Definition of Rhinoplasty
Rhinoplasty in simple terms is the procedure to correct the shape of the nose also known as the nose job. There are two things in rhinoplasty one is the functional aspect of rhinoplasty which involves correction of the nasal passage. and other is cosmetic which involves correction of the
deformities . Whenever the surgeon does rhinoplasty he has both thing in mind that is to correct both the functional and aesthetic problems.
Whenever the nose surgery is done the patient then realises that how much the changes can be done. the procedure involves taking care of the skin which can either be thin or thick. Then we have to consider the whether to change the existing structure or use the cartilages, bone or fascia from other places. the structures to be placed in such a masterly fashion so that the nose looks perfect. Truly speaking rhinoplasty surgery is to be done by the surgeon who is dedicatedly doing rhinoplasty procedures and not by some person who seldom does it.
Philosophy of Rhinoplasty
Since 2003 I have been doing rhinoplasty and over the last 15 years the concept of rhinoplasty and understanding has greatly change. The anatomical studies and advances in techniques have greatly influence the result. With better understanding the results have greatly improved and now we have more control over the result predictability but not all.
Dr. S.S. Gambhir
Open vs Closed Rhinoplasty
There has always been the debate that rhinoplasty to done either closed or open. to the layman the terms seems confusing as to what to decide once given a choice. one thing is clear that no matter what method of approach you choose the results should be satisfactory.
This involves approaching the nose inside by giving the incision inside along the upper lateral cartilage and then joining the two incision together or by rim incision and not joining along the columella . this limits our visibility to see inside and continues traction over the skin to see inside can cause slight deformity. with adversity of endoscope the visibility criteria is somewhat limited.
Open method This involves giving the rim incision and joining at the columella . this gives good exposure to the inner structures. All the deformity can be corrected under visualisation this approach is good for patients who have severe deformity, secondary revision rhinoplasty and cleft rhinoplasty.
There is always been worry regarding the visibility of columellar scar but over the years i have experienced that the scar is nearly invisible whether it is asians, Indians, caucasians, arabs etc. As a rhinoplasty surgeon my prefer approach is open rhinoplasty.
Crooked nose correction
Newer advances in rhinoplasty As part of the teaching programme in rhinoplasty Dr Gambhir is doing what is the latest technique to give excellent result. The newer is diced cartilage graft for dorsum of the nose. This graft gives more control of the dorsum and give natural aesthetic result.
Tip correction- the tip of the nose is most important structure. The tip can be broad, bulbous, bifid , drooping. This all needs to be corrected.the tip height need to be maintained for there is ratio of height to length of the nose which needs to be achieved in correction.
Dorsal hump and depressed tip correction
Dorsum of nose
Dorsum of nose the dorsum of nose may have varying problem of broad dorsum, dorsum hump, depressed dorsum(saddle nose) and crooked dorsum.The above are the common problem for which the patient comes to us . the patient is first assed and then the plan is made to correct the problem.The photographs of common problem is given below.
The dorsum of the nose can be broad both at the alar area or at the nasal bone area. The treatment is to bring the nasal bone together and also if alar flaring is there then alar reduction procedure can be combined.
This requires augmentation of the dorsum. This depression may be due to congenital, post traumatic , post surgery etc. The augmentation will be done with autogenous tissue or by alloplastic implant. Autogenous tissue are cartilageous, bone or fascia. These are the first choice.
Nasal Septal correction
Crooked deviation of septum is very difficult to correct. The procedure that we follow is very radical we take out the septum and then remould it and then put it back. The other procedure that we follow is PDS splint we use to make the septum absolutely straight.the results are very good.
Some Of Frequently asked Questions
It is the surgery of the nose which involves correction of the septum and correction of external deformity to have the normal breathing and cosmetic pleasing nose.
Yes there are two approaches of rhinoplasty exposure. One is closed approach in this the incision are given inside the nose but the exposure is limited. If we are doing open approach there will be a small columellar scar which is not visible but exposure to nasal anatomy is good . Now a person going for rhinoplasty who is concerned with result should not be bothered by the inconspicuous scar in the columella.
Definitely the overlying skin makes a difference in the result but planning is important so patient with thick skin are given extra care in augmentation as the result is depend on the height and fine work is not very visible and they require lot of cartilage. The result is satisfactory and nowadays we are giving isotretenoin to decrease the thickness of skin and results have definitely improved.
Ideally we prefer to give general anaesthesia as it is comfortable for the patient. It is very safe and is given by a board certified anaesthesiologist. The anaesthesia is given by I.V drugs and then patient is intubated . Once the surgery is finished the patient comes to conscious immediately
Sometimes we use local anaesthesia for tip work. In this we are using the local injection to block the nerves and sometimes we give iv sedation to comfort the patient.
Once survey is done the result are immediate but next day swelling occurs and it takes about 2 months to have good result and the result will keep on improving for next 4 to 6 months
Yes breathing will definitely improve if you have problem before for in rhinoplasty we are correcting the septum as well as all the nasal valve so the breathing improve. Nowadays it is call nasal framework correction. Dr. Gambhir is trained in both the septal framework correction and nasal framework correction so the cosmetic and functional aspect of nose is corrected at the same time.
Normally we prefer that after one rhinoplasty procedure you should wait at least one year before the next surgery as result improve with time and also the tissue get softened so that they can be manipulated in better way. For revision rhinoplasty dr. Gambhir is best as his experience is very vast in this field.
We prefer to do cosmetic rhinoplasty in female at age above 15yrs and in male above 16 yrs as the nose is in growing phase before then. In case the patient has severe functional breathing problem we can operate at 12 to 13 yrs of age.
Normally in younger age group it give good result but above 60years of age the healing is slow and cosmetic results are not good . These patient because of ageing skin may develop functional problem they definitely require rhinoplasty.
Normally after full cosmetic rhinoplasty there is a small bandage over the nose and slight bruising under the eyes. This normal is there for 1 week so patient having desk job can go back to work after this and those who have physical activity will require additional 1 week. Strenuous exercises are to be avoided for at least 4 weeks.