ULTRASOUND-ASSISTED RHINOSCULPTURE
The Break-Free Rhinoplasty® technique is the most modern rhinoplasty method used worldwide, first introduced in Greece in 2018 by Dr. Ektor Panayi. The innovation is based on the combination of ultrasound-guided rhinoplasty, along with personalized 3D pre-operative planning.
Break-Free rhinoplasty applies the most modern piezoelectric ultrasound technology, through which precise sculpting of the nose is possible without the need to break the nasal bones using a conventional osteotome, as it is done in traditional rhinoplasty. The Break-Free technique allows for precise rhinoplasty, thus avoiding severe swelling & bruising after surgery. Importantly, it allows for absolute control in the operating room, enabling the creation of natural and predictable results, without the stigma of surgery (e.g. visible osteotomy lines, break points) based on 3D preoperative planning.
The Advantages of Break-Free Rhinoplasty:
– It reduces the need for bone breaking, making the procedure more precise and completely painless.
– It avoids and eliminates asymmetries and irregularities in the nasal skeleton.
– It gives the surgeon, for the first time, the ability to directly see the bone he wants to shape and to completely control how much hump (bump) he will remove.
– It thins the nasal bones, especially in patients who have a very thick nasal skeleton and pronounced asymmetries.
– In cases of a repeat (revision) rhinoplasty or post-traumatic surgery, it allows the surgeon to easily handle even fragile mobile bones, after an osteotomy that was not done exactly where it should have been carried out or a bone fracture.
– It does not damage the soft tissues of the nose.
– The postoperative course is lighter and completely painless, while bruising and swelling are clearly less.
BREAK-FREE TECHNIQUE
Through the Break-Free® technique, precise rhinoplasty and correction of internal nasal anatomy problems are possible, without the need to break the nasal bones. The use of Piezo ultrasound allows both the reduction of bone thickness and their perfect smoothing, for a harmonious & flawless result. Unlike the closed approach, the open rhinoplasty technique offers the surgeon a better intraoperative view of the internal anatomy of the nose, as well as the application of precise sculpting of the nasal bones without the need to break them. This allows us to achieve natural results, without surgical scars and the risk of complications. Break-Free ultrasound rhinoplasty does not injure the other sensitive tissues of the nose, such as skin, mucous membranes, vessels and nerves. This significantly reduces the creation of postoperative swelling & bruising, which allows an immediate return to daily life after the splint is removed in one week.
How Break-Free Ultrasonic Rhinoplasty Works
Break-Free ultrasonic rhinoplasty is intertwined with the concept of open rhinoplasty (instead of the common closed approach), which is performed with complete visibility and control. Traditionally, patients interested in undergoing rhinoplasty have the fear that the surgeon will have to “break the bones of the nose”. The classic surgical instruments used on the bony nasal skeleton (osteotomes and rasps) usually offer satisfactory results, but in a significant percentage of procedures the bones are not broken exactly at the point or in the straight line that the surgeon wants, thus creating minor or major deformities, but also breathing problems. Also, until now, there was no possibility of reducing the thickness of the bone itself, but only of moving it inwards overall, in order to reduce the width and slim the nose. The new Break-Free open rhinoplasty technique applies a system (Piezo) which converts electrical energy into ultrasound, enabling the surgeon to perform real "sculpting" of the nasal bones, without having to break them. With this tool, the surgeon can now lower the hump (bridge bump) with precision and change the shape and thickness of the nasal bones as needed, without creating any problems in the other sensitive tissues of the nose, such as skin, mucous membranes, vessels and nerves, since Piezo only affects the bones. Thus, the nose is slimmed down without ultimately requiring any osteotomies (breaking the nasal bones) in most cases.
The operation is usually performed under general aneasthesia, while the application of a completely atraumatic technique results in a quick recovery and immediate return to daily life. The methodical and scientific approach followed by the Dr.Ektor makes the procedure completely predictable, even in the most difficult cases. The great advantage of Break-Free rhinoplasty lies in the quick and easy recovery. Even immediately after surgery, the presence of swelling and bruising is minimal, while there is no pain or discomfort, thanks to the avoidance of breaking the nasal bones. The postoperative course is lighter and completely painless, while bruising and swelling are clearly less. Good breathing is fully restored in 1 week, while the use of a nasal spray is recommended for 1 month. The nasal splint remains for 5-7 days, depending on the procedure that has been performed, while it is recommended to avoid physical activity for 4 weeks, so as not to increase pressure in the nose. Intense weight training is safe at 3 months.
