Rhinoplasty, A complex operation simplified.

Summary: Rhinoplasty is the most difficult and challenging operation in all of cosmetic surgery. The anatomy of the nose is complex and varies greatly on an individual basis. Much of rhinoplasty is done under the cover of the skin, and the operating surgeon must understand how the changes made in the underlying structures will look when the skin shrinks down upon them.
Rhinoplasty is the most difficult and challenging operation in all of cosmetic surgery. The anatomy of the nose is complex and varies greatly on an individual basis. Much of rhinoplasty is done under the cover of the skin, and the operating surgeon must understand how the changes made in the underlying structures will look when the skin shrinks down upon them.

The internal anatomy of the nose consists of a pair of comma shaped tip cartilages, one on each side, a pair of upper cartilages, and a pair of bones at the top. The nasal septum, which divides the nose down the middle is made of both bone and cartilage. The soft tissues of the nose may be thick or thin. The width of the nostrils is determined by soft tissue. With the exception of the nostril width, the soft tissues cannot be changed, and must be allowed to shrink down onto the bony and cartilaginous skeleton which is revised during rhinoplasty.

A lengthy pre operative consultation is required between the surgeon and the patient in order to determine to what degree the patient desires for a change in the appearance of the nose can be accomplished by the surgery. The operation generally requires two to three hours to complete. The patient is most often under a general anesthetic (asleep) administered by an anesthetist, so that the patient is not aware of what goes on during the procedure. Many rhinoplasties are done through an open tip incision across the base of the nose, which allows the tip cartilages to be exposed and modified. Some rhinoplasties are done with no external incisions, by the so called closed technique, and changes are made in the bones and cartilages from the inside.

Nasal tips may be excessively round (bulbous) or wide. Some tip cartilage may need to be removed from each side, or the two tip cartilages may need to be sewn together in the middle to narrow the tip. The profile of the nose may be too high or there may be a ump?over the top of the nose. The height is reduced and/or the hump is removed by sliding a chisel along it or by using various filing devices called rasps. Some noses are excessively wide, which is corrected by a controlled racture?along the junction of the sides of the nose with the cheeks. If the nostrils are too wide, a small wedge is removed from the base of each, and sutures are placed to close the gap. If the nose or the nasal septum is deviated, this can be corrected by removing the deviated portion of cartilage, and/or sculpting the septal cartilage back into the midline.

When the surgery is complete, a molded splint is placed on the nose for a week. When the splint is removed, the change is the profile is generally noticeable, but swelling on the front view persists for several weeks, and a little bit of it lasts several months. One must be careful not to bump the nose for about a month.

Even the most experienced surgeon occasionally has to go back and ouch up?a rhinoplasty surgery, if things do not settle as expected. Secondary rhinoplasties are usually done in the operating room, but under local anesthesia, and take just a short time to accomplish.

Most patients experience a major improvement in their appearance, and also in their self esteem. For more information on Rhinoplasty please visit us online at http://www.nvpsaz.com/face/rhinoplasty-nose.
Martin Bell, MD, FACS
Steven Gitt, MD, FACS
North Valley Plastic Surgery
Phoenix, Arizona.
www.nvpsaz.com