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Rhinoplasty

Rhinoplasty, or nasal reshaping surgery, is arguably the most challenging and complex operation in facial plastic surgery.

SURGICAL PROCEDURES

The nose is a defining feature of the face.

In no other area are both function and appearance so intimately related. When the nose is straight, appropriately proportioned and aesthetically pleasing, the nose blends into and balances the other facial features. The nose doesn’t draw attention and focus remains ideally on a person’s eyes. However, when the nose is deviated to one side, twisted, too large, too small, or otherwise out of proportionate with a person’s other facial features, the nose draws attention away from the eyes. 


There are a number of reasons a person may seek to change the appearance of their nose. They may dislike a hump on the dorsum of the nose, or feel the bridge is too wide. They may feel the nose is too short or too long for their face, or have concerns about the width, size, or shape of the nasal tip. And in many cases, they may have a number of these concerns. 


The nose is also functionally important. Our noses breathe for us, warm, humidify and filter the air we breathe, and provide our sense of smell. It is critical to preserve and sometimes improve these functions when crafting a new nose. Because nasal function is intimately associated with nasal form, a nose that does not breathe well often has structural problems that contribute to a less appealing appearance as well. For this reason, the facial plastic surgeon must be well-versed in facial analysis, nasal analysis and the surgical techniques required to meet both a person’s cosmetic and functional objectives.

Aesthetic vs. Functional

As previously mentioned, the nose is both a defining element of our unique outward appearance and serves a number of functions. Patients typically seek consultation for one of these reasons or the other, only to find that both may be an issue. Many cosmetic nasal surgeries do not need to improve nasal breathing, but they certainly must maintain it when a nose is already functioning well.

 

Similarly, improving the nasal airway in certain patients may also translate into an improved outward appearance. It is important for your surgeon to evaluate all of these factors at your consultation, and educate you on the steps needed to reach your goals.

Primary vs. Revision

In no other area is both function and appearance so intimately related. When the nose is straight, appropriately proportioned and aesthetically pleasing, the nose blends into and balances the other facial features. The nose doesn’t draw attention and focus remains ideally on a person’s eyes. 

 

 

However, when the nose is deviated to one side, twisted, too large, too small, or otherwise out of proportionate with a person’s other facial features, the nose draws attention away from the eyes.

Septoplasty

The nasal septum is the wall that divides the nose into two halves.  It is made of cartilage anteriorly and comprised of bone further back into the nasal cavity.  Not only does it provide a partition between the two nasal passages originating at the nostrils, it also provides support for the nose.  The septum can be thought of as a load-bearing wall in a building.  Superiorly, it provides support to the roof of the nose and nasal cavity.  Anteriorly, it supports nasal length, nasal tip projection and tip rotation.  In these ways, the septum is truly the foundation of the nose.

 

A septum that deflects to the right or left can dramatically reduce airflow on that side of the nose.  This deflection may be inherited, may be the result of nasal trauma, or may arise over time due to extrinsic forces that influence the growth and shape of the septal cartilage.  Irrespective of the cause, septal deviation is a common cause of nasal obstruction.

Septoplasty, or septal straightening surgery, is traditionally performed through an incision on the inside of the nasal cavity just inside the nostril.  The lining of the septum is elevated and the deflected cartilage and/or bone is removed or reshaped to fall within the nasal midline.  The incision is then closed with dissolving sutures.  The procedure can be performed alone or in concert with additional nasal procedures.

Age of Rhinoplasty Patients

There are special circumstances and considerations for nasal surgery at different ages of life. In general, nasal surgery is avoided in pediatric patients. Surgery, itself, is traumatic, and manipulation of the pediatric nose can have deleterious effects on nasal growth – having an impact on bone, cartilage, and the skin (soft tissue envelope). Even so, there are specific circumstances where nasal surgery cannot be avoided. These include instances when children are born with congenital anomalies like a cleft lip and nose or in cases of certain growths and tumors found in infants and young children. In addition, trauma or another factor that impacts nasal growth can lead to complete obstruction of nasal breathing and distortion of nasal appearance. In these cases, surgery may be the only option to reconstruct the nose and provide a child with the ability to breathe.

 

 

 

More commonly, young patients present with an interest making cosmetic changes to their nose. Despite good health and appropriate motivation, though, young men and women may not be old enough to undergo nasal reshaping surgery. Ideally, rhinoplasty is not undertaken until facial and nasal growth has completed. In general, nasal growth in young women is typically complete between fifteen (15) and seventeen (17) years of age. For young men, this may be at a later age of sixteen (16) to eighteen (18) years old. These ages are only guidelines and may vary greatly from person to person. Ultimately, Dr. Stallworth will need to meet with a patient to determine their candidacy for surgery.

 

 

 

Rhinoplasty is not limited to the younger patient, but, rather, is possible at any age. In the more senior patient, though, new considerations must be taken. There is some evidence that nasal cartilage growth may continue throughout adulthood, leading to an increase in nasal size. More often, though, the suspension ligaments of the nose weaken with time leading to a drooping of the nasal tip and an apparent lengthening of the nose. This cannot only make the nose look less appealing, but also negatively impacts breathing. Patients suffering from these unwanted changes are also good candidates for rhinoplasty to help restore their nasal appearance and nose function.

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