RHINOPLASTY

PRIMARY AND REVISION RHINOPLASTY

You may also hear the terms “primary” rhinoplasty, referring to the first nasal procedure, and “revision” rhinoplasty, implying that you have had at least one rhinoplasty in the past. Revision procedures are often more complex given existing scar tissue, and are more likely to require an open technique. You should also consider if you desire a purely “aesthetic” correction, or if your complaints are mainly “functional”. For many of our patients, improving the aesthetic and functional components of the nose is required.

INCISION APPROACHES

In general, nasal surgery is described as either “closed” (endonasal) or “open” (external). These terms refer to the placement of incisions – closed rhinoplasty incisions are completely hidden inside the nostrils, whereas open rhinoplasty also includes an incision made in the skin between the nostrils.

Some surgeons use the closed technique when the majority of nasal work is performed on the top and the bridge of the nose or if only small modifications are being made to the nasal tip. This is performed through incisions inside the nose. This is a lot simpler to do and results to complete absence of visible scar from the outside. However, the downside of this technique is lack of exposure of the nasal tip. This is commonly used in nasal augmentation using silicone implant.

In Reconstructive Rhinoplasty, the open technique is used. This provides excellent exposure of the nasal anatomy and allows for a more precise rhinoplasty. This requires a very small incision along the thinnest part of the skin (columella) between the nostrils. The incision which is only 3-4mm long normally heals without any visible scar.

Since every nose is different and has unique surgical requirements, Dr. Lansangan discusses the options with each patient and describes the surgical plan in detail. The choice of approach is dependent on what he thinks is the best outcome for the patient and the technical aspects of the procedure.

A. Nasal illustration using open technique

External incision used in “open

External incision used in “open technique"

B. Nasal illustration using closed technique

Intra-nasal incision used in “closed technique

Intra-nasal incision used in “closed technique"

TYPES OF RHINOPLASTY

Reduction Rhinoplasty is very popular among Caucasians since they generally have very high and too pointed noses which are sometimes droopy, with hump or deviated. The opposite is true among Asians whose noses are generally wide, flat, bulbous, and with flaring nostrils, thus making augmentation rhinoplasty the most popular cosmetic enhancement procedure for them.

Depending on the nature of the problem, reduction rhinoplasty may involve nasal osteotomy or breaking of the bones, bone repositioning, shortening of the nasal septum, tip reduction, or alae trimming.

Augmentation Rhinoplasty involves the insertion of an implant to increase the height of the nasal bridge. There are different kinds of implants the patients can choose from. He may opt to have a silicone, a gore-tex or a cartilage implant.

Silicone remains to be the most popular implant in most of the third world countries. However, after more than 20 years of usage, many cases of material rejection, nasal contraction and other complications have been continuously encountered. Cartilage implant is the best option because it is safe, rejection- and worry-free but extremely expensive. The next best option offering the same safety level is the GORE-TEX implant.

NASAL ANATOMY

The nose is made of many types of tissue, which makes rhinoplasty especially difficult for the untrained surgeon. The nasal framework consists primarily of cartilage, which forms the lower two-thirds of the nose and the anterior septum. Complexity is created by the many individual pieces of cartilage, their unique shapes, and the strong connective tissue that holds them together. Bone is also important, forming the upper one-third of the nose and posterior septum. The nose also has the pink, moist tissue on the inside – the “mucosa” – and several small muscles that affect its shape. Most, if not all, of these tissues need to be altered during a rhinoplasty surgery, so the skin will lay down over them in consistent manner, and the nasal appearance and function will improve.

THE NOSE AS CENTRAL FACIAL FEATURE

Nose is the most central structure of the face and is actually eighty percent of the mid-face beauty. It effectively dictates and affects the overall look of the face. This is why it is the first thing that people notice when they look at us. This is especially true when our nose is too large, too small, too wide and flat, deviated, or not proportionate to the rest of our facial features.

As the central feature of one’s face, the nose is arguably the most important structure in determining identity, and influencing the balance and harmony of the face. So, it is easy to see why nasal deformities, however minor, can affect facial beauty. In addition, nasal shape can affect function as well as form, given the nose’s significant role in breathing. We feel that surgery of the nose should therefore be performed only by facial plastic surgeons, who are specialists in nasal anatomy, function, and aesthetics.