by the patient; the initial procedure is not a package that includes possible further operations.

Frequently asked questions