Reshaping of the nose through rhinoplasty surgery is one of the most popular plastic surgery procedures. it has a significant effect on one’s facial appearance by putting in proportion the nose to other facial features. while rhinoplasty surgery has a long history, contemporary methods produce a more natural looking nose that holds its shape over time.
Historically, rhinoplasty surgery was associated with after surgery appearances which were ‘overdone’. These older forms of reductive rhinoplasty often resulted in noses that were too small for the face, low bridges and up-turned tips. even if the nose did not appear this way immediately after surgery, this appearance developed months or years later. This nasal appearance was the result of removing too much of the natural structures of the nose. Taking the bridge of the nose down too low (bone and cartilage) or shortening the tip of the nose excessively (all cartilage), while immediately looking good, weakens the support of the nasal framework. over time, as scar forms and tissues heal and contract, the nose gradually ‘falls’ and assumes an unnatural appearance. it may look too small, too upturned, or too narrow and pinched at the tip.
The importance of maintaining as much of the support of the nose is better appreciated today. the nose is like a house, the framework must be maintained to keep the roofline intact. Modern rhinoplasty is about rearranging nasal structures rather than simply removing them. In this way, the nasal dorsum (line along the bridge to the tip) remains smooth but at a good height, the end of the nose is lifted but not too high, and and the nasal tip is narrowed but is not made into a single point.
Besides less cartilage and bone removal, the natural rhinoplasty makes use of adding support through cartilage grafts as necessary. Supporting the tip of the nose through strut grafts, using small hand-carved grafts to improve tip shape, spreader cratilage grafts in the middle of the nose to open up breathing, and actually increasing the height and line of the nose through onlay or radix grafts are some of the methods by which the nose can be builtup and strengthened. These cartilage grafts are usually acquired from the septum of the nose (which may be simultaneously straightened) or from the back of the ear.
Natural rhinoplasty methods utilize the concepts of nasal tissue preservation, artful alignment of the different areas of the nose, and skillful manipulation of small nasal elements. it is usually best done through an ‘open approach’ with a resultant indetectable scar across the columella. (strip of skin between the nostrils) Natural noses fit each patient’s face more proportionately and never have that ‘operated’ appearance. the long-term results with these techniques are rewarding to both patient and plastic surgeon alike.