FUNCTIONAL RHINOPLASTY WITH EXPERT TECHNIQUES
Dr. Ektor performs a complete septo-rhinoplasty procedure, which ensures both a functional, as well as an aesthetically pleasing nose with a straight septum and parallel dorsal lines. The application of the most advanced rhinoplasty techniques, such as the implantation of cartilage grafts, e.g. taken from the nasal septum (spreader / rim / strut grafts, cartilage powder) allow for the perfect alignment of the septum, and the long-term elevation of the nasal tip, thus improving the function of the nose.
SPREADER GRAFTS (INTERNAL SPLINT GRAFTS)
Proper alignment of the nasal septum is essential for proper nasal function and a harmonious facial appearance. The use of autologous cartilage grafts as internal spreader grafts allows the physician to achieve long-term maintenance of the septum in a straight position.
SUPPORTIVE TIP STRUT GRAFT
Postoperatively, but also over time, the nasal tip has a tendency to fall, as its structural support gradually decreases, due to the absorption of the sutures and the elasticity of the cartilage. Through the use of an autologous supportive cartilage strut graft, Dr.Ektor eliminates the risk of possible tip fall, ensuring a long-lasting result.
ALAR RIM GRAFTS
The elevation of the tip of the nose results in the upward displacement of the lower lateral cartilages. To avoid the 'emptying' of the nostrils (nostril show) and to prevent the gap from being prominent, we use special autologous grafts, Alar Rim Grafts, to maintain/improve the shape of the nostril contour, ensuring both symmetry and a natural appearance of the nostril-tip complex.
FREE DICED-CARTILAGE POWDER
Reducing the hump (bridge bump) of the nose results in the creation of small, but visible irregularities on the bridge, which can alter the reflection of light and its harmonious image. The use of autologous cartilage powder acts as a 'paste' on the bridge of the nose and camouflages any irregularities.
OPEN vs. CLOSED RHINOPLASTY
The main surgical approaches to rhinoplasty, whether to correct the septum in order to improve the function of the nose, or to improve its aesthetic appearance, or both, are closed and open rhinoplasty.
Although closed rhinoplasty, as a technique, has the obvious advantage of leaving no external scars, there are several parameters to consider when deciding which approach is best for you. Closed rhinoplasty has some advantages such as reduced postoperative swelling, invisible incisions, and a shorter recovery time compared to open rhinoplasty. This is due to the fact that the skin envelope is not completely separated from the nasal skeleton. The closed approach may be more suitable for smaller or less extensive changes to the structure of the nose, e.g. reshaping of the nasal tip, compared to the more invasive procedures associated with open rhinoplasty, since it is accompanied by milder postoperative edema and a faster postoperative recovery. However, the closed approach does not allow the surgeon a complete visibility of the internal anatomy of the nose, resulting in a significantly higher risk of complications, in case of any injury to the anatomical structures.
Open rhinoplasty has proven to be very popular for the most difficult cases, especially where there is a problem with the septum, either congenital or after an injury to the nose, and is the personal preference among the various approaches followed by Dr. Ektor. The main reason is that the open rhinoplasty technique offers the surgeon a better intraoperative view of the internal anatomy of the nose. Undoubtedly, the execution of specific techniques and surgical maneuvers makes the operation more difficult when we keep the skin covering of the nose intact, in terms of the accuracy of its execution. With the progress made in rhinoplasty techniques over the last 10 years, many of which are based on the implantation of cartilage grafts (e.g. obtained from the nasal septum or from lateral cartilage such as spreader-grafts, strut-grafts, rim-grafts and cartilage powder) and on the revision of the position (alignment) and shape of the septum (reduction of the hump, correction of septal scoliosis), as well as on the precise but atraumatic sculpting of the nasal bones through the use of ultrasound (Piezo Ultrasonic Rhinoplasty), this has become even more important. Furthermore, in the new era of preoperative planning with the help of 3D simulation, there is little benefit in carrying out such an extensive and precise planning if the steps cannot be performed with precision and consistency, which is almost impossible with closed rhinoplasty, during which the surgeon does not have a direct view of the internal nasal anatomy. Also important is that the small scar resulting from open rhinoplasty, although external, with good postoperative care heals very well within 3-6 months and is completely imperceptible.
PRESERVATION vs.
