Rhinoplasty surgery can correct physiological complications that disrupt your ability to breathe properly. It can also refine the shape of your nose for enhanced aesthetics. There are several types of rhinoplasty designed to meet a range of needs.
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Rhinoplasty Types
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BY
Geoffrey Keyes, MD
SENIOR SECTIONAL EDITOR
updated March 12, 2015
Source:
http://www.docshop.com/education/cosmetic/face/rhinoplasty/types
Your nose is one of the most distinct features of your face, and its
function is essential in your everyday life. When you are unhappy with
the look of your nose, or have functional complications that make it
difficult for you to breathe, it can compromise your quality of life.
Rhinoplasty surgery can correct physiological complications that disrupt
your ability to breathe properly. It can also refine the shape of your nose
for enhanced aesthetics. There are several types of rhinoplasty
designed to meet a range of needs.
Rhinoplasty Types
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Functional Rhinoplasty Procedures
Functional rhinoplasty can correct physical abnormalities that obstruct
breathing, like those caused by congenital defects. They can also
correct the effects of physical trauma. By reshaping and repositioning
the cartilage and bones of the nose, your rhinoplasty surgeon can help
you achieve nasal contours that allow you to breathe properly and feel
confident in your appearance.
Rhinoplasty can be an "open" or "closed" procedure. Open rhinoplasty
involves making incisions on the outside of the nose, while closed
rhinoplasty only involves incisions within the nose. Whenever possible,
surgeons will use a closed technique to avoid visible scarring, but open
rhinoplasty may be necessary in cases of severe damage, or when the
treatment area is located high in the nasal cavity. A skilled and qualified
surgeon can create open surgery incisions within the contours of the
nose to minimize visible scarring as much as possible.
Correcting a Deviated Septum
The septum separates the nasal cavity into two passageways that
extend from the upper part of the nose, where it connects with the skull,
down to the nostrils. The septum consists of several sections of
cartilage and bone. Its lower portion rests upon the anterior nasal spine,
a supportive bone that you can feel at the point where your nose and
the area above your upper lip meet.
A septum becomes deviated when it develops or shifts to one side of
the nasal cavity, rather than creating two equal passageways. When the
septum bends to one side, it can create an S-shape, or bow out into a C-
shape. Both types of deviated septum can block airflow and eventually
damage the soft tissues in the nose.
Depending upon where it has deviated, the surgeon may need to
reshape the bony upper portions of the septum near the top of the nose,
or the cartilaginous lower portion. In some cases, the septum will
actually move off of the anterior nasal spine in a condition called caudal
septal deviation. In this case, the surgeon must correct the shift in the
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septum and realign its base upon the anterior nasal spine.
Enlarged Turbinates
Rhinoplasty can also correct enlarged turbinates. These long, thin bones
extend outward from either side of the septum within the nasal cavity,
ending in small, curled, knob-like shapes. There are three sets of
turbinates: superior turbinates, which are high within the nose between
the eyes; middle turbinates, positioned in the middle of the nose; and
inferior turbinates, which end just above the nostril line. Soft tissue
covers the turbinates, humidifying air as you inhale.
Turbinate rhinoplasty can refine turbinates that have become swollen
because of allergies or other irritants. In some cases, one turbinate
becomes constricted because a deviated septum pushes it to one side.
As a result, the turbinate in the opposite nasal passageway grows larger
to compensate for the constricted turbinate, which further obstructs
breathing.
Some surgeons correct enlarged turbinates by removing tissue and
reducing their size. I personally do not remove any of this tissue.
Instead, I fracture the turbinates outward. Turbinates humidify and
warm air as it enters the nose, which is very important to breathing. In
some cases, removing them can lead to a painful condition called
atrophic rhinitis. This can result in chronic infection and excessive
mucus production. By fracturing a portion of the turbinates outward
(away from the septum) and setting them in place, I can create larger
passageways, improve breathing, and sustain the benefits of functional
turbinates.
Nasal Polyps
Like enlarged turbinates, nasal polyps are often associated with
allergies and irritation. These benign growths develop within the nasal
passageways as soft, jelly-like bulbs. To remove them, the surgeon will
reach within the nostrils using a snare instrument and carefully excise
them. Unfortunately, nasal polyps are very likely to grow back, so
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patients with this condition should pursue allergy medication as well.
Nasal Fractures
There are many types of nasal
fractures. Without treatment,
these fractures can cause
obstructed breathing and result
in a crooked or misshapen nose.
Fractures can occur anywhere
along the nasal "bony pyramid" -
the pyramid-shaped bony
structure of the nose that
protrudes from the face. Different
types of fractures require
different types of osteotomy, the practice of rejoining and resetting
bones:
Greenstick fractures occur along the sides of the nasal bones. They
occur most often in children, whose bones are still developing and
are much more flexible. As a result, greenstick fractures are typically
incomplete rather than fully broken bones.
A more severe type of fracture causes saddle deformity. This
condition causes the bridge and septum of the nose to break down
and become depressed toward the face, creating a saddle-like shape
visible when viewing the face in profile. It can result from severe
facial trauma or from cartilage breakdown caused by snorting drugs
like cocaine. In these fracture cases, the surgeon will use donor rib
bone tissue or cartilage to rebuild the bridge and septum.
A comminuted fracture occurs when a bone has broken into more
than two pieces. To repair a comminuted fracture, a surgