Nose Surgery (Rhinoplasty)
Overview | FAQ | Photo Gallery
- How does rhinoplasty effect breathing?
- Does nasal surgery (rhinoplasty) last forever?
- Does nasal surgery require internal splints?
- How can the results of nasal surgery (rhinoplasty) be assessed?
- What is the desired look for the nasal tip?
- Can nasal surgery worsen breathing ability?
- What happened to Michael Jackson’s nose?
- Why are revision rhinoplasties so common?
- Why do some rhinoplasties cause the nose to look like a pig nose?
- Who do some women end up with sky slope noses?
- Is there a minimum age when nasal surgery (rhinoplasty) can be performed?
- Why do some postoperative noses droop following nasal surgery?
How does rhinoplasty affect breathing?
Nasal surgery involves alteration of the underlying infrastructure, which not only affects the external contour aesthetics but also the internal airway functionality. The internal infrastructure directly affects the internal airway opening diameter and thus airflow. The internal nares can be thought of as two tubes that allow air to flow in and out. When the internal nares, which act like tubes, are well supported and smooth then the airflows in without turbulence. However, when the nose is crooked, twisted, collapsed, overly long, then airflow is compromised by turbulence. Air turbulence further irritates the nasal lining (mucosa) further inflaming the walls and decreasing the tube diameter. As a result, even when patients seek only improvement of the external nasal contour, they often remark on improvement of their breathing.
Does nasal surgery (rhinoplasty) last forever?
Nasal surgery performed to correct the external contour aesthetics involves correction of the underlying infrastructure. The underlying structures are compromised of nasal bones over the upper 1/3rd and cartilaginous structures over the lower 2/3rd. Whereas alteration of the nasal bones which are rigid is stable, alteration of cartilage components is considered more malleable. Cartilagenous structures are not only pliable and less rigid but they also maintain “memory” of their prior shape. As a result when changes in cartilaginous structures are performed, several steps are taken to reinforce these structural changes. Changes in cartilage shape are secured by utilizing techniques to weaken unwanted shapes (by scorring the cartilage) and by reinforcing new desired shapes (with suture fixation). Regardless, when a crooked nose is fixed and aligned, there is a risk that the aligned nose may minimally deviate to its prior shape. In addition, long-term changes in the nose are possible over decades as the nose is one of the body organs that continue to grow with age.
Does nasal surgery require internal splints?
Although internal splints were a mainstay of nasal surgery in the past, today internal splints are no longer routinely utilized. In contrast, external splints are routinely utilized to maintain the contour changes completed during surgery until the nasal bones set and fuse in their new position. Internal splints have been associated with a more difficult postoperative recovery by inhibiting breathing ability and are also associated with external distraction (lateralization) of the nasal bones negating attempts to narrow the nasal base. Internal splints are only used to ensure straight alignment of the nose following correction of a complicated crooked or twisted nose as these noses have a tendency to return to their preoperative shape due to cartilage “memory”.
How can the results of nasal surgery (rhinoplasty) be assessed?
Standardized photographs are typically obtained to assess the effects of nasal surgery (rhinoplasty). Typical views include an AP (anteroposterior- straight ahead view), 2 lateral profile views, 2 oblique profile views, bird’s eye view (taken from the top down), and worm’s eye view (taken from the bottom up). Viewing the pre and postoperative set of these views can assess nasal contour improvements.
What is the desired look for the nasal tip?
Nasal tip shape alterations are indicated to provide “highlights” to the nasal tip, which involve decreasing tip fullness and/or improving ill-defined tip features associated with obtuse shaped underlying cartilages. Tip defining points represent shine spots at the most projected aspect of the tip which are created by the shadowing/ effects created by outside lighting. Tip defining points are considered aesthetically pleasing when spanning a distance of 4 to 6 mm depending on the over all size of the nose and gender of the patient.
Can nasal surgery worsen breathing ability?
Functional breathing compromise can occur if the patient develops collapsing of underlying infrastructure. This complication follows excessive reduction of the tip and bottom 1/3rd cartilage support. Another cause of breathing compromise is due to collapse of the middle 1/3rd cartilage structural elements. Preoperative analysis of this region can warn the surgeon against this complication. Propensity for this complication can be detected by performing the Cottle test maneuver, which results in improved breathing capacity when the medial cheeks are pulled outward.
What happened to Michael Jackson’s nose?
Whenever surgery is performed on the skin and underlying tissues such as in the nose, the tissues become slightly thinner in thickness. This thinning effect gets compounded when multiple surgeries are performed in the same area. The skin thins out, and pretty soon, you literally see the underlying cartilage sticking out. That’s what went wrong with Michael Jackson. The lesson learned is that you want to get it right the first time.
Why are revision rhinoplasties so common?
The nose is very complex in its structure and dynamics so that the nose can change over time if not adequately supported. The supporting structural elements must be reinforced during nasal surgeries – especially during open rhinoplasty. “Open Rhinoplasty” is a surgery which involves elevating the entire nasal skin in order to expose all of the infrastructural support elements. This procedure requires further reinforcement of underlying support elements. In contrast, “Closed Rhinoplasty” involves minimal dissection and exposure of underlying structure, and as such, less supportive reinforcing measures. Surgeons who were trained only to perform closed rhinoplasties, and who are now performing open rhinoplasties, tend to make this mistake.
Why do some rhinoplasties cause the nose to look like a pig nose?
The relationship of the nose to the upper lip is critical. The angle created by the upper lip to the nose (the nasolabial angle) has been studied and should be set at 95 degrees in men and 105 degrees in women. When this angle is judged inappropriately and set at greater than 105 degrees (more obtuse) then the pig nose results.
Who do some women end up with sky slope noses?
The top of the nose (nasal dorsum) should be set at 1 to 2 mm below the tip of the nose. In men the top of the nose should be straight but in women there may be a slight slope (concavity). However, inexperienced surgeons may inappropriately exaggerate this slope thus giving their patients an undesired “sky slope” look.
Is there a minimum age when nasal surgery (rhinoplasty) can be performed?
Rhinoplasty should not be considered for patients until they become adults (age 18 and older). This is because patients have to demonstrate the physical maturity required with changing the appearance of such a vital facial structure located at the center of their face. Perception of beauty and the capacity to cope with ensuing results is not a trivial matter!
Why do some postoperative noses droop following nasal surgery?
The problem of the droopy postoperative nose is unfortunately all too common. The nasal tip is relatively heavy when compared to the other parts of the nose. Thus, when changing the structural elements in an attempt to alter the shape of the nose, the surgeon must be careful to not compromise the structural stability of the nose. This concept is most important following open rhinoplasty surgery where several measures must be taken to reinforce the nasal tip structural elements. Surgeons trained in only closed rhinoplasty and who are not accustomed to open rhinoplasty principles are most likely to achieve this complication.
