Today I would like to discuss a common plastic surgery procedure called a rhinoplasty, otherwise known as a “nose job.” This is a procedure that involves reshaping or resizing the nose. There are two major categories of rhinoplasty: aesthetic and functional. Aesthetic rhinoplasty involves changing the outward appearance of the nose for cosmetic reasons. The most common reasons for cosmetic rhinoplasty are a dorsal hump (a hump on the mid to upper front part of the nose), a wide tip, and a crooked nose. A functional rhinoplasty is done to improve nasal airflow and reduce obstruction to improve breathing.
Most of the human nose is made of cartilage, much like the ears. The cartilage joins to bone at about the level of the bottom eyelid. The nasal septum divides the two sides of the nose internally. There are upper lateral cartilages on both sides which form most of the nose and there are small lower lateral cartilages below the upper ones. The bridge of skin that separates the nostrils is called the columella. There are two surgical approaches to rhinoplasty. In the open approach, a small incision is made externally on the columella and other incisions are made internally. An endonasal rhinoplasty is done with extensive internal incisions only. With either technique, the incisions allow access to the bony-cartilaginous framework of the nose.
In functional rhinoplasty, there are three major components of the nose that are evaluated for repair — the septum, inferior turbinates (ridges on the lateral inside of the nostril), and the valves (just above the inferior turbinates). In some cases, the inferior turbinates may become enlarged, thereby restricting airflow. Likewise a deviated septum may obstruct airflow. In addition, the nasal valves, which are the narrowest point in the entrance of the nasal cavity, may need to be widened to improve airflow.
In cosmetic rhinoplasty, dorsal hump reduction involves removing both bone and cartilage from the roof of the nose to create a more aesthetic profile. Tip reduction may involve removal of nasal tip cartilage. Straightening a crooked nose may involve any of a variety of techniques, including osteotomy (breaking the nasal bones) to create more symmetry in a frontal view. Once the surgeon is pleased with the new appearance of the nose, the incisions are closed. Splints are usually placed outside of the nose to maintain stability during the early healing process. In cases of septal surgery, internal splints are often used for the same reason.
For more information go to the American Academy of Facial, Plastic, and Reconstructive surgery at www.aafprs.org/patient/procedures/rhinoplasty.html
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