INTRODUCTION:

changed with the times. In the sixties, people often wanted a "ski slope" nose with a scooped out look and a very thin tip. Today, people seek out surgeons that can create a nose that looks natural and does not stand out. In fact, an ideal nose should blend with the face and " bring out " the eyes.

IS RHINOPLASTY SURGERY FOR YOU?

The ideal candidate for rhinoplasty is any person who is not content with their nose and would like to have it improved. Of course, the person should be in a state of good health and able to go through the surgery. There is no ideal age for rhinoplasty, as patients from ages sixteen and older can undergo the surgery.

The consultation process begins with a discussion with the patient about specific issues and concerns regarding nasal aesthetics. Any functional problems should be discussed at this time. For example, whether there is any nasal obstruction, allergic nasal symptoms, or sinusitis. Theses may require further work up. It might be possible to address these issues at the same time as the cosmetic rhinoplasty is performed.

The pre-operative pictures are then taken. These can then be reviewed by the surgeon and the patient. This is another opportunity to discuss particular concerns regarding the aesthetic goals. Some surgeon use computers to "image " the nose in order to simulate what the post-operative result will look like. This modality is helpful at times for patient education and for communication between the patient and surgeon. It is important for the surgeon to fully understands what the patient expects out of his/her rhinoplasty surgery, and just as important for the patient to fully understand the limitations of the operation.

UNDERSTANDING THE SURGERY:

The rhinoplasty operation can be performed with either local anesthesia, sedation or general anesthesia. The decision should be determined together with the surgeon, the patient, and the anesthesiologist. All aspirin and aspirin-like products should be stopped two weeks before surgery, to help reduced the risk of bleeding and bruising.

The rhinoplasty operation can be performed with either of two approaches. They are called approaches because they are simply a method the surgeon can use to assess the areas of the nose that need to be altered. They are not techniques. Techniques are what the surgeon uses to change or alter the specific anatomic areas of the nose. These two approaches are the external approach and the endonasal approach. The external approach involves an incision in the columella, or the area under the tip of the nose. The endonasal approach involves a series of incisions inside the nose. One approach is not better than the other. Results depend on the surgeon, his technique, and the way the particular patient heals after surgery.

Occasionally, grafts may be required to achieve the desired result. Grafts are structural elements, typically made from cartilage. For example, they can be used to define a tip or to fill in depressions. They can easily be acquired from the cartilage in the septum. If the patient has had a previous septoplasty or has had a previous rhinoplasty, the cartilage grafts may need to be taken from the ear or the rib. The rib can be also used to harvest bone, which is rarely needed in cosmetic rhinoplasty but sometimes is utilized for reconstruction of congenital and acquired nasal deformities.

In the past, the nasal tip was usually sculpted by cutting the nasal tip cartilages. However, experience has taught rhinoplasty surgeons that simply cutting away the nasal tip cartilages can lead to functional and aesthetic complications. For example, the weakness caused by the absence of cartilage can lead to severe nasal obstruction as well as pointy "pinched-looking" nasal tips. Rhinoplasty surgeons today use small sutures to change the shape of the cartilages, instead of cutting them. This not only allows the preservation of nasal function, but also allows better accuracy when shaping the cartilages.

If work needs to be done on the nasal bones, for example to narrow the width of the nose, an osteotomy of cut in the bone is performed. These are done with small metal chisels (osteotomes) which can be placed in position through incisions inside the nose, in the mouth, or sometimes in the skin just above the nasal bones. These incisions are very small and leave imperceptible scars.

If the width of the nose is excessive, sometimes a small amount of the tissue is removed from the base of the nose in order to narrow the dimension at this point. Although this can result in small scars, they are usually very well concealed.

Like every surgical procedure, there are some possible complications that can follow the rhinoplasty operation. Bleeding after the surgery is rare, but it occurs, it can be controlled with measures such as cauterization or packing. The risk of post-operative bleeding is about 1%. There is also the risk of infection, which extremely rare, occurring less than 1% of the time. This risk is increased if the surgeon is using implants made of synthetic materials. The remainder of the complications can be divided into functional and aesthetic. Possible functional complications include nasal obstruction from over-aggressive removal of tip cartilages, an incorrectly performed septoplasty, or scar tissue in the nasal cavity. Aesthetic complications can vary a great amount. Aesthetic complications are often the result of either not correctly diagnosing the problem before the surgery, poor technique, or poor healing post-operatively. These can range from slight irregularities of the nasal bones, dorsum or tip to severe irregularities requiring revision rhinoplasty.

WHAT TO EXPECT AFTER THE SURGERY: