Rhinoplasty

The nose is one of the most prominent facical features, and is offten readily tnjured. It is also a common site of congenical deformity and tumour formation. Rhinoplasty is plastic surgery performed on the nose, and is also one of the most frequent plastic surgery operations. The surgeries often involve the shaping or restructuring of the bony or cartilaginous deformities or an associated correction of a deviated nasal septum which can be a functional disability. For cosmetic surgeries, the common ones are corrective Rhinoplasty, Augmentation Rhinoplasty, Reduction Rhinoplasty or a combination of one of more of these.

AUGMENTATION RHINOPLASTY. AmongAsians, the nose is often flat at the bridge and broad and bulbous at the tip. As a result, the main desire is to have the nasal contour highter, the nose tip smaller and more prominent in appearance and projection. The low nasal bridge can be enhenced by bone, cartilage or synthetic material like silicone. For the own bone and cartilage it can be harvested from sites like the patien's iliac csest or rib.It has to be carefully carved to fit the desired contour. This is the best implant as it is the patien's own tissue, but there are some disadvantages. The desired shape can not be achieved sometimes because the cartilage or bone may bend, and hence cause distortion. Anatomically, the nose can be divided into an upper two-thirds bony fixed portion soft cartilaginous or mobile segment. If we use the bone or even a rigid cartilage graft, it is often too stiff for the whole nose and hence may appear rather unnatural. In addition tha patient will have to undergo an additional operation to harvest the graft, and this may leave varying degree of scarring at the donor site.

The next option is to use synthetic material, and the most widely use one in rhinoplasty, is the silicon prosthesis. These prosstheses are often soft and pliable, and are available in various shape and sizes. They can be further shaped to conform to the desired profiles. As it is also soft, the nose will not look stiff, unless the patient decides to have a very prominent nose like the Westerners do. It is crusial to position the prosthesis to rest securely on the nasal bone, so that it will not stick out and become mobile. It is almost always difficult toeradicate, and the prosthesis are also available like coral extracts, Teflon and others. But, there must be carefully selected to suit the individual patients.

REDUCTION RHINOPLASTY. For westerners, the nose can be over prominent in both in the bony and cartilaginous portion. There may also be an osvious nasal hump, unusually high nasal tip which does not conform to the surrounding anatomical structures. There will have to be reduced proportionately, so that the nose will blend with the surrounding facial features. Asians differ by having broad nostrils can be narrowed and the bulbous nasal tip reduced by removing the excess fibrofatty tissues. The low nostril contous can also be enhanced by re-arranging the cartilges.

CORRECTIVE RHINOPLASTY. Sometime the nose can be deformed due to either congenital mal developments or acquired through accidents or traumas. It can involve the nasal bone or cartilage or both. Correction of these deformities will depend on the existing conditions. For patients with cleft lips, the nasal deformities can be corrected by rearrangements of the deformed cartilages and reinforced by cartilage grafts taken from the nasal septum of the patients. For burn or tumour deformities, proper reconstructive procedures will have to be tailored to restore the soft tissues, as well as the framework of the nose. In a very severely deformed nose, sometimes external prosthesis may have to be considered if the reconstructive surgeries cannot restore the damaged nose to a reasonably acceptable condition.

CONCLUSION. Rhinoplasties can be complex surgical procedures which involve a good knowledge of the anatomy and functions of the nose. Good and versatile surgical skills, understanding of the soft tissues and appreciation of the aesthetics of the nose are also important. Complex surgical restorations after severe traumas or burn injuries may be time consuming, The primary and ideal objective is to correct the damaged nose to a state acceptable by both the patient and public.

In aesthetic rhinoplasty, it is vital for us to ensure that the patient is satisfied with the final results of the surgery. Therefore it is routine for the plastic surgeons to study the nose carefully, analyse the deficiencies and plan for the most appropriate surgery to enhance the nose. Any serious mistake may leave complications which may require much challenging efforts to rectify and often over a prolonged period. So please consult qualified plastic surgeons who are able to perform the best rhinoplasty procedure for you.

From: Healthy Times
APR-JUN 2011 ISSUE 46
www.healthytimes.com.sg