COMMON NASAL PROBLEMS

Is “revision” rhinoplasty as easy as primary rhinoplasty?

When a nose has already undergone an operation, there are two major changes to the anatomy compared to a nose that has not had surgery. First, although the same components of skin, cartilage, bone, and mucosa (pink tissue inside the nose) are present, their shapes have been altered by the previous surgery. A Revision Surgeon therefore cannot rely on the normal shapes, or “landmarks”, when doing a revision surgery. He or she needs to proceed more slowly and carefully when identifying all structures. Second, there is always scar tissue that builds up under the skin and around the nasal structures. This scar tissue is firm and difficult to open. It hides the structures of the nose, so again, the revision surgeon must proceed slowly and carefully.

When a surgeon performs a Revision Rhinoplasty, it is very helpful to have a good understanding of what was done during the primary surgery. If you have had a rhinoplasty in the past,as much as possible, try to obtain an operative report from the first surgeon, and present it to Dr. Lansangan for a thorough review.

THE CHIN – A PART OF NASAL EVALUATION

The size of the chin affects the way a nose is perceived. To complete the process of nasal evaluation, it is vital to consider the chin and mention its importance to the patient.

Even if the patient only wants to change her nose, it is worth knowing how the size of her chin will affect her look with or without altering it. A small chin makes the nose appear larger and vice versa.  Dr. Lansangan includes and mentions this to the patient during the consultation. To some patients with very short chin and only want to have a noselift, he may suggest to augment the chin as well to create facial balance.


chin1  chin2

A chin which project forward to the level of the level of the lower lip creates facial balance as illustrated above.

AIRWAY OBSTRUCTION

Correction of the nasal airflow depends on the cause of airway obstruction which can be categorized into two:

Enlarged Turbinates
Turbinates are three mounds of mucosa that humidify the air as it travels to our lungs and help filter foreign particles. They are called as:
1)    Superior Turbinate
2)  Middle Turbinate
3) Inferior Turbinate
Nasal_Turbinates
Once enlarged, they impede the airflow which results to difficulty in breathing.  This can be corrected by either cauterizing or excising them.

Nasal Deviation
Turbulent airflow with each breath which makes breathing much more difficult is caused by a deviated septum. This can be markedly improved and even resolved once the deviated septum is repositioned or removed.
Normal_Airflow
Illustration of normal airflow

WIDE BULBOUS ALAE AND BIG NOSTRILS

These problems can be corrected through alae reduction. It is done by removing a precise amount of the alae at its base.

Illustration:        Wedge Incision (c/o Artist)


Nostril_Incision

Nostril Reduction is done with wedge incision of the alae base which results incision hiding in natural crease.

DROOPY NASAL TIP

Some patients with deviated dorsum also have deviated nasal tip. As earlier mentioned, this is a difficult case to completely correct.

DORSUM