Rhinoplasty has been performed in the United States for over 100 years. While the goals established have largely remained unchanged, many techniques have been developed since its introduction. Perhaps the two most important advances are the use of the open approach technique and the development of high quality implant materials, which are well tolerated by the body.
The open approach technique is contrasted with the standard closed approach technique by the addition of a small staggered incision on the columella, the small bridge of skin that separates the two nostrils from one another. This small incision allows direct access to the tip of the nose for precise correction of tip problems, such as asymmetries and irregularities of the nasal tip cartilages.
The open approach is not necessary for all rhinoplasty. It is most commonly used in the patient who has had previous rhinoplasty or who has tip problems that either require precise correction, a graft or implant placement. The scar on the columella is the most common concern, but can be well hidden. In 15 years of practice I have not encountered a patient who was unhappy with the open technique. In properly selected patients, the downside of the scar is far outweighed by the benefits derived from the ability to correct difficult problems.
The second advancement has been in the development of implant materials. Prior to the development of these implants, grafts were harvested from the ribs or skull. The other option was to use donor materials, such as human donor cartilage. While these materials are available, their long term stability is debatable.
Today, the use of newer man-made materials eliminates the need for harvesting materials from the patient. It also saves the patient from the trauma of the resulting scars and the pain involved in the graft process. The use of alloplastic or man-made materials also eliminates the risk of disease transmission from donor to patient.
Whether you are contemplating nasal surgery (rhinoplasty) for the first time or considering revision rhinoplasty, it is important to be proactive and do your homework. The following indicators can be of help in making your decision:
Imaging - Computer imaging is very helpful. I use it in my practice to educate the patient, to show what can be accomplished and to ensure that we have the same expectations after surgery.
Qualifications of the surgeon – When consulting with a surgeon, ask how long he has been in practice and how often he performs cosmetic nasal surgery. Make sure that you feel comfortable with the surgeon and his bedside manner. Be fully informed regarding the post operative healing process. You should be told what to expect regarding the potential risks, benefits and complications of the procedure. Finally, ask to see preoperative and postoperative photographs of patients to indicate the level of skill of the surgeon. Just keep in mind that all patients are different and those results will not be yours.
Whether you are contemplating rhinoplasty for the first time or considering revision rhinoplasty, call our office at 314-432-7760 for more information or email us at facialplasticsurgery@ent.wustl.edu.
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