Rhinoplasty by Wave Plastic Surgery & Aesthetic Laser Center

Consultation:

Initial and subsequent consultations are key in establishing a rapport and understanding realistic goals and outcomes. Patients are asked to bring several photographs of a nose shape that the patient likes. The goal of this exercise is to determine the patient’s perspective of a pretty nose shape. After reviewing the photographs, the realistic shape of the nose can be determined for each individual patient.

Dorsum and Bridge:

This refers to the bony area of the nose. In Asians, the nose is usually flat and short so most patients require an augmentation of the this area. The important features of all dorsum is the smoothness in transition. The transition from the forehead to the nose should be smooth and curved. The transition from the dorsum to the tip should also be smooth. Some people may wish for slightly curved profile from the dorsum to the tip, and others may wish for straighter profile. With a very few exceptions, most patients desire a smoother, more natural, and not very high bridge and dorsum.

There are many different types of material that can be used to augment the dorsum. Using ones own tissue is ideal but there is not enough cartilage to augment the dorsum. Many synthetic materials are available, but at Wave plastic surgery the preference is using a smooth silicone implant. If the overlying skin is too thin, then the implant is covered with Alloderm to provide additional soft tissue coverage to avoid visibility of the implant.

Columella:

Columella is a structure of the nose that is located from the tip to the upper lip. The angle created between the columella and the upper lip determines the rotation of the tip. A feminine nose lip angle is 110 degrees for women and 90 degrees for men. Too much upper rotation will cause more visibility of the nostrils and an unnatural appearing nose.

Some patients may also have either a hanging columella, or retracted columella. Correcting this condition is an important point in the overall aesthetics of the nose.

Some people have a deep groove of the columella/upper lip junction or have a retrusion of the midface. Without doing major craniofacial surgery, this area can be filled with diced cartilages to give more projections.

Alar rim / Width:

Some people have alar rim that is thick and/or flared out. This can create an appearance of increased nostil show. Lowering the alar rim so that the nostril is not as visible is another subtle, but an important point.

After refining the tip and increasing the tip projection, the alar width will become narrower. For some, if this is not enough, the width can be narrowed using various method of excising the alar sides.

Step 1 – Anesthesia

Medications are administered for your comfort during rhinoplasty surgery. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.

Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

Step 3 – Reshaping the nose structure

Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body.

Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, is used for this purpose.

Occasionally a piece of cartilage from the ear and rarely a section of rib cartilage can be used.

Step 4 – Correcting a deviated septum

If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.

Step 5 – Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Step 6 – See the results

Splints and internal tubes will likely support the nose as it begins to heal for approximately one week.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine.

During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your nose surgery.

A nose surgery procedure to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.