Детально, о пластике носа с пластическим хирургом Данилой Александровичем Кузиным

Сегодня мы побеседуем с пластическим хирургом Данилой Александровичем Кузиным, на тему ринопластики. Зададим самые часто задаваемые вопросы связанные с пластикой носа от гостей энциклопедии Cosmoplastica.ru


СР

Здравствуйте, Данила Александрович! И первый вопрос: есть ли возрастные рамки для проведения пластики носа?

Д.А.

Здравствуйте. Самостоятельно гражданин России может сделать пластическую операцию при достижении совершеннолетия (18 лет). До достижения совершеннолетия – с письменного согласия родителей или ответственных лиц, именно с ними заключается договор. 

Эстетическая пластика носа – операция, выполняемая по запросу клиента. Мы не будем рассматривать реконструктивно-восстановительные операции, где возраст не имеет значения. Психологическая зрелость и половое созревание (стабилизация гормонального фона) – те факторы, которые должен оценивать пластический хирург при принятии решения о проведении операции, лицам младше 18 лет. 

Есть ли верхние возрастные ограничения? Все знают, что существует такой термин – «омолаживающая ринопластика». Аккуратный, не длинный, пропорциональный нос, без горбинки значительно омолаживает лицо, делает его более привлекательным, добродушным и отдохнувшим. Именно эти эффекты наиболее ценны в антивозрастной хирургии. Паспортный возраст пластическом хирургу в таких ситуациях не указ. Сочетание тщательной оценки состояния тканей (кожа, хрящи) и четкого понимания пациентами возможностей и результата позволяют активно выполнять омолаживающие ринопластики. 

СР

Какие виды пластики носа бывают?

Д.А.

Видов пластики носа достаточно много, смотря от каких критериев сравнения отталкиваться. Эстетическая и реконструктивно-восстановительная ринопластика абсолютно разные по своей сути и целям, которые она преследует. В эстетической ринопластике хирург сталкивается с изначально анатомически и функционально полноценным носом. В последнее время стало нормой, когда клиент, обратившейся за изменением формы наружного носа, просит исправить искривленную перегородку и восстановить или улучшить дыхание. Тогда операция будет называться септоринопластика – воздействие на структуры наружного носа одновременно с перегородкой. Для этого введен специальный термин – функциональная эстетическая ринопластика. Важно не только изменить форму носа, но и сохранить или восстановить дыхание.

Можно разделить ринопластики по тем зонам, где проводится операция. Пластика кончика носа, пластика спинки носа, коррекция формы ноздрей, коррекция формы крыльев носа. Изолированно эти операции выполняются крайне редко. 

Часто пациенты задают один и тот же вопрос – у меня будет разрез под носом (на колумелле)? Этот небольшой с виду разрез делит ринопластику на две принципиально разные школы – открытая и закрытая ринопластика. Могу с уверенностью сказать, что те технические приемы, которыми гордились приверженцы открытой ринопластики, давно и, в совершенстве, освоены. Хирурги делающие ринопластику закрытым способом владеют полным арсеналом хирургических приемов и огромными преимуществами закрытой ринопластики. Но, обязан оговориться, умеют это делать ограниченное число хирургов. 

СР

Сколько дней нужно носить гипсовую повязку после ринопластики? 

Д.А.

 Гипсовая повязка накладывается только на нос. Никуда больше на лицо она не распространяется. Я снимаю гипсовую повязку через 7-10 дней. К моменту снятия гипса у человека, как правило, уже нет синяков и выраженных отеков. После снятия гипсовой повязки человек может вести полноценный социальный образ жизни.

СР

Через какое время после операции снимаются швы?

Д.А.

Количество швов и вид шовного материала сильно зависит от техники выполнения операции и привычек хирурга. Есть методики, которыми в частности пользуюсь я, позволяющие вообще не снимать швы. Можно это назвать «бесшовной ринопластикой» - сейчас очень востребованный термин! При использовании не рассасывающего шовного материала швы снимаются в промежутке от 5 до 10 дней. 

СР

Под какой анестезией проводятся операции по пластике носа?

Д.А.

 Ринопластика, в особенности септоринопластика, выполняются под общим обезболиванием. Современная фармакология и опыт анестезиологов позволяют это делать максимально комфортно и безопасно для клиента. Общее обезболивание позволяет хирургам полностью визуализировать все структуры носа и добиваться оптимальных результатов с максимально коротким периодом восстановления. Небольшие операции по коррекции крыльев носа или колумеллы можно выполнять под местной анестезией.

СР

Остаются ли швы или заметные шрамы после ринопластики?

Д.А.

Открытая ринопластика подразумевает разрез на колумелле носа. Насколько он будет заметен и будет ли он влиять на форму колумеллы, зависит исключительно от мастерства хирурга. При закрытой ринопластике видимых швов и рубцов нет, все находится внутри носа. Коррекция крыльев носа выполнятся с разрезов в основании ноздри. В дальнейшем шрам становится полностью незаметным и находится в складке крыла носа. 

СР

Когда после пластики носа можно вернутся к активному образу жизни и занятиям спортом?

Д.А.

Современная концепция реабилитации и усовершенствованная техника операции позволяют вернуться к активному образу жизни уже через 2 недели после операции, а к активным занятиям спортом на 3-4 неделе. 

СР

Как подготовится к операции по пластике носа, и чего ожидать в реабилитационный период?

Д.А.

Специальной подготовки к операции не требуется. Безусловно вы должны быть здоровы – никаких острых воспалительных явлений, особенно в области носа, околоносовых пазух, гортаноглотке. Обязательным пунктом, помимо обследований и анализов для общего обезболивания, является КТ (компьютерная томограмма) носа и придаточных пазух. Одно специфическое требование все-таки есть – нос перед операцией следует постричь. 

После операции нос не болит. Приема обезболивающих препаратов не требуется. Первые 4-5 дней могут быть небольшие синяки под глазами. Нос после операции необходимо прочищать специальными каплями и ватными палочками. Физиопроцедуры по реабилитации можно начинать на 4-5 день после операции. 

СР

Почему процент повторной ринопластики достаточно высокий?

Д.А.

Эстетическая ринопластика одна из самых сложных операций в пластической хирургии. Почему высок процент повторных операций? Позволю себе выделить всего несколько, но очень веских причин. 

Первая – высочайшие требования пациентов к полученным результатам (как обоснованные, так и не обоснованные). 

Вторая – недостаточная теоретическая и техническая подготовленность хирургов, которая сказывается на диагностике и способности воплотить задуманное. 

Третья – высочайшая востребованность и финансовая выгодность операции (оперируется очень много людей и берутся за операции все кому не лень). 

Детализация каждого пункта достойна отдельных статей и очень многогранна. 

СР

Почему считается, что конечный результат после пластики носа можно оценить только через год?

Д.А.

Один год – усредненные сроки, в течение которого полностью проходят все отеки, созревает и размягчается рубцовая ткань. Нос перестает значительно меняться, и мы видим окончательный результат. Однако в последнее время эти сроки стали значительно сокращаться, и можно иногда подводить итоги через 8-9 месяцев. 


Cosmoplastica.ru благодарит Данилу Александровича за интересную беседу и развернутые ответы для читателей нашей энциклопедии. С резюме пластического хирурга можно ознакомится в разделе "Рейтинги пластических хирургов".

 
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