Rhinoplasty (also known as nose job) is one of the most complex specialist procedures in plastic surgery. There is significant variation in the anatomy of the nose between individuals meaning that the Plastic Surgeon needs to have a deep understanding of the complex structures that make up the nose, and how they can be altered in any given case to achieve the desired result.
There are a range of rhinoplasty techniques or approaches that can be used by an experienced surgeon to achieve the patient’s perfect nose shape depending on the circumstances.
In the closed approach, incisions are made inside the nostrils called marginal incisions. It is through these marginal incisions that alterations to the shape and contour of the nose are made. Closed rhinoplasty is associated with reduced swelling and recovery time and is most suitable for patients who require less significant nose reshaping.
In the open approach, the marginal incisions made in the closed approach are repeated. In addition, an incision is made across the bridge of tissue that connects the two nostrils at the bottom of the nose (the columella). This incision joins the incisions made inside the nostrils. The open approach forms an envelope of tissue that can be folded upwards to expose the nasal cartilage and bone. The surgeon is then able to examine the anatomy of the nose and perform the precise reshaping process.
Although open rhinoplasty involves making an incision on the external visible portion of the nose and scarring is possible, with excellent surgery and postoperative care these incisions often heal well. Any scarring from open rhinoplasty would not be easily noticeable since it would be located on the underside of the nose.
The septorhinoplasty procedure can be used to correct septal deviation which can cause problems with airflow through the nose. The septum is the structure that divides the nose internally into left and right halves. In this procedure, incisions are made in the internal lining of the nose to expose the underlying cartilage and bone. Any corrections that need to be made to the shape of the septum can then be completed. Septorhinoplasty also involves correcting structural problems in other parts of the nose and is not reserved exclusively for septal defects.
The nasal tip is a complex structure and alterations to it can change the overall appearance of the nose. This procedure is most suitable for individuals who feel that the tip of their nose is too broad, narrow, bulbous or asymmetrical, or if the nostrils are too large. The plastic surgeon is able to remove or reshape the cartilage to ensure that the nasal tip is in proportion with the other parts of the nose and achieve a result that fits with the other facial features in harmony.
So far, we have covered some of the technical differences between the different types of rhinoplasty, as well as some advantages and disadvantages of the open and closed approaches.
One thing in common between all types is that anaesthesia is required, and although general anaesthesia is considered safe and complications are rare, there is some level of risk involved.
With rhinoplasty, there are two anaesthetic options:
Each method has its associated advantages and disadvantages and the decision on which method is best should be considered on an individual basis.