A significant proportion of patients seeking rhinoplasty surgery are concerned that the sheer size of their nose is disproportionate with their facial features. Areas of particular concern are the presence of a bump on the bridge of the nose, excessive width of the bridge tip of the nose, and possibly excessive width of the nostrils.
Part of the consultation process is to help determine which features contribute more significantly to this impression, and therefore which should be addressed as a priority.
Using computer simulation in the process of assessment, makes it easier to appreciate the degree of change required in order to achieve balance, but also the characteristics of the nose shape that fits nicer with the rest of the features.
The bump on the bridge of the nose is primarily made of cartilage (lower two thirds) and only the top third is due to the nasal bones. Reducing the bump can target either a straight profile, a slightly concave one or in some instances a slightly convex one, but not as prominent.
Reduction in the tip of the nose requires a more complex combination of lowering the cartilages (that decrease projection) and reshaping that allows for a narrower, more and delegate or more defined to contour.
In order to achieve more significant correction and control for the shape of the tip of the nose, it is often necessary to use an open tip approach during the rhinoplasty, and combine it with some thinning of the skin of the tip and supra-tip (area just above the tip).
When the nostrils are relatively wide, an alar base reduction is the procedure capable to achieve and narrowing effect, and involves removing a wedge of tissue in the area where the nostrils meets the cheek. Inevitably this leads to a fine scar to the area.
One of the main conflicts in achieving satisfactory results with reduction rhinoplasty is related to the combination of reduction in the tip projection and narrowing of the tip the context of relatively thick nasal tip skin.
Augmentation rhinoplasty refers to the type of surgery where the dimensions of the nose are increased.
This may well be the case in congenital underdevelopment of the nose, after injuries were the support cartilage has been damaged, after surgery which has led to loss of support, or when too much tissue has been removed.
n general terms, the proportions of the nose compared to the rest of the facial features are subject to significant personal interpretation, although a number of measurements have been designed to define balance and beauty. The primary elements to be assessed are the height of the bridge, the projection of the tip and whether there is an element of lengthening of the nose (correction of a tip that has become too upturned).
Depending on whether there is enough cartilage still inside the nose – in the nasal septum -to operate the changes, or whether there is no more source for cartilage graft within the nose, it may be necessary to resort to other sources for building up the nose. The options include using bone, cartilage from the rib, using your cartilage, or implantable materials which can be either artificial or biological.
In essence, all rhinoplasties are ethnic rhinoplasties, because they take in consideration ethnic characteristics of the nasal shape, skin and facial proportions.
The term has been associated however more with rhinoplasty for population groups with softer nasal contours, like the Afro-Caribbean, the Far Eastern or Pacific Rim populations. Specific features for this nasal shape include often a lower and wider bridge of the nose, wider nasal tip and nostrils (alar base), relatively soft support to the tip of the nose and thicker nasal tip and nostrils skin. Characteristically, for patients that want just a degree of narrowing of the nostrils, an alar base reduction can achieve a satisfactory correction.
Injuries to the nose, frequently lead to damage to the bone and cartilage support, and change the appearance of the nose, resulting in deviations, asymmetries and sometimes airway problems.
Deviations of the bones and cartilages of the nose, can be reset with relatively good success rate within the first week to 10 days after the injury.
The main worry is that injury to the nose can generate bleeding on both sides of the nasal septum, and the blood clots that accumulate around the cartilage deprive it from blood supply and the cartilage then dies. This situation referred to as septal hematoma, can be treated as an emergency, and when the haematoma is evacuated promptly after injury, the cartilage in the septum is protected.
Loss of the cartilage support from the septum under the bridge of the nose, creates the saddle nose deformity or boxer nose deformity.
Dr. Robert Vitolo and his team offer experienced and skilled rhinoplasty to residents and visitors in the areas in and around New York City, Brooklyn, Queens, Staten Island and New Jersey.
By focusing on the needs of each client, Dr. Vitolo provides personalized care using the latest technology to improve the experience and leave every patient feeling confident and satisfied. For more information, or to schedule a patient consultation, call 800.332.1067 to speak with our friendly expert staff.