STRUCTURAL
RHINOPLASTY
Two subcategories of rhinoplasty techniques that the surgeon may follow are preservation rhinoplasty and structural rhinoplasty. Preservation rhinoplasty refers to a method of hump reduction that aims to preserve the dorsal structures (upper lateral cartilages and upper part of the septum), without removing them. Here, hump reduction is achieved by removing a strip from the middle part of the septum (strip removal) and vertical compression (push-down/let-down technique). This technique is ideal in cases of primary rhinoplasty, where there is no significant deviation/scoliosis in the septum and the hump is small. In contrast, when there are significant functional problems, such as severe deviation (scoliosis) of the septum where restoration of the nasal anatomy is required, as well as in revision cases, structural rhinoplasty can offer a better solution since it allows the precise placement of supporting grafts such as the internal splint graft (spreader-grafts) and the special graft for supporting the tip of the nose (strut graft). This strengthens the internal and external valve and improves breathing. Dr. Ektor specializes in both techniques with excellent results, after first choosing the right method for each patient.
REVISION
RHINOPLASTY
CORRECTIVE TECHNIQUES
When there are significant functional problems and restoration of the nasal anatomy is required, as we often see in repeat cases, open structural septo-rhinoplasty can offer a better solution compared to the closed approach since it allows for the precise placement of supporting grafts such as the spreader-graft and a strut graft to support the tip of the nose. In extremely difficult cases, when total correction of the nasal anatomy and septum is required, while grafts from the septum have been used previously, the use of an additional cartilage graft from the ear (ear cartilage graft) or from the rib (rib graft) may be necessary. Learn more about the advanced techniques we apply in revision rhinoplasty cases.
RECONSTRUCTING THE NATURAL ANATOMY FOR AESTHETIC & FUNCTIONAL IMPROVEMENT
An unsatisfactory, or even worse, a harmful rhinoplasty can be an emotionally draining experience. Revision (secondary) rhinoplasty is performed to correct cosmetic and/or functional issues following a previous rhinoplasty surgery. The procedure can further improve or restore a more natural appearance and function to a nose that has undergone surgery that did not produce the desired results. By applying the most advanced rhinoplasty techniques, such as ultrasound-assisted rhinoplasty (Break-Free® technique), precise rhinoplasty and correction of internal nasal anatomy problems are possible without the need to break the nasal bones.
SURGICAL PROCEDURE
The nose is a delicate organ for which it is strongly recommended to choose a specialized and skilled surgeon. Furthermore, the internal scars that arise after a primary rhinoplasty procedure make the revision rhinoplasty surgery particularly difficult. Dr. Ektor, having an extensive 20+ years of experience in revision rhinoplasty, recognizes the responsibility and trust that his patients place in him. His unparalleled technique, experience and understanding of the complex anatomy of the nose enable him to deliver excellent results, even in the most difficult cases of revision rhinoplasty. His uncompromising and patient-oriented nature guarantees that he will not leave the operating room until the desired result is achieved. The understanding and respect he has for his patients are key ingredients that allow him to improve the appearance and function of the nose, giving them back self-confidence and relief. The methodical and scientific approach followed by the Dr.Ektor makes the process understandable, while instilling confidence and trust in each patient even in the most difficult cases.
Common problems after rhinoplasty procedure:
– Large concavity formation on the nasal bridge after excessive hump removal
– Deviated septum and deviation of the central axis of the nose
– Excessive nasal tip projection in profile view
– Excessive elevation - rotation of the nasal tip
– Dropping/Lack of support of the nasal tip
– Rounded/Wide nasal tip
_ Lateral shadowing in the central part with convergence of the dorsal lines due to injury to the upper lateral cartilages/open roof (inverted V deformity)
FEMALE RHINOPLASTY
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NATURAL-LOOKING RESULTS
All before-after results show are original works by Dr. Ektor
MALE RHINOPLASTY
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All before-after results show are original works by Dr. Ektor
REVISION RHINOPLASTY
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FAQs
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Is rhinoplasty surgery painful?
Due to the use of an atraumatic, precise break-free technique, nasal surgery in the hands of Dr. Ektor is not painful at all. The mild discomfort that may be felt post-operatively can be dealt with using oral analgesia at home, usually for 1 week.
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How long does surgery usually last?
Usually, depending on the severity of the problem, nose surgery may last from 3-5 hours. If a full septo-rhinoplasty procedure is to be carried out, with correction of both a deviated nasal septum and aesthetic improvement of the nose, the duration of surgery is usually 5-6 hours.
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How long does it take to full recovery after surgery?
Following a rhinoplasty procedure, the doctor will apply a special nasal splint that is left in place for 5 days, until all incision wounds heal up. Some bruising might be expected, which usually lasts for 5-7 days. Patients can expect a full recovery after 1 week.
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In which months of the year can nose surgery be performed?
Rhinoplasty surgery can be done throughout the year, even in the summer months, when the patient is advised to apply SPF 50-100 sunscreen on the scars to prevent any colour alterations.
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How long do the results of a rhinoplasty last?
A septo-rhinoplasty procedure using the Break-Free technique results in stable, long-lasting results due to the avoidance of injuring the nasal bones, as well as due to the use of supportive cartilage grafts that stabilize the nasal skelton.
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Will i have to stay in the hospital overnight after a rhinoplasty procedure?
Yes, we recommend to all our patients to stay in the hospital overnight, the day of surgery, in order to guaranty safety and ensure a smooth post-operative recovery, as we administer intravenous analgesia and antibiotic treatment for 24h. Also, the internal nostril gauzes that are placed during surgery are left in for 24h, and removed the morning after, to aid rapid healing.
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When can i resume daily activities and exercise after surgery?
Daily activities can be resumed 1 week following surgery. Weight lifting should be avoided for 1 month. Cardiovascular exercise can be done 1 month after the procedure, while heavy weight lifting in the gym must wait 3 months.
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Can i smoke before or after surgery?
The consumption of nicotine (in any form) can significantly affect wound healing, and might delay your recovery after surgery. Dr. Ektor recommends to all his patients to abstain from smoking for 4 weeks before and after surgery to ensure smooth wound healing and good-quality scars.
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How does a Break-Free open rhinoplasty procedure compare to conventional closed rhinoplasty surgery?
Closed Rhinoplasty, while faster and more simple to execute, is practically a blind procedure, since all changes are performed with the skin of the nose closed. This significantly increases the risk of unpredictable outcomes and complications, that can affect both the aesthetic appearance of the nose, as well as breathing. Dr. Ektor therefore always prefers the open approach, which allows him absolute control of the procedure, as the internal nasal anatomy is fully visible, as well as the execution of the Break-Free technique, through the introduction of the piezo-ultrasound device into the nose.
SPECIALIZATION
All Rhinoplasty procedures carried out by Dr. Ektor are products of careful and extensive study. During the consultation, Dr. Ektor will assess your suitability for such a procedure, as your safety and achieving the desired end-result must be perfectly aligned. After completing the initial consultation and assessment, Dr. Ektor prepares a detailed and customized surgical plan based on your goals, needs and unique facial features. Nothing is left to chance as Dr. Ektor is totally committed to specialized solutions that suit the specific unique characteristics of each patient. The philosophy of Dr. Ektor relies on personalized solutions, as he approaches each patient according to their personal situation and unique characteristics. In this way, he achieves solutions that have been studied and adapted exclusively to each individual patient. To achieve this, Dr. Ektor, faithfully follows a comprehensive series of procedures before each operation, starting with photographing targeted areas and taking detailed measurements. Then, after having all the necessary information at his disposal, he performs a pre-operative 3D simulation, an integral part of the procedure, through which the patient gets a clear picture of what to expect after surgery. After the pre-operative planning is completed, it is carefully and accurately performed in the operating room. The importance to detail and the unparalleled artistic eye of Dr. Ektor ensure the most natural possible result with the smallest possible scars. Dr. Ektor has over two decades of experience in rhinoplasty, having specialized under the most renowned plastic surgeons in Europe and USA.
CUSTOM DESIGN WITH 3D SIMULATION
Dr. Ektor is a big believer in the fact that best post-operative results can only be achieved through careful and detailed pre-operative planning. This is why he always uses the most advanced tools that allow him to plan and discuss with his patients each individual outcome. The use of 3D Simulation (Crisalix 3D , Arbrea AR) allows the doctor to predict important aspects that require clarification before a Rhinoplasty procedure, while the patient feels reassured that the result will perfectly fulfil his/her expectations. A 3D Pre-Surgical Simulation is always performed, through which the patient, together with the doctor, decide together on the ideal shape of the nose. Through the 3D simulation, the patient can also see the result before the operation, which prepares her psychologically as to what to expect.
EXPERT TECHNIQUES
