Rhinoplasty

Rhinoplasty changes the appearance of the nose.   It can improve a nose that is large, long, wide, crooked, hooked or has a hump on top.   It can change the bony structure of the entire nose or the cartilage tip, or both.  Very well concealed incisions are made inside the nostrils and sometimes on the lower midsection.

Rhinoplasty may be either cosmetic or reconstructive.  The purpose of the cosmetic rhinoplasty is to enhance the appearance of a nose which, though not perfect, falls into the range of general acceptability.  Reconstructive rhinoplasty implies tissue deficit from trauma or disease, and is performed to restore both function and appearance to be as close to normal as possible.

Rhinoplasty is a complex and demanding procedure.  The nose is like a signpost for everyone to see since it is the most prominent feature of the face.

Rhinoplastic surgery can be performed as either an open or closed procedure.  The decision about an open or closed rhinoplasty depending upon the complexity of the proposed nose job.  The open approach generally permits the surgeon to see more of the nasal structure, allowing for more precise correction.

Surgical Technique (Closed Rhinoplasty)

With the nostrils reacted by a double-pronged retractor a bilateral intercartilagenous incision is made.  Elevation of the soft tissue over the cartilaginous dorsum and upper lateral cartilages proceeds with scissors.  Once the soft tissue has been elevated, an elevator is used to elevate the eriostemon off the nasal bones.  At this point the hump is addressed either by scalpel or rasp.  Once the bony hump hs been reduced, the superior edge of the upper lateral cartilage must be trimmed.  The lower lateral cartilage is then delivered externally via a marginal incision.

A caliper is used to measure the amount of cephalic trim to be performed on the lower lateral cartilage.  A scalpel used to trim, sparing the vestibular lining of the nose.
At this point the bony osteotomies (breaks) are performed in order to narrow the nose.

Nasal packing and splint are applied.

Surgical Technique (Open Rhinoplasty)

The incisons for the open rhinoplasty should be marked precisely, so that they can align perfectly at the time of closure.  The internal nasal vesibule incision follow the margin of the lower lateral cartilage.  The transcolumellar incision is performed at the narrowest part of the columella.

Small sharp scissors are opened to spread the transcolumellar incision and reveal any soft tissue attachments.

Now the lower lateral cartilage is exposed in their entirety.  Dissection is continued over the lower lateral cartilage and up to the bony dorsum.   The bony dorsum is rasped down.  The cartilaginous dorsum is directly excised via scalpel.
If grafts are needed, at this point the mucopericondrium is carefully dissected from the cartilaginous septum.

After the septum is exposed, a portion of the septum is taken for use as graft material.

Spreader grafts are formed from septal harvested cartilage and placed between the upper lateral cartilage and nasal septum. Suturted in place with 5.0 clear nylon suture.  Next, the lower lateral cartilage are trimmed in order to refine the nasal tip complex.  Suture is then used to shape the lower lateral cartilage.

Occasionally tip projection needs to be improved.  Using the harvested cartilage, grafts are fashioned to increase columellar projection and tip projection.  The skin is then redraped over the nasal structure.  The internal nasal vestibule incisions are closed using chromic absorbable suture.  The transcolumellar skin incision is closed using a non absorbable prolene suture.

If the septum has been harvested, a plastic internal nasal splint is sutured into position to splint the septum.  The nose is packed.  An external splint is then placed over the nose.