On this page
- Functional Procedures
- Correcting a Deviated Septum
- Enlarged Turbinates
- Nasal Polyps
- Nasal Fractures
- Cosmetic Procedures
- Correcting the Radix
- Straightening a Crooked Nose
- Tip Rotation & Reduction
- Projection Adjustment
- Nasolabial Angle Adjustment
- Width Reduction
- Alar Adjustment
- Ethnic Rhinoplasty
- Creating a Conservative Transformation
Your nose is one of the most distinct features of your face, and its function is essential in your everyday life. When you are unhappy with the look of your nose, or have functional complications that make it difficult for you to breathe, it can compromise your quality of life. Rhinoplasty surgery can correct physiological complications that disrupt your ability to breathe properly. It can also refine the shape of your nose for enhanced aesthetics. There are several types of rhinoplasty designed to meet a range of needs.
Functional Rhinoplasty Procedures
Functional rhinoplasty can correct physical abnormalities that obstruct breathing, like those caused by congenital defects. They can also correct the effects of physical trauma. By reshaping and repositioning the cartilage and bones of the nose, your rhinoplasty surgeon can help you achieve nasal contours that allow you to breathe properly and feel confident in your appearance.
Rhinoplasty can be an "open" or "closed" procedure. Open rhinoplasty involves making incisions on the outside of the nose, while closed rhinoplasty only involves incisions within the nose. Whenever possible, surgeons will use a closed technique to avoid visible scarring, but open rhinoplasty may be necessary in cases of severe damage, or when the treatment area is located high in the nasal cavity. A skilled and qualified surgeon can create open surgery incisions within the contours of the nose to minimize visible scarring as much as possible.
Correcting a Deviated Septum
The septum separates the nasal cavity into two passageways that extend from the upper part of the nose, where it connects with the skull, down to the nostrils. The septum consists of several sections of cartilage and bone. Its lower portion rests upon the anterior nasal spine, a supportive bone that you can feel at the point where your nose and the area above your upper lip meet.
A septum becomes deviated when it develops or shifts to one side of the nasal cavity, rather than creating two equal passageways. When the septum bends to one side, it can create an S-shape, or bow out into a C-shape. Both types of deviated septum can block airflow and eventually damage the soft tissues in the nose.
Depending upon where it has deviated, the surgeon may need to reshape the bony upper portions of the septum near the top of the nose, or the cartilaginous lower portion. In some cases, the septum will actually move off of the anterior nasal spine in a condition called caudal septal deviation. In this case, the surgeon must correct the shift in the septum and realign its base upon the anterior nasal spine.
Rhinoplasty can also correct enlarged turbinates. These long, thin bones extend outward from either side of the septum within the nasal cavity, ending in small, curled, knob-like shapes. There are three sets of turbinates: superior turbinates, which are high within the nose between the eyes; middle turbinates, positioned in the middle of the nose; and inferior turbinates, which end just above the nostril line. Soft tissue covers the turbinates, humidifying air as you inhale.
Turbinate rhinoplasty can refine turbinates that have become swollen because of allergies or other irritants. In some cases, one turbinate becomes constricted because a deviated septum pushes it to one side. As a result, the turbinate in the opposite nasal passageway grows larger to compensate for the constricted turbinate, which further obstructs breathing.
Some surgeons correct enlarged turbinates by removing tissue and reducing their size. I personally do not remove any of this tissue. Instead, I fracture the turbinates outward. Turbinates humidify and warm air as it enters the nose, which is very important to breathing. In some cases, removing them can lead to a painful condition called atrophic rhinitis. This can result in chronic infection and excessive mucus production. By fracturing a portion of the turbinates outward (away from the septum) and setting them in place, I can create larger passageways, improve breathing, and sustain the benefits of functional turbinates.
Like enlarged turbinates, nasal polyps are often associated with allergies and irritation. These benign growths develop within the nasal passageways as soft, jelly-like bulbs. To remove them, the surgeon will reach within the nostrils using a snare instrument and carefully excise them. Unfortunately, nasal polyps are very likely to grow back, so patients with this condition should pursue allergy medication as well.
Different types of fractures require different types of osteotomy, the practice of rejoining and resetting bones
There are many types of nasal fractures. Without treatment, these fractures can cause obstructed breathing and result in a crooked or misshapen nose. Fractures can occur anywhere along the nasal "bony pyramid" - the pyramid-shaped bony structure of the nose that protrudes from the face. Different types of fractures require different types of osteotomy, the practice of rejoining and resetting bones:
- Greenstick fractures occur along the sides of the nasal bones. They occur most often in children, whose bones are still developing and are much more flexible. As a result, greenstick fractures are typically incomplete rather than fully broken bones.
- A more severe type of fracture causes saddle deformity. This condition causes the bridge and septum of the nose to break down and become depressed toward the face, creating a saddle-like shape visible when viewing the face in profile. It can result from severe facial trauma or from cartilage breakdown caused by snorting drugs like cocaine. In these fracture cases, the surgeon will use donor rib bone tissue or cartilage to rebuild the bridge and septum.
- A comminuted fracture occurs when a bone has broken into more than two pieces. To repair a comminuted fracture, a surgeon will realign the bones and remove any excess bone shards that could otherwise cause serious damage. This type of fracture is most common after severe physical trauma, and in elderly patients with brittle bones.
- In some cases, severe trauma can cause damage to the bones behind the nose, called maxillae. The maxillae are two bones that form the upper jaw and palate, and support nasal structures. These are known as Le Fort fractures, and they are classified into three types.
Le Fort I fractures occur horizontally, damaging the jaw above the teeth and across the nostril line. Le Fort II fractures damage the maxillae beneath the eye sockets around the nasal bridge. A Le Fort II fracture breaks bones in a pyramid shape, extending in an upside-down V shape from the bridge of the nose to the corners of your mouth. Le Fort III fractures extend across the orbital sockets, which are the bones that surround your eyes.
Le Fort fractures are very serious. They can cause permanent damage to the brain and palate, and require immediate attention. A plastic surgeon may be able to treat these types of fractures while performing a rhinoplasty, but may choose to work in conjunction with a specialist.
Cosmetic Rhinoplasty Procedures
When it comes to cosmetic rhinoplasty, the ultimate goal is to enhance the appearance of your nose and provide a flattering complement to your unique facial structure
When it comes to cosmetic rhinoplasty, the ultimate goal is to enhance the appearance of your nose and provide a flattering complement to your unique facial structure. Cosmetic rhinoplasty combines different techniques to meet your specific goals.
When a surgeon evaluates the nose, he or she will take note of imperfections in the three different vaults: the upper vault (also known as the bony vault), the middle vault, and the lower vault. In order to maintain proper proportions in your final results, treatments can involve adjustments to more than one vault, even if you only notice imperfections in one area. There are several common techniques plastic surgeons use to help patients achieve their desired nose size and shape.
Correcting the Radix
The radix is the upper bony portion of the nose. The radix and underlying cartilage may be large, causing a bump. If the radix is shallow, it can cause a depression and a bump. Your surgeon can reduce the radix by carefully shaving away small portions. The surgeon might add volume to a depressed area using a portion of the patient's own cartilage harvested from elsewhere in the nose. By augmenting the space just above the radix, a surgeon can create a straighter slope.
Straightening a Crooked Nose
If the nose is slightly crooked or shifted to one side, a surgeon can straighten it by reducing some bone or cartilage, or by physically shifting the tissues. As with a broken nose in need of functional rhinoplasty, your surgeon may apply a splint to hold the nose in place while it heals.
Tip Rotation and Reduction
If the tip of the nose lacks definition or is overly defined, it may lack proper rotation. Rotation refers to the upward or downward turn of the tip of the nose. When adjusting the tip of the nose by reshaping cartilage, the surgeon will also pay close attention to the base of the nose, as it affects the tension and rotation.
Olga is a patient of mine who was specifically unhappy with the tip of her nose. She felt that it was "too bulbous," so we were able to reduce the tip and slightly adjust its rotation. As a working actress, Olga felt it was especially important to feel confident in the appearance of her facial features.
"I would tell other patients that if you are 100 percent sure that a rhinoplasty is what you want, find a qualified surgeon who can help you," Olga said. "I had never really liked my nose, and eventually, I decided it was time to go ahead and change it."
Olga feels that the change in her nose is subtle, but she is still able to notice a difference and is pleased with her results.
"I think I'm happier now," she said. "I did something I have wanted to do for a while. It's not really about my appearance. It's more about how I present myself."
The projection of the nose is the distance that it extends outward from where it meets the upper lip to its tip. If this tip projects too far, it can greatly affect the overall look of the nose. Under-projected noses, on the other hand, can look too shallow and may result in a nose that looks too small in proportion with the other facial features.
To reduce the projection of the nose, a surgeon can trim a portion of the cartilage at its tip. To increase projection, the surgeon may separate and realign your cartilage, pushing it forward and suturing it into a refined position. If there is not enough cartilage in the tip of the nose, the surgeon might use a cartilage graft to supplement it.
Nasolabial Angle Adjustment
If you look at your profile, the nasolabial angle consists of two lines: the line from the tip of the nose to the area above the upper lip, and the line from the upper lip to the bottom of the nose, where the nostrils are separated. The projection of the nose and the rotation of its tip affect the degree of this angle. In most cases, the surgeon will seek to create a 90- to 95-degree nasolabial angle in male patients, and a 100- to 105-degree angle in female patients. A combination of projection and rotation adjustment techniques can refine this angle.
Viewing the nose from beneath, the nostrils and the tip of the nose form a triangle called the pyriform aperture. To reduce the width of the tip of the nose, a surgeon will adjust the pyriform aperture. By making the angles of this triangle steeper at the point where the nostrils meet the face, a surgeon can reduce the width of the nose.
Alar adjustment is a surgical technique that reduces wide or flared nostrils. The ala are the outer edges of the nostrils. Alar adjustment is commonly performed in conjunction with width reduction. By removing a portion of tissue, your surgeon can change the level of tension that is creating excessive flair in the nostrils. The Weir technique is a special type of Alar adjustment involving a specific type of incision. The surgeon tissues to create a wedge-shaped void, and closes it with sutures to create the desired contours.
Each race has unique aesthetic characteristics. While not every member of a specific race shares these characteristics, those that do sometimes elect to undergo plastic surgery to change them. Rhinoplasty is a popular treatment among those whose ethnic characteristics include a broad nose. Many patients of African and Asian descent consider cosmetic rhinoplasty to reduce the width from one edge of their nostrils to the other. It is very important that your surgeon modulates his or her approach to the individual anatomic components of your nose. Your surgeon should not change your nose beyond a point that would drastically change your appearance.
Creating a Conservative Transformation
It is extremely important that your surgeon designs a conservative surgical plan. Plastic surgery should never change the characteristics that make a person unique. Instead, it should enhance a patient's natural beauty.
One of my patients, Isabelle, is of Cuban descent. She wanted to achieve some refinements to the shape of her nose, but she did not want to lose her unique appearance.
"I had some friends who were worried that my face would be changed," Isabelle said. "It isn't. I'm proud that it doesn't look like I had work done. What I liked about Dr. Keyes was that he was able to make subtle changes. He was able to keep my ethnic characteristics."
The best way to achieve long-term satisfaction through rhinoplasty is to find a surgeon who is willing to pursue your goals with the most conservative approach possible
Meanwhile, too much work can cause a breakdown in tissues. You may remember the deflated and tissuey appearance of Michael Jackson's nose toward the end of his life. Because he had undergone so many rhinoplasty surgeries, the cartilage that supported his nose eventually deteriorated, causing it to collapse inward. The best way to achieve long-term satisfaction through rhinoplasty is to find a surgeon who is willing to pursue your goals with the most conservative approach possible.
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