Cosmetic Surgery
PROCEDURES TO REFINE THE SHAPE OF THE NOSE
Cosmetic nasal surgery – a ‘nose job’ or plastic surgery of the nose – covers procedures to refine the shape of the nose, or eliminate disturbing defects. Removing a hump is one example. Raising the bridge to offset a ‘saddle depression’ is another. We do a tip rotation – sometimes combined with a ‘tip projection’ procedure – to correct a bulbous or drooping nose (‘Polly beak’). Surgeons can reduce large or flared nostrils. It depends on what our patients require to achieve a pleasing result.
CLOSED APPROACH
Whether we use the ‘open’ or ‘closed approach to surgery depends on the complexity of the proposed procedure. The ‘closed’ approach is intra-nostril surgery. The surgeon works through the nostrils (slightly distended for surgery). ’Closed’ surgery is generally quicker and less costly, and the preferred way for ‘virgin’ (first surgery) noses.
OPEN APPROACH
We use the ‘open’ approach for more complex procedures. The surgeon makes a tiny incision at the base of the columella (the pillar between the nostrils). This allows the surgeon to partially raise the skin/tissue to expose the underlying anatomy of the adjoining nostrils, and tissue cartilage on either side of the nose. The open approach gives the surgeon a clear and unfettered view of the anatomy.
HUMP REMOVALS
Rhinoplasty nose hump removal – trimming the dorsum (bridge) to remove or reduce a hump – is a common, and popular procedure. It’s usually done through the nostrils (‘closed approach’), and in its simplest form, it’s a routine procedure.
Trimming a severe hump can restrict breathing by narrowing the nasal passage in the ‘mid-vault’ of the nose (located under the hump in the mid section of the nose). Traditional prevention entails shaping a spreader graft from septal cartilage harvested from the septum (the dividing wall of the nose), and then, to maintain the width of the air channels, inserting it like a spacer into the apex of the nasal passage. Our simplified technique evolved from work done by Dr Pieter Swanepoel early in 2006, when he devised a spreader graft from the naturally occurring upper lateral cartilages on either side of the patient’s dorsum. Because the upper lateral cartilages lie adjacent the apex of the nasal passage where the surgeon would normally insert the spreader graft, it is a near perfect solution.
Where a drooping nose tip creates the perception of a hump, we dispense with the usual hump removal procedure. We perform a simple ‘tip projection and rotation.’ This lifts the tip of the nose into a natural alignment with the dorsum (bridge) and the chin.
MENTOPLASTY
If a receding chin weakens the profile, we perform mentoplasty. The surgeon, on completing the nose refinement, inserts a pre-molded soft silicone implant into the chin through a small incision on the inside of the mouth. The improvement to the profile is immediate and pleasing.
AUGMENTATION SURGERY
Surgery associated with ‘saddle depressions’ and snub noses. Done to raise the bridge of the nose to create a more pleasing and pronounced profile. At the Nose Clinic, we use a laminated ‘beam’ graft made from lyophilized (freeze dried) donor cartilage to raise the bridge.
REVISION SURGERY
Surgery to improve a disappointing result. Many of our patients approach us for revision surgery following surgery elsewhere by other surgeons.
CONGENITAL TIP FORMATION
Surgery to refine a structural deformation at the tip of the nose present from birth.
COMBINED SURGERY
A procedure that combines a cosmetic refinement and a functional procedure (to improve breathing) into a single operation. Traditionally two surgeons preside over this dual procedure. An ENT specialist, repairs the air channels, a cosmetic surgeon, usually a general cosmetic surgeon, shapes the nose. They work as a team. Besides being more expensive, it introduces a dilemma. Who takes ultimate responsibility for a disappointing result? At the Nose Clinic one surgeon presides over a single, combined operation.
LOCAL ANESTHESIA
For all surgery at the Nose Clinic, we use intra-venous target-controlled conscious sedation, and sensory nerve block anesthesia for surgery; not general anesthesia. We can then discharge our patients after surgery to recover at home. This hastens recovery.
CAUTION: THICK, OILY SKIN
In usual cases of cosmetic surgery, the skin over the nose will drape, settle, or mould itself neatly over the revised shape and structure of the nose to display, or show off the flattering results of surgery. This is the goal of undergoing nose surgery.
Thick, sebaceous (oily) skin textures, on the other hand, especially around the tip of the nose usually indicate that a patient should not undergo cosmetic rhinoplasty.
Just as a heavy blanket draped over your shoulders would conceal the outline of your body, a thick skin would hide the very changes you would want to display to the world. The disappointment would not warrant the cost of surgery. Confronted with such a possibility, we usually decline to operate.
For information on the ‘Ideal Nose‘ click here. For ‘Functional Surgery‘ click here.
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