The history of nasal surgery, often referred to as “rhinoplasty”, goes back to India. Generally, this process includes the changes of skin structure, bone, cartilage, and nasal passages by surgery. Modern rhinoplasty refers to the application of the techniques that have been used in recent decades helping to improve the results of nasal surgery.
Over the past few decades, the techniques used in nasal surgery have been changed dramatically and this has helped the result of rhinoplasty to be more natural and normal. In a period of time, the purpose of rhinoplasty was to miniaturize the nose. The people choosing this type of rhinoplasty usually had a nasal hump which could be corrected by surgery.
In the overaggressive methods, the nasal hump is removed and its place is concave. Under this condition, the patient leaves the surgery room with a saddle and mostly pointed nose. During this defective surgery, nasal bridge is narrowed more than enough and does not fit with the other facial features. Moreover, nostrils are shrunk and patient’s nose looks like ski jumping platform which is completely abnormal. This form of nose does not fit with many faces.
Less changes, more favorable results
The newly developed techniques for modern nasal surgeries bring more natural results to the nose. Dr. Andres Bustillo in his page has declared that “I work conservatively. Less is more in plastic surgery”. Less changes result in better outcome.
Imagine that the nose is a structure separate from the body; although it may be completely big for the face, it does not have big mass in compare with other organs.
At the moment, the techniques for the changes such as nasal shrinking, removing the nasal hump, modifying the nasal tip, reforming the nostrils have been improved. Along with the emersion of conservative techniques in the modern rhinoplasty, the results have become more natural and more durable. Nowadays, the surgeons do not consider the nose as a separate organ anymore; rather, they compare the nose with the other facial features surrounding the nose and apply the unique sizes to make sure that facial harmony is drawn scientifically and also is attractive.
New solutions for normalizing nose appearance in reconstructive surgery
While the artificial material were used for the nasal implant in the past, biologic material of patient’s body (e.g. cartilages in the patient’s body) can be used within modern methods to fill the parts getting empty during the surgery.
The role of modern rhinoplasty techniques in reconstructive surgery
Reconstructive surgery does not focus on gaining a pretty nose. However, it also considers enhancing the nasal efficiency. Most of the rhinoplasty candidates have the respiratory problems or their nose may be droopy after the primary surgery.
In reconstructive surgery, there is a high probability that both aspects of nasal cosmetic and efficiency need to be addressed. The surgeon should choose the techniques and tools applied in the modern rhinoplasty with regard to the current situation in order to achieve the best results.
The patients, who have done the rhinoplasty and are not satisfied with their new nose, need more time and attention. In most cases, undesirable outcomes can be modifies with reoperation. Currently, the secondary and tertiary surgeries are common, especially when there is an unintentional mistake in the previous operation or the surgeon is not very skillful in the modern rhinoplasty techniques. The secondary or reconstructive surgery usually would be more complicated than the primary surgery and needs more accurate plan for supporting all nasal parts. The most common problem in the reconstructive surgery is overaggressive surgery. It means that a lot of cartilage and bone have been removed from the patient’s nose during the previous surgery and it needs for cartilage, rib or other parts’ transplant.
Attitude of 21st century toward the rhinoplasty: linking the beauty and effectiveness
According to the Academy of Plastic Facial Surgery and Reconstructive Surgery in the United States in 2012, the rhinoplasty has been the most popular surgery among the men and women under 35. At the same time, nasal surgeries are still among the most complex surgeries that should be done well; since the surgeon not only should try to make the nose more favorable, but also s/he ought to consider the nasal efficiency.
Every nose is unique because the faces are different. Therefore, a personal approach is required to reach the unique goals of each patient. A nose with natural appearance should match other facial features such as upper lip, chin, and cheeks. Preserving the structural support of the nose is an important factor in order to gain a natural result in rhinoplasty.
If the deviation degree of deviated septum is significant (more than 50%), it can lead to respiratory problems and it may be treated through septoplasty. Septoplasty can be done lonely or combined with other surgeries such as sinus surgery and or rhinoplasty. Improving the patient’s breathing along with nasal appearance through rebuilding the cartilage or bone lost in the previous surgery is more beneficial for the patient. The rhinoplasty with the purpose of functional improvement can be combined with nasal cosmetic surgery without any risk for appearance or function of the nose. In fact, this is what the patients want.
If the nasal frame consisting of bone and cartilage is operated accurately and sensitively, it can protect the internal structure of nose. Even a minor calculation mistake may lead to the patient’s dissatisfaction. Evaluating the strength of nasal cartilages is a way to assess whether a nose has an appropriate support. If the nasal tip has good support, it can be modified by removing the extra cartilage. Another important aspect of nasal anatomy is the skin thickness. The thick skin often is more challenging for the surgeons since they should be able to display the nasal specifications and create a beautiful new look. The round nose is more common among the patients with thick skin and it may get larger and droopier by age.
The importance of facial harmony in the modern rhinoplasty
A natural angle between the nose and the forehead and between the nose and the upper lip, as well as a natural arch from the profile to the tip of the nose is one of the important characteristics of a natural nose.
A smooth nasal tip which is not so pointed and a nasal bridge which is not very narrowed can contribute in the improvement of nasal appearance. The appropriate length of the nose and not much distance between the nasal tip and the upper lip are vital features of a beautiful nose. The normal state of nostrils must not be very narrow or droopy. A natural nose should also be coordinated with the other facial features, especially with the chin angle and facial bumps. In addition, there are certain standards determining the relationship among the nasal size, face, and eyes. Actually, the modern rhinoplasty represents the combination of art and operation. Finally, each technique must be applied in accordance with the intended patient in order to achieve the desirable results.
The role of counseling session in the modern rhinoplasty
One of the crucial issues is that the patients see their chosen surgeon’s before and after photo gallery to determine whether their idea about an attractive nose is in line with their surgeon’s. Also talking with the other patients who have done the rhinoplasty can be useful. This helps the patients to understand what they have to expect before, during, and after surgery.
After the general examination of the nose, I check the strength of the cartilages and skin thickness. In some cases, only one part of the nose may be very striking. If the main concern of the patient is the malformed hump on the nasal bridge, we can remove it to make the nasal bridge smoother. If the nasal bone is too wide, it can be narrowed. Repairing the fractured nose is very sophisticated. Although the nose can become smoother through the rhinoplasty, creation of a perfectly smooth nose is not always possible.
What is the effect of personal characteristics on choosing the rhinoplasty techniques?
Bone structure, skin type, and ethnic differences all play an important role in determining the optimal design for the rhinoplasty. Cultural differences must be respected in changes of size, form, and personal features of each nose. In most cases, African / American, Middle Eastern / Mediterranean, and Latin / Spanish hybrids and Asian patients may have thicker skin requiring specific techniques for reshaping the nasal tip. Instead of cartilage cutting techniques that are most commonly used for patients with thin skin, the methods used for these patients need more skill and experience. It is not so surprising if there are cases whose nasal tip is completely round, having no support, or thick skin with weak cartilage support. These types of rhinoplasty usually require the cartilage transplant from the patient’s septum or behind the ear. It is necessary to remove a little bit of skin fats for improving the appearance of the nose.
Using modern nasal surgical techniques, a natural nose with hidden and tiny incision trace can be created. It should be mentioned that in general, there is no ideal nose; each surgery is planned in a way to make a nose fitting to the facial harmony of the same person. The perception and creation of a beautiful nose is an artistic work and an intrinsic qualification which can be understood with observing the rhinoplasty result. . Education and experience provide the tools needed to achieve the goal, but they are only the basis of the work.
