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Rhinoplasty: One Surgery, Two Techniques

The term rhinoplasty means "nose molding" or "nose forming." It refers to a procedure in plastic surgery in which the structure of the nose is changed. The change can be made by adding or removing bone or cartilage, grafting tissue from another part of the body, or implanting synthetic material to alter the shape of the nose.
CosmeSurge Rhinoplasty
Rhinoplasty is the third most common cosmetic procedure among both men and women. It is most often performed for cosmetic reasons. A nose that is too large, crooked, misshapen, malformed at birth, or deformed by an injury can be given a more pleasing appearance. If breathing is impaired due to the form of the nose or to an injury, it can often be improved with septal surgery at the same time. Rhinoplasty should not be performed until the pubertal growth spurt is complete, ages 14–15 for girls and older for boys.

The external nose is composed of a series of interrelated parts that include the skin, the bony pyramid, cartilage, and the tip of the nose, which is composed of cartilage and skin. The strip of skin separating the nostrils is called the columella. The quality of the skin plays a major role in the outcome of rhinoplasty. Persons with extremely thick skin may not see a significant change in the underlying bone structure after surgery. On the other hand, thin skin provides almost no cushion to hide many minor bone irregularities or imperfections.

Surgical approaches to nasal reconstruction are varied. Perhaps one of the most confusing dilemmas confronting the prospective rhinoplasty patient is the choice of open versus closed rhinoplasty. In the closed rhinoplasty approach, also called endonasal rhinoplasty, all of the surgical incisions are positioned inside the nostrils. Although parallel incisions encircle nearly half of the nostril lining, no part of the incision can be seen externally and a visible scar is avoided.

The external, or "open," technique involves a skin incision across the base of the nasal columella. An external incision allows the surgeon to expose the bone and cartilage fully and is most often used for complicated procedures. During surgery, the surgeon will separate the skin from the bone and cartilage support. The framework of the nose is then reshaped in the desired form. Shape can be altered by removing or adding bone, cartilage, or skin. The remaining skin is then replaced over the new framework. If the procedure requires adding to the structure of the nose, the donated bone, cartilage, or skin can come from another location on the patient's body or from a synthetic source.

When the nose is reshaped or repaired from inside, the scars are not visible. But when the surgeon makes the incision on the outside of the nose, there will be some slight scarring. In addition, tiny blood vessels may burst, leaving small red spots on the skin. These spots are barely visible, but may be permanent. Closed rhinoplasty has the advantage of decreased operative time, less swelling and postoperative healing and avoidance of a scar along the columella. The patient seeking rhinoplasty is best suited if his surgeon is able to perform closed and open rhinoplasty without bias.

A cosmetic change of the nose will change a person's appearance, but it will not change self-image. A person who expects a different lifestyle after rhinoplasty is likely to be disappointed.

The alternative to cosmetic rhinoplasty is to accept oneself, literally, at face value. Persons contemplating rhinoplasty may want to question some of the conventional standards of beauty and work on their body image issues to improve their self-confidence.
CosmeSurge Rhinoplasty
During an open rhinoplasty, an incision is made in the skin between the nostrils . Closed rhinoplasty involves only incisions inside the nose.

Marwan Youssef, M.D.
Facial Plastic Surgeon

www.CosmeSurge.com

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