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Rhinoplasty

Rhinoplasty or nose-reshaping surgery can improve the balance and aesthetics of a patient’s face, as the nose is at the center of our faces.  Nose re-shaping can refine the appearance of the nose and enhance the unique natural beauty of the patient.

Nose re-shaping can effectively straighten a crooked nose, reduce nose size, narrow a nose, refine the tip, or smooth a bump in the bridge of the nose.  A natural looking nose that enhances a patient’s face can boost confidence and self esteem.

Assessment and Treatment

Proper evaluation of the nose is critical to understanding which techniques to apply during the various stages of the operation in order to obtain the best possible result.

The nose can be broken down into three basic compartments. The dorsum (the outer
surface), the tip, and the intranasal structures.

Inside the nose is a structure called the septum which separates right from left in the
midline and provides support to the tip and the dorsum. If the septum is not straight,
then narrowing of the nose can result in a constriction of airflow on one or both sides
of the nose. Additionally, the septum can create tension on the dorsum or tip which
can distort the shape of the nose, if it is not properly addressed.

Along the side walls of the nose are structures called inferior turbinates which warm
and humidify the air we breathe. These often need to be reduced in size to make room
for improved airflow through the nose.

Evaluating the function of your sinuses should be considered based on your history. If
you are having sinus problems, the time to fix these issues is at the time of your
rhinoplasty. This can be performed safely at the same time without interfering with
the cosmetic outcome.

The outside of the nose is composed of skin, cartilage, and bone. Each of
these contribute in different ways to the shape of your nose and must be recognized
and considered when deciding upon the proper approach.

The skin itself must be evaluated. The thickness of the skin is an important contributor
to the outcome. Very thin skin can easily expose any irregularities or sharp edges of
the cartilage and bone, so techniques which create soft and smooth edges are
preferred. Very thick skin is more difficult to manage. It may disguise any irregularities,
but it will also diminish the final outcome, as all the work done on the nose will not
show through as well. Techniques which add cartilage for support, create sharper
edges, and thinning of the skin must be considered.

The tip of the nose is formed by the lower lateral cartilage. This C-shaped
structure has a medial and lateral component (crura) and a midpoint referred to as
the dome. The relationship of these three parts to each other, their size and shape, its
connection to the septum and the dorsum, and its proportion to the dorsum defines
the appearance of the nasal tip.

The shape of the tip can be described as boxey (square, wide, thick, tall cartilage); thin
(pointy and long); over-projected (sticks out too far); under-projected (cartilage is too
short); over- or under-rotated (piggy or droopy). The tip’s relationship to the dorsum
and the lip form angles which should be taken into consideration when planning the
surgery. The length of the dorsum, the tip, and the upper lip have particular ratios
which can have dramatic effects on the appearance of the nose when properly
maintained.

The dorsum is the top of the nose and is made up of the nasal bones and the upper
lateral cartilage. Most frequently, there is too much of both bones and cartilage,
giving the appearance of a bump and excessive width. The dorsum’s relationship with
the septum, the tip, and the facial bones create various issues which need to be
addressed, so they can be managed with the proper technique.

If the dorsum is straight, but too big and wide, then trimming the cartilaginous middle
third of the nose and then rasping down the over-projected nasal bone will provide a
smooth and aesthetic profile. To narrow the nose, narrowing or removing part of the
bone is created along the junction of the nasal and facial bones and then infractured.

If the nose is crooked, then the source of the deviation must be found so that it can be
rectified using the right technique.

As you can see, the surgical procedures must be tailored to each individual nose and
the patient’s needs. The nose must be evaluated as a whole by examining each of its
parts, determining how they interrelate with one another and with the rest of the face
and body type.

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