Open Tip Rhinoplasty:
The operation is performed under general anaesthetic using totally intravenous
anaesthesia. Once asleep, a small "W" type incision is made across
the columella (the fleshy bit of tissue between the nostrils) and this is
extended to inside the nostrils. Using this approach provides excellent exposure
of the tip cartilages which can then be manipulated to improve the tip aesthetics,
usually by a combination of removal of some of the tip / alar cartilage, and
using internal stitches to reshape these.
The bridge / dorsum can also be addressed using this open approach, and often
some filing down of a bony / cartilaginous hump is done to get improved "dorsal
aesthetic lines" to the nose. In addition, it is often necessary to infracture
the nose to make it more narrow, once a hump is removed.
Over the past several years, increasing importance has been placed on the
functional aspect of rhinoplasty - the idea being to have an aesthetic nose
that functions (breathes) as well, or better than pre-operatively. As such,
we often have to address the nasal septum (internal cartilage) by septoplasty,
and use some of this septal cartilage to support certain internal structures
/ valves. Previously somewhat neglected, this type of functional surgery
is currently commonly performed as part of a modern rhinoplasty.
The surgery may take 2-4 hours - depending on what is required. Not all patients
need a "full rhinoplasty"; some patients can be adequately treated
using a "tip rhinoplasty" in which only the tip cartilages are reshaped,
and no bony work is done.
Either way, the surgery is often done as a day case (occasionally an overnight
stay is needed). A splint is placed over the nose at the completion of the
surgery, and is generally worn for the first week or so. External sutures
(across the columella) are removed at 5 days to a week post op. Bruising is
variable and always more in men than women. I usually recommend Arnica to
be taken post op to assist with the resolution of the bruising
and swelling, but not pre operatively. As regards
pain, rhinoplasty patients have remarkably little pain post op - just some
stuffiness, especially when nasal plugs are used for the first 24 hours.
Although some result will be seen at about a week when the cast is removed,
it is important to realise and understand, that it takes about a year to 18
months before the final result can be appreciated. This time is needed for
the skin envelope to contract and re-contour to the cartilage farmework that
was adjusted at the surgery, and the thicker one's skin, the more protracted
this process.
Medical complications are relatively uncommon in rhinoplasty (infection,
bleeding etc ), however, rhinoplasty allows little room for error - as little
as 2mm can be the difference between a great result and a poor result. Patient
satisfaction with the results of the surgery does vary, and a sobering statistic
is that about 12% of rhinoplasty patients request a second, corrective surgery
- this coming from the best surgeons in the world! Provided the goals of surgery
are clear, and the patient expectations are realistic, a good outcome should
be anticipated. It can be a life changing operation, increasing one's confidence,
and often one's breathing!
If you have any questions about this, feel free to email
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