Undergoing Your Rhinoplasty Procedure
If you're having closed rhinoplasty, your procedure will probably last approximately one to two hours. If you're having open rhinoplasty, your procedure will take about two to three hours. More complex cases may take even longer. Once you're sedated, your surgery will begin with the surgeon
making small incisions just inside the rim of each nostril.
If the open rhinoplasty technique is being used, an additional incision is made on the columella, between the nostrils. This incision may be made in the shape of an inverted V, a W, or a zigzag, which is referred to as a "step off" incision.
If your surgeon is using the open technique, the skin is lifted away from the underlying nasal structures so that they are clearly visible. In the closed technique, the skin is separated, but not lifted away, from the underlying tissues.
Depending on the characteristics of you nose, your rhinoplasty may involve reshaping one, some, or all of the following: the bridge of your nose, the upper portion of your nose, the cartilage at the tip of your nose, and the nostrils. If it's necessary to improve the function of your nose as well as its appearance, your surgeon may perform additional
reshaping of the septum and other tissues within the nose.
It's important to note that each of these steps may be performed using a variety of surgical techniques. The techniques your surgeon chooses depend largely on your anatomy and his or her personal preferences. Likewise, surgeon preference often dictates the order in which the steps of the procedure are performed.
Reshaping the Bridge
Shaping the bridge of the nose may involve reducing or augmenting its size or refining its shape. The bridge of the nose consists of both cartilage and bone. To reduce a hump on the nose, a surgeon will remove excess cartilage and bone
and then refine the remaining tissues with a rasp, an instrument similar to a nail file. When removing a hump, most surgeons take a conservative approach, removing less cartilage and bone than they think is necessary and then making minute refinements until the desired result is achieved. When a hump is removed, the remaining bone may have what's called an open-roof deformity, or a gap between the two sides, that needs to be closed. This is done in a controlled manner by making fine cuts, small fractures called osteotomies, in the bone. These cuts are made with a
small chisel, called an osteotome, and a surgical hammer. After the bone is cut, it is gently guided into the desired position. If the bridge of your nose requires only refinement, your surgeon may simply use a rasp to make slight improvements in its shape.
To augment the size of the bridge, a surgeon may be required to add cartilage, soft tissue, or alloplastic material. (See the sections on "Cartilage Grafts", "Soft-Tissue Grafts", and "Alloplastic Implants" in this chapter for more information.) Augmenting the bridge of the nose is especially common in certain ethnic rhinoplasty procedures. Added cartilage is generally sutured in place within the nose and then refined.
Reshaping the Upper Portion of the Nose
The upper portion of the nose, which is made of bone, is commonly reshaped in rhinoplasty procedures. To narrow the nose, a surgeon must move the bones closer together. If a hump is removed from the bridge of your nose, your nose will most likely require narrowing as well. To correct a crooked nose, the bones must be realigned in a straight fashion.
Narrowing and straightening the nose are both accomplished in a controlled manner by making osteotomies in the bone.
Reshaping the Tip of the Nose
The tip of the nose is made of cartilage. Reshaping it may involve reducing its size, refining its shape, augmenting its size, shortening or increasing its projection, shortening or increasing its length, or changing the angle between the tip and the upper lip. To reduce its size, shorten its projection, shorten its length, or raise its angle, your surgeon may
remove or refine excess cartilage using a number of surgical techniques. In some instances, sutures may be placed in the cartilage to help achieve the desired effect.
When the tip of the nose is too small and requires augmentation, a cartilage graft, a soft-tissue graft, or a combination of both may be necessary. In some instances, when the tip of the nose is the only portion of the nose that requires refinement, the procedure is called tiplasty.
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