The Patient's Complete Guide to Rhinoplasty

The Seattle Rhinoplasty Center Patient's Complete Guide to Rhinoplasty© copywrited William Portuese MD, 2007/8

RHINOPLASTY AND NASAL SURGERY

A Rhinoplasty is one of the most challenging of cosmetic surgeries to perform. When the nose is out of harmony with the rest of the face, patients become self conscious. For that reason, nasal surgery and/or rhinoplasty is performed. It is a very popular procedure in the United States, being third in popularity of cosmetic procedures performed. Rhinoplasty means to change form, shape or function of the nose. It is also referred to as a nose job and is performed for purely cosmetic reasons. It is a surgical procedure that is performed to bring the nose to a more harmonious balance with the rest of the face. A septoplasty is performed to improve a person's functional breathing from the inside of the nose and to improve the airflow dynamics through the nose. A turbinate reduction surgery on the inferior turbinates is also performed internally for breathing. A turbinectomy also improves the airflow through the nose. A Rhinoplasty can be performed together with internal functional breathing procedures. In addition, a broken nose can also be repaired if needed at the same time as a rhinoplasty or septoplasty. Nasal surgery is one of the more complex of all cosmetic procedures because the nose is a 3-dimensional structure that includes bone, cartilage and skin. These components must look symmetrical in a 3-dimensional fashion as well as allow for proper breathing. Making changes in one of these components can affect other elements within the structure of the nose, changing functionality as well as appearance. Following a rhinoplasty surgery, the patient's nose should look very natural and be in balance with the remainder of the face. Most close family members and friends do not recognize the fact that a patient has had a rhinoplasty surgery. They just look better.

OPEN VS CLOSED RHINOPLASTY

Your rhinoplasty surgeon will determine which is the better technique for them to use with each different nose. Both techniques offer excellent exposure to allow the surgeon to perform the rhinoplasty. The closed technique makes 2- 4 incisions inside the nostrils , the skin is then lifted off of the cartilage and bone , the surgery is performed and the skin put back down. The open technique involves making the incisions on the inside as well as an incision across the columella(outside) and peeling the tip skin upwards to gain exposure. The skin is then lifted off of the cartilage and bone, surgery is performed and the skin put back down. The incision across the columella is then sewn up. The advantage to the closed technique is there is no external incision and faster healing time. The advantage of the open rhinoplasty is to gain more exposure which is sometimes required in revision rhinoplasty. The disadvantage to the open technique is that the incision will be visible for several months , there is more scar tissue and prolonged swelling and edema of the tip. This is a tradeoff when performing difficult revision rhinoplasty such as when cartilage grafts are placed. Dr. Portuese has performed thousands of rhinoplasty surgeries and can perform both open and closed techniques. He prefers to perform most routine primary rhinoplasty thru the closed technique while most revision rhinoplasty can be done either closed or open technique.

RHINOPLASTY LIMITATIONS

Everyone's nose is different and no two noses are the same. There are some limitations to what a rhinoplasty can do for preexisting conditions. The amount of correction that can be achieved with the nose depends on certain characteristics and traits such as thickness and oil content of the skin, underlying structural support system of cartilage, bone, septum and projection of the tip. When looking to perform a rhinoplasty, realistic expectations from the patient's perspective are very important. The goal of rhinoplasty is to reshape and sculpt a new nose that fits harmoniously with the face and fits into the facial balance for each individual patient. Every nose job is different. There is no one perfect nose.

GENERAL CONDITIONS

The earliest age at which a Rhinoplasty should be performed is usually age 15 for girls and about 17 for boys. The nasal bone growth plates have not finished growing until that point and cosmetic surgery should be withheld until the face is fully developed. The septum of the nose continues to affect the growth of the middle portion of the face and maxilla. Any changes to the septum either surgical or through injury, before it reaches maturation, can affect further facial development. In addition, it is also extremely important that at whatever age the rhinoplasty is performed, the patient is in excellent health and has no preexisting medical conditions. It is also very important to follow all pre- and postoperative instructions for a seamless surgery and postoperative recovery. Chronic health problems such as liver, heart, lung or kidney disease may render the patient unsuitable as a surgical candidate for cosmetic surgery. Uncontrolled high blood pressure can cause nose bleeds, diabetes can cause infections, and smoking can cause healing issues.

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