Medicine is a science that contributes the public health through such services as diagnosis, treatment and preventive services. It consists of applications (treatment-surgery, etc.) and services, on one hand, and education and research activities on the other hand. Any title granted for the studies conducted in this education and research field (assistant professor, professor) should only be used at the universities.
Factors that render an operation simple r challenging do vary according to experience of the operator, mental-physical preparation period, quality of coordination nd cooperation with the patient, information given to the patient, operator’s performance during the operation process, quality nd adequacy of the operated tissues, quality of the utilized materials, preferred surgical technique, the operation team from anesthetist to assistant, stress management skills nd capability of the operator, esthetic r functional but in any way rational expectations that are developed in coordination with the patient..
İNotwithstanding if it is long or short, r simple or sophisticated, the chance for an operator to successfully nd easily perform any operation s/he undertakes taking these factors into account will be higher than those operators performed without considering these factors. Simplicity is in the ability to take responsibility; challenge is in the negligence.
Are Plastic surgeons artists?
Plastic surgery is a subbranch of the general surgery. The artistic esthetics is, on the other hand, is a subbranch of the philosophy.
The imperfection is the lack of pre-defined reference values in all inanimate products, objects nd items that are produced on the basis of metric measurements. A 1 mm shortness in a product is considered a factor that makes that product imperfect.
Gestalt, is a German word that means a whole or the form, a term that suggests that an item r an object is more nd different than the components which create it.
Gestalt defines the perception principles, what we see and how we see, perceive nd memorize. Since the beauty is in the eye of the beholder, it is important for us to comprehend how nd through which mechanisms we perceive the beauty.
Every cosmetic surgeon is a plastic surgeon, although not every plastic surgeon is a cosmetic surgeon …
Any operation that is performed with unrealistic expectations nd is not well planned, will not yield sustainable and satisfying results; other than this;
Breast surgery conducted for aesthetic reasons can be classified as: reduction, enlargement (lift or winding up), asymmetry removal, breast reconstruction, nipple reconstruction, nipple concretization, nipple shaping, areola reduction, scar rehabilitation, breast shaping.
“Bariatric surgery” is the general term for such processes as gastric banding, intestine by-pass operations, etc., which are implemented on obese patients (>40 body mass index); while the term “post-bariatric surgery” covers the esthetical make-up of the tissues that are deformed due to abovementioned procedures, which cause 30-90 kg weight loss.
A nose with its bone, cartilage, soft tissue and skin structure having a normal relation to its location, size, and ratio and which does not cause breathing problems nd most importantly which has an adequate unity with other organ nd/ r units forming the face is ideal that each person.
Ideals can not be standardized and everyone’s ideal is formed up with the location, adequacy and harmony of organs and tissues owned by genetic heritage. All idealized values nd criterions differ from time to time and between cultures. Thus, an ideal nose can not be evaluated singly nd only by measurements of nose and an ideal evaluation can only be acquired by adding organs nd lines of the face into the criterion. For this wholistic evaluation, we can use a car you like as an example. Just as an ideal wheel, headlight or steering wheel does not make a car ideal nd we look for a harmony of those ideal parts in a car, evaluation of an ideal nose is conducted by the harmony of all the organs of the face. In facial aesthetics, the statement explaining this situation the best is one for all, all for one. And that is the ideal.
Each nose intervention emerges as a treatment of a problem. These interventions can have nonsurgical forms such as touch-up like upstring-filling and treatment can also be conducted via extensive operations called surgery.
Briefly, along with operations treating a superficial problem in an area under local anesthetics, there are also rhinoplasty techniques conducted under anesthetics. If the nose aesthetic operations called rhinoplasty are conducted with operations that intend to improve breathing, they are called septorhinoplsty. The septum operations that do not include removal of any piece are called septoplasty or SMR (submucosal resection). The reduction (resection, cauterisation) of outgrown (hypertrophy) spongy material named concha, that prevent breathing, can be conducted simultaneously nd with same reason. Replacement of missing structures in nose is called nose reconstruction, compensating irregularities with small fillings nd pieces (grafts) is called counterplasty, operations regarding only the tip of the nose are called tipplasty, secondary correction operations are called secondary rhinoplasty, operations conducted with cuts on the exterior structure named columella are called open rhinoplasty, operations conducted only with inter-nasal incisions without these cuts are calledclosed-rhinoplasty. The congenital anomaly in the nasal structure suffered by cleft-lip/cleft-palate patients is called CLN (cleft-lip-nose) deformity. Other corrective interventions regarding nasal structure in general, that has occurred as a result of accident, trauma or surgery are called nasal repair or reconstruction. For these operations, plastic surgeons with single specialty area who have qualified by having 6 years of training and ENT specialists who have completed their training beside these surgeons and maxillofacial surgeons with dentist origin are employed. Lectures regarding these subjects have recently been included in the curriculum of these specialties other than plastic surgery.
It is solving aesthetic nd functional problems in consideration of personal priorities and expectations. Examination: It is conducted by taking into consideration the quality of breathing along with the structures of bone, cartilage, soft tissue and skin.
