Rhinoplasty is the generic term for an operation which changes the shape of the nose.
The human nose is comprised of an underlying structure of bone and cartilage overlaid with skin and soft tissue. In the vast majority of aesthetic rhinoplasty procedures the underlying bony / cartilaginous framework is altered while the skin itself remains unchanged as it tends to conform to the remodelled underlying framework.
The most common reason for undertaking aesthetic or cosmetic rhinoplasty is to make a nose look smaller. This usually involves reducing the bridge (or dorsum) of the nose which may be humped or adjusting the extent to which the tip of the nose projects from the face.
However, there are many other aspects to rhinoplasty and cosmetic adjustment such as changing the angulations of the nose, the shape of the nasal tip, the shape of the nostrils, the width of the nose and the straightness or symmetry of the nose.
Types of Rhinoplasty
While the basic principle of rhinoplasty may seems straight-forward there are, in fact, several different approaches available to the surgeon.
Open and Closed Approach Rhinoplasty
An open approach rhinoplasty is when an incision is made across the skin of the columella (the skin between the nostrils at the base of the nose) after which further incisions become internalised. However, in the majority of cases, a closed approach is appropriate – this is when all incisions are made inside the nose.
The open approach allows the surgeon to lift the skin off the nasal tip cartridges and bones to see the area in detail. Jarrod Homer uses the open approach when there are issues to address with the intrinsic features of the nasal tip (using sutures, removing cartridge and/or grafting), if a graft is required to strengthen the nose, to help straighten the nose or increase tip projection and for more complex revision surgery required following a previous rhinoplasty.
Of all the rhinoplasties Jarrod performs, approximately 80% are closed and 20% open.
The open approach does, of course, leave a scar, but in the vast majority of cases this is almost invisible and rarely the source of concern. With an open approach there tends to be more swelling in the first 2-3 post-operative weeks compared to closed approach. There can also be more tip ‘numbness’ and a feeling of tip ‘rigidity’, but these do resolve with time.
Jarrod uses a closed approach whenever possible as the open approach leads to greater destabilisation of the nasal tip cartilages which in turn leads to more variance in outcome and potential complications. For this reason, very careful consideration is given before undertaking an open approach to ensure the additional benefits clearly outweigh the additional risks.
Jarrod’s personal view is that younger, less experienced rhinoplasty surgeons perform too many rhinoplasties via an open approach.
A Septorhinoplasty is a rhinoplasty that involves the straightening of the nasal septum – the cartilage and bone that separates the two sides of the inside of the nose and forms the bridge in the mid-third of the nose.
This approach may be necessary to overcome nasal obstruction and/or cosmesis – a twisted nose. Straightening a twisted nose can be challenging, especially if the twist is in the mid third of the nose, and sometimes grafts made of cartilage from the nose are necessary.
Grafts and Reconstruction
Some forms of rhinoplasty involve strengthening the support of the nose, for example, when the nasal tip or supratip structures have collapsed due to previous surgery or trauma – or when a twisted cartilage that is twisting the nose requires correction.
When rhinoplasty requires the use of additional cartilage or other materials, there are choices regarding the source of the graft but most often, the nasal septal cartilage from inside the nose is used. If a curved piece of cartilage is required for the nasal tip, the bowl-like cartilage from the external ear can be used or, in much rarer cases, cartilage from the rib can be used.
Other materials used for grafts and reconstruction include eradiated cartilage from a human cadaver or pig-derived products which can all act as a scaffold for natural tissue to grow into.