Cosmetic Nose Surgery
The nose must be able to breathe well, and must look good too.
The nasal pyramid is the most prominent part of the face. Plastic surgeons must have a thorough understanding of its function and must be able to examine it from both an aesthetic and a functional perspective. We must know how to perform a septoplasty of the cartilage and of the bone as well if necessary, and we must know how to treat the turbinates.
First we carry out a functional and aesthetic examination and prepare the protocol.
If the rhinoplasty is secondary and complex, we use an open approach to correct the problem. In the case of a nose with a wide perforation of the septum we perform open rhinoplasty and insert an oral mucosa perforator flap. We also useopen rhinoplasty in the case of cleft lip, if the nose is very crooked, or if the tip is deflected.
We avoid the use of a surgical chisel to remove nasal humps, because the upward and downward movement may leave the nose slide-shaped.
if we need good vision to operate, we have to detach the skin and then lift it with a separator. When it heals, the skin looks shiny and tight. These two features – the slide-shape and shiny skin – are tell-tale signs of nose surgery.
If the rhinoplasty requires only moderate remodeling of the nasal hump and tip, we have developed a highly atraumatic endoscopic technique that obtains very good results. The objective of this technique is to correct defects in shape, while either improving or preserving the function and avoiding any signs of the operation.
It is most important to avoid scars - both external scars in the columella and internal scars caused by excessive detachment of the skin. We agree that a good view is essential, and for this reason we use endoscopy in conservative rhinoplasty procedures. We use a 2-mm endoscope, which provides an excellent enlarged view, and the skin detachment is minimal.
Conservative endoscopy-assisted rhinoplasty represents a major step forward in nasal pyramid surgery. In this technique the dorsum is removed using a 2 mm rasp (or file), which is introduced through one of the nostrils. Through the other nostril we introduce the endoscope to obtain good vision and without detaching much of the skin. The result is an attractive nose that does not look operated.