As an operation to be conducted on nose is going to provide a change of image, this 3 dimensional anatomic relation with other facial organs and structures is determined with gestalt perception criterion. Gestaltist approach is the perception of a single object, or as in this case the aesthetic view of the nose (image), as a whole with other facial organs. Contrary to the belief, perception of nose is not limited to nose and includes perception of chin edge, lips, forehead and cheekbones as a whole. With paying attention to determined reference point, margin, angle and adjacency, by conducting small touches to those sections if needed, the new image study of the patient is completed by practice of single and/or combination of the pieces.
It is the name given to corrective rhinoplasty operations. It is the second operation conducted In case inadequacies resulting from either the patient or the surgeon occur or the nose aesthetics is destroyed as a result of a trauma.
In selective cases, it can be conducted 6 months later than the first operation and in emergencies it must be conducted within 48 hours following the trauma. The difficulty level of these operations is higher, healing process is longer and they frequently require a follow-up operation. It requires advanced level experience, surgical equipment nd anatomy knowledge from the operating surgeon and as this operation causes stress on tissues weakened in previous operations, it requires utmost care nd respect for the tissues. In some of these operations, strengthening filling must be conducted in lost tissues with a graft (shaped fat, cartilage, foreign material etc.). However, in safe hands, the results are satisfactory nd elating.
Nose is a unit/organ which is located in the centre of our face nd which has a irreplaceable aesthetic importance. As well as being the most dominant, effective and memorable part of facial image by itself, it is also perceived together with other organs nd units of the face.
A nose, which seems obtrusive itself, will not seem that obtrusive nd big when the flat image of the cheekbones is corrected. These perception mechanisms that define how our brain perceives and records things are called gestalt perception principles.
Thus, Rhinoplasty evaluation is conducted in 6 phases that differ from each other but also complete each other. In the first phase the length, angle and ratios regarding the nose itself such as bone structure, location nd sizes of cartilage structures, harmony of nostrils and nose tip are taken into consideration. Second phase consists of the relations nd positions of soft tissue structures neighboring nose such as cheeks, lips, brow lines, eyelids etc. In the third phase, rigid structures such as chin tip, chin contour, forehead, cheekbones and teeth and their combination with nose is evaluated and whether or not does a perceptional nd/r physical cohesion or contradiction exists is determined by measurement.
In the fourth phase, skin structure, characteristics, scars, acne marks, acquired suture scars of facial mucosa in general and nose mucosa in particular are evaluated as a whole with location nd depth. In the fifth phase, as they are located near nose, apparent deep cracks (under eye bags and nasolabial cracks between nose verge and lip verge) are evaluated in detail. Sixth phase consists of functional breathing capacity nd sufficiency and conchas, septum, valve angles etc. of the patient. Seventh phase is the evaluation of tissues lost as a result of accidents, traumas and previous nose operations, asymmetries, and such structures nd determination of tissues lost in previous operations.
Short nose, long nose, pug nose, disproportional nose, wide flat nose, nose with big/small nostrils, nose showing inside from front, nose with flat wings, roman nose, hooked nose, nose with forked tip, broad nose, thin nose, curved nose, asymmetric nose, nose big/small for the face, low nose, tip-tilted nose, unassertive nose, nose appearing bad from side view, pointed nose, swollen nose, separated nose…
- Weight, age, life style of the patient, lactation period, if any, pregnancy expectancy
- Structure of the upper torso, width of rib cage nd shoulders
- Presence of any anomaly in the musculoskeletal system that underlies the breasts
- Breast problems experienced by close relatives (sister-aunt-mother) and current status of the breasts
Age limits in rhinoplasty operations
(18 in females, 20 in males). In higher ages, these operations can be conducted in patients with even the highest ages with the condition that the general situation is stabile nd normal. Nose anatomic structures formed as a result of accidents must be corrected as soon as possible with taking into consideration the, aesthetic subunits nd expectations.
1. Do you have membership for a national or international official institution?
2. What is your specialty? Plastic surgery, dental or ENT?
3. Do you have a qualification certificate received from the institution?
4. Why nd for which qualification of yours should I choose you for this operation?
5. How much experience do you have on rhinoplasty?
6. What percentage of all the operations you have conducted are rhinoplasty operations?
7. When is the last time you conducted a rhinoplasty operation?
8. In your opinion, what percent of the patients you have conducted rhinoplsty operations on are happy now?
9. How often do you conduct corrective revision nose surgery on your subjects?
10. Do you have any subjects waiting on judicial or court decision?
11. Which technique do you frequently prefer for rhinoplasty?
12. Which technique do you see fit for my condition and why?
13. How long does it take you to complete an average rhinoplasty operation?
14. In which hospital do you conduct the surgeries? Why?
15. What is the most frequently seen complication in rhinoplasty surgeries?
16. What type of anesthetics do you use? Why?
17. Do you encounter any unexpected situations during and after surgical operations?
18. Did you loose any patients in surgical or post-surgical phases due to unexpected reasons?
19. Do you thing the hospital you choose for surgical operation has the equipment nd experience to provide immediate treatment in situations such as these?
20. Do you operate with your own team or with the hospital team on shift?
21. If I want you to show me the operations you have conducted to convince me, would you show them?
22. Are there any patients you have convinced for surgery by using photoshop program? Does this program have any relation with the technical difficulties nd skills needed for the work?
23. Do you have the technical skills that can meet my expectations or do you make the stereotype nose for all your patients?
24. If I am to have a secondary operation, when can I have it at the earliest?
25. Along with this operation, which other applications can you conduct in this session simultaneously?