Rhinoplasty surgery is one of the most finessed and complicated of all cosmetic surgical procedures. A plastic surgeon typically will evolve and improve their rhinoplasty techniques throughout the course of their career.
Rhinoplasty is one of the most commonly performed aesthetic surgical procedures in the United States. In addition to providing cosmetic benefits, rhinoplasty can also improve nasal airway breathing, and in those cases, is viewed as a functional procedure.
In addition to addressing the functional components, which typically involves surgery on the septum and/or turbinates, there are a variety of ways to categorize rhinoplasties.
A full rhinoplasty typically involves working both on the nasal bridge (the dorsum) as well as on the tip of the nose. A tipplasty refers to surgery only on the tip of the nose. The term closed rhinoplasty refers to rhinoplasty procedures where there is no externally visible scar. This contrasts with open rhinoplasty, where there is an external scar.
Reduction rhinoplasty refers to a procedure in which the overall size of the nose is being reduced, whereas an augmentation (enhancement) rhinoplasty refers to a case in which either the patient’s own tissues or other materials, are added to the dorsum and/or tip of the nose.
Primary rhinoplasty refers to a first time rhinoplasty, while secondary rhinoplasty means that the patient has had a rhinoplasty performed earlier and is having a revision.
The most common form of rhinoplasty performed by our surgeon is a full reduction rhinoplasty. The patient that requires this type of rhinoplasty typically has some degree of bump on the bridge of his/her nose (plastic surgeons call this a dorsal hump!) and also wishes to have some degree of refinement of the tip of the nose.
This procedure involves shaving or rasping the bone and cartilage which make up the bump. After the hump has been reduced, the bridge of the nose appears widened. This is referred to by plastic surgeons as an open roof deformity. This temporary intra-operative deformity is eliminated by moving or fracturing the nasal bones, thereby closing the open roof deformity.
The tip of the nose is typically treated with a conservative removal of cartilage and/or internal suturing to improve its shape. If the base of the nasal tip appears wide, alar base resections may be performed to produce narrowing. A full rhinoplasty, as described above, is performed under general anesthesia and takes about 1.5 hours to complete.
In instances where a patient only desires or needs a refinement of the tip of the nose, a tipplasty is performed. Tipplasty may be performed either under local anesthesia, or with sedation anesthesia. As opposed to full rhinoplasty where the bone is moved (and therefore, a plastic splint is applied for several days), after tipplasty, no splint is needed and the tip area is taped for several days.
OPEN VERSUS CLOSED RHINOPLASTY
For the past 15-20 years, there has been a continuous discussion and debate among rhinoplasty surgeons regarding which technique is best. Open rhinoplasty, by including a small incision on the tip of the nose (on the columella), allows for the skin of the nasal tip to be raised up and retracted, thereby giving the surgeon full view of the nasal tip cartilages. This can allow for more precise suturing, grafting, and overall manipulation of the tip. However, the maneuver of “opening” the tip results in increased swelling and a prolonged period of healing, in addition to the fine, usually invisible, columellar scar.
In contrast to the above, healing is more rapid and tip swelling generally less pronounced following closed rhinoplasty. While some surgeons perform all of their rhinoplasties either open or closed, our surgeon individualizes his approach depending on the anatomy, complexity, and goals raised in each case.
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