There are two main surgical techniques for rhinoplasty: the open technique and the closed technique. The majority of cosmetic surgeons in the US use the open technique, which I also prefer. The open technique affords a wide range of visibility of the nose’s anatomy and allows the surgeon many procedural options for alteration. Rhinoplasty does not have a set series of steps; it is different for each patient. Depending on the patient’s anatomy and goals for the procedure, this is how a rhinoplasty shapes up for me:
- The open technique begins with a small skin incision in the columella (the tissue between the nostrils), followed by additional incisions hidden inside the nose. Using these incisions, I lift the skin off of the nasal cartilages for increased exposure of the internal nasal anatomy.
- After the skin is opened, I direct my attention to the septum, which I treat through the same approach. I generally straighten the septum and remove some cartilage that I later use to graft various areas of the nose. I take care to leave adequate septal cartilage for nasal support and strength.
- Once the septum is completed, I will trim some of the lower cartilages of the nose that make up the nostril rims. Trimming this cartilage allows narrowing and shaping of the nasal tip.
- At this time, I address the bridge of the nose. Oftentimes patients desire a hump reduction. If a large hump is removed, we insert spreader grafts (pieces of cartilage harvested from the septum) to open the internal nasal airway. This also helps contour the nasal bridge by producing a smooth continuous contour, and it improves symmetry in some cases.
- Next, I generally shape the lower nasal cartilages. I employ a variety of suture techniques to narrow, lift, project or otherwise address what is needed for that particular case. During this time, I use some of the remaining cartilage from the septum to control the position of the nasal tip by securing it in place.
- After tip is complete, I narrow the bony framework of the nose with osteotomy bone cuts that I perform with a small chisel. This lets me narrow and shape the bony portions of the nose. Many cases require reduction of the turbinates (the internal bone and soft tissues of the nose) using several different techniques. This helps to open the airway.
- I close the wounds with removable stitches in the columella and dissolving stitches on the interior. I use splints internally to secure the septum—and externally to hold the nasal bones in place.
After the Surgery
Rhinoplasty is done on an outpatient basis, unless additional procedures are necessary or the patient’s medical condition requires additional overnight monitoring. Patients can expect swelling, drainage of blood and mucus, and sometimes black and blue discoloration of the eyelids. One week post-surgery, I see the patient for suture and splint removal. The technique I use depends on the patient’s anatomy, the specifics of their how their procedure was performed, and their desires.
Rhinoplasty is a truly custom surgery with no two cases exactly alike. If you are considering modifying the appearance of your nose, I encourage you to schedule a consultation to assess your options.
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