Poliklinika za estetsku kirurgiju Dr. Toncic

The surgery doesn’t take more than 30 to 60 minutes. However, to perform the operation successfully it takes a very experienced cosmetic surgeon who needs to know a wide range of surgical methods in order to apply the best method for every individual case. 30 years of aesthetic surgery experience and tradition make Dr Toncic competent to make almost every aesthetically imperfect nose more beautiful, even if previous surgical interventions have failed.

An eye for details and love for art and painting, combined with excellent knowledge of surgical techniques enable Dr Toncic to turn his patients’ dreams into reality. Rhinoplasty is an operation where the surgeon’s knowledge and meticulousness can be best seen.

The medical team headed by Dr Toncic performs aesthetic and functional nose surgeries, and all other surgeries extremely carefully and minimally invasively and paying great attention to details.

BEAUTIFUL NOSE IS A PERMANENT FACIAL FEATURE

Nose is the most prominent feature of one’s face. As such, it contributes a great deal to facial harmony. Therefore, it is not unusual that people who don’t have a beautiful and correct nose suffer. They are aware how noticeable their aesthetic imperfection is. This makes sensitive people psychically restrained, disabling them to achieve their potentials and results, both in their personal and professional spheres of life.

Opinion polls conducted on patients who have undergone rhinoplasty¸ mostly young people, show that after their operation they experience increased confidence, become more active and deal with everyday problems more successfully. "Nothing is like it used to be. I feel that people listen to me and respect me", said our patient, when she came back for her 3 month check-up, after having a successful nose job. The patient gained stability and self-confidence.

The beauty of the nose is reflected in its size, its proportion to the face, a straight upper line, nicely shaped nostrils and the optimal width (narrow nose is generally more beautiful).

The success of rhinoplasty depends on many factors. Primarily, it depends on the surgeon’s skill and experience. The importance of anatomical peculiarities of skin and subcutaneous structures is quite considerable too – the way of healing and patient’s reaction to the operation. Very important factor for the outcome of the operation is also preoperative consultation and examination of the patient. This is where patient’s wishes are discusses in great details, and according to the anatomical peculiarities of each individual patient; they need to be harmonized with the possibilities of aesthetic surgery.

Patient’s preparation for the surgery:

Before the operation, patient goes through a preoperative preparation which involves blood test and final preoperative consultation and medical examination in our clinic.

Choosing the appropriate method:

During the preoperative medical examination and consultation in the clinic, Dr Toncic defines nasal deformations and accordingly decides for the best method in every individual case. Dr Toncic and his team will pay great attention to the patient’s wishes and concerns, and they will look into all possible aesthetic surgery options together with the patient.

Basic aesthetic nose surgery techniques:

There are two basic approaches in rhinoplasty: so called closed and open rhinoplasty. Closed technique enables us to perform the surgery through the incisions placed inside the nostrils. Using this technique makes sure there are no visible incisions on the outer side of the nose.

Open approach is also called outer or decortication approach. Using this technique, we make a tiny incision in the columella, which leaves tiny, hardly visible scar. Outer approach can be described as elevating the skin off the cartilage on the tip of the nose, which enables better approach to the tip of the nose.

Both methods have been considered as standard in the aesthetic nose surgery. In our clinic, we use both techniques, applying high standards and tip quality performance. The choice of the method depends mostly on our surgeons’ evaluation of the individual situation.

We can combine these two basic methods with a range of other auxiliary techniques, which enable us to deal with different deformities and irregularities in the nasal area.

Special techniques and methods used in our clinic:

REOPERATION ON THE NOSE AND REVISION RHINOPLASTY

Aesthetic and functional nose surgeries are quite common nowadays. Accordingly, the number of surgeons has also risen. Therefore, it happens quite often that nose corrections are unsuccessful or partly successful, being performed by less experienced surgeons or by surgeons who aren’t specialized for this procedure and don’t perform it regularly.

Over the years, we have, therefore, taken the opportunity to specialize in revision rhinoplasty, i.e. re-operation of the nose.

Re-operations or revision rhinoplasty procedures are the terms used for correction of the noses that have already been operated. These procedures are much more demanding than the initial nose operation, and it is crucial for the surgeons to have extensive experience and an array of methods available, like our surgeons have.

We have had extensive experience with revision rhinoplasty, and we can precisely analyze the possibilities and realistic expectations in every individual case.

RAISING THE DROOPING I.E. COLLAPSED TIP OF THE NOSE

This is the method which enabled us to reach the highest level of modern nose surgery. We have improved this method of raising the drooping i.e. collapsed nose tip by implanting a piece of ear cartilage.

Quite many people complain about the drooping tip of the nose. This irregularity comprises the acute columella-labial angle, which can damage the aesthetic aspect of the nose. This irregularity can be natural or a consequence of improperly performed aesthetic or functional nose surgery.

In order to fix and support the tip of the nose and achieve desired height, we need a support at the nasal base which raises the tip of the nose. For a long time, artificial materials had been used as the support (silicone, Medpor, etc.) but they were not acceptable due to many disadvantages.

One of few reliable methods which we can use today to raise the drooping tip of the nose is adding a part of the ear-cartilage to make the nasal tip support. It is a small, but for surgeon very demanding procedure, which we combine with other rhinoplasty techniques. In this procedure, we shape the ear cartilage and implant it at the nasal base, to make the support.

Behind the ear, there is a small, unnoticeable scar left. After the recovery period, there will be no visible traces of the performed surgery. The ear will retain the identical shape it had before the surgery, because we take cartilage form the area that is not relevant for the appearance of the ear.

In the nasal area, there are either no scars at all or they are hidden on the inside of the nose.

CORRECTION OF BOXER’S NOSES AND BROKEN NOSES

Many patients suffer for years because of the impaired image and function of the nose that were caused by injuries. The corrections of injured, boxer’s and broken noses are among the most demanding nose surgeries, but for us, they are also the most challenging.

Dr Toncic and his surgical team have had extensive experience in this field too. We often encounter bent noses, broken nasal septums, collapsed tips of the noses and multiply broken nasal bones.

When dealing with these deformations, we mostly use a combination of basic nose surgery methods with the corrections of nasal septums or with ear cartilage implantation to raise the tip of the nose. By any standard, these are complex procedures that make the highest point in nose surgery, and they demand highly skilled and educated aesthetic surgeon.

ETHNIC RHINOPLASTY

On of the procedures that have been extremely successfully performed in our clinic, led by Dr Toncic, is ethnic rhinoplasty. The majority of our patients that require this surgery are of Afro-American and Asian origin. The anatomy of their noses is specific; the bony part of the nose is less projected and the tip of the nose is drooping and quite soft, with wide nostrils.

Drooping or soft tip of the nose is irregularity that can pretty much impair the appearance of the nose. The columella-labial angle is acute in such situations. The tip is collapsed and soft and it lacks natural, cartilage support.

In order to fix and support the tip of the nose and achieve desired height, we need a support at the nasal base which raises and fixes the tip of the nose. For a long time, artificial materials had been used as the support (silicone, Medpor, etc.) but they were not acceptable due to many disadvantages.

One of few reliable methods which we can use today to raise the drooping tip of the nose is adding a part of the ear-cartilage to make the nasal tip support. It is a small, but for surgeon very demanding procedure, which we combine with other nose surgery techniques. In this procedure, we mold the ear cartilage and implant it at the nasal base, to make the support.

Behind the ear, there is a small, unnoticeable scar left. After the recovery period, there will be no visible traces of the performed surgery. The ear will retain the identical shape it had before the surgery, because we take cartilage form the area that is not relevant for the appearance of the ear.

Beside the drooping and soft tip of the nose, these patients often have less projected bony part of the nose – so called rhinolordosis, which appears as imperfection. In such cases, we make substitute for the missing bony part.

In most cases, we substitute the bony part with a small part of a bone we take from patient’s pelvis. We shape the bony part and implant it in the bony part of the nose, where it supplements the inborn lack of the bone. There is a tiny scar left on the place where we take the implant from.

This is a very demanding operation for a surgeon, but by the extent, it is considered to be a minor operation. This procedure solves the problem of less developed bony part of the nose (rhinolordosis) mostly for our patients of the Afro-American, Asian and very rarely Caucasian origin.

Ethnic rhinoplasty often comprises the narrowing of the wide nostrils, at patients with wider nasal base, and wide nostrils. The majority of the patients who have this surgery are of Afro-American origin. To solve this problem, we use simple method, often combined with other nose surgery techniques.

Generally, we combine all of the mentioned methods, which enable us to achieve a beautiful nose that fits the facial features.

Rhinoplasty of ‘ethnic nose’ is just one of the techniques we have been successfully applying in our clinic for years.

CORRECTION OF LESS DEVELOPED BONY PART – CORRECTION OF RHINOLORDOSIS – NOSE ENLARGEMENT

Smaller number of patients sometimes has less projected bony part of the nose – so called rhinolordosis, which appears as imperfection. In such cases, we make substitute for the missing bony part.

Generally, we substitute the less projected bony part with a small part of a bone we take from patient’s pelvis. We shape the bony part and implant it in the bony part of the nose, where it supplements the inborn lack of the bone. There is a tiny scar left on the place where we take the implant from.

This is a very demanding operation for a surgeon, although by the extent, it is considered to be a minor operation. This procedure solves the problem of less developed bony part of the nose (rhinolordosis).

SEPTOPLASTY – CORRECTION OF NASAL SEPTUM – FUNCTIONAL NOSE CORRECTION

Heavy nose breathing

Operation of nasal septum is one of very important segments in nose surgery. There are two reasons that indicate the necessity for operation of septum:

First reason is heavy nose breathing caused by nasal septum deviation. It needs to be mentioned here that there is no perfectly straight septum. During the examination, we have to determine whether the septum is deformed up to the point that it significantly blocks nasal holes. If not, nose operation will not solve the main problem – heavy breathing. Therefore, we must look for the causes of heavy breathing elsewhere, for example look for allergies, nonallergic rhinitis, etc.

Rhinoscoliosis

The second reason that calls for a septum operation is aesthetic nose surgery. If the nose is asymmetrical, meaning not in the central position but bends to one side, the most likely cause of this deformation is irregular and deformed nasal septum, which pulls the outer nose to one side.

In order to reposition the nose in the central position, beside the standard aesthetic nose operation, we usually need to place the nasal septum to the central position. These situations require combination of standard rhinoplasty and nasal septum correction.

USEFUL INSTRUCTIONS FOR OUR PATIENTS

Prior to the operation – patient’s preparation:

• We have a special arrangement with our foreign patients. Prior to the operation and preoperative examination, we hold consultation through emails, photos and by phone. This way, our surgeons get a deeper insight into the individual case, according to which they can estimate whether the patient is a suitable candidate for the desired operation. This procedure allows our patient to come to Zagreb for the operation one time only. When our patient arrives, we hold final preoperative consultation and medical examination, where we, together with the patient, discuss the details of the operation. After the consultation, we perform the surgery.
• Rhinoplasty is preceded by a routine preoperative analysis of the patient, which includes blood tests and medical examination.
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• Before the operation, in our correspondence and detailed conversation, we instruct our patients to stop using painkillers and nonsteroidal anti-inflammatory drugs, containing acetylsalicylic acid like Aspirin, Andol or Acisal, in case they usually take these. This is very important factor in patient’s preparation for the surgery, as this way we prevent possible bleeding and haematoma during and after the procedure. Following this instruction makes the recovery quicker and more successful, and the result of the operation is improved.

Anesthesia and the procedure:

• Rhinoplasty is performed under enhanced local anesthetic. That means that besides the local anesthetic, a patient is also given a light sedative. The patient is asleep during the operation and the whole procedure is painless.
• After the operation, we put a metal splint on the nose. We take it off after seven days, because all nasal structures heal in this period. First three to four days patient has nasal packing in the nose and its purpose is to prevent the bleeding and to support the new form of the nose from the inside
• A patient stays in the clinic for approximately 5 hours. It takes about an hour for preoperative preparations, 1 hour for the operation itself after which the patient rests for 3 to 4 hours. Once discharged from the surgery the patient is sent to home care.

Postoperative period and recovery:

• The final result of the operation depends on the course of the operation, the experience of the surgeon and his team, but to a significant extent, it also depends on conscientious and detailed postoperative monitoring and control. Great success of the operations in Dr Toncic’s clinic is largely due not only to the experience of our surgical team, precise and enhanced techniques, but also to well organized professional postoperative care.
• To be sure of the success of the operation and wellbeing of the patient, Dr Toncic and his team insist on regular check ups and everyday contact with the patient. For our patients’ safety and successful recovery and postoperative monitoring, we recommend optimal length of stay in Zagreb. This way, we leave nothing to chance. We monitor our patient’s recovery completely, which is crucial for our patient’s health and the result of the operation.

Required stay in Zagreb:

• Required stay in Zagreb is 3 to 7 days. The nasal packing needs to be removed from the nose on the third or fourth day after the operation. The nasal splint remains on the nose until the 7th day after nose job. The patient can go home on fourth or the fifth day, after the nasal packing is removed, but we recommend going home on the 8th day after the operation, after we remove the splint and do the final postoperative check up.
• Sick leave lasts 8 to 10 days for rhinoplasty. A week to ten days after the surgery, the patient can continue with his or her normal private, social and professional activities.
• However, for two months after the operation, the patient should avoid extensive physical activities that could result in injuries to the nose (for example, contact sports).

• Keywords:
• Nose operation, aestethic, recovery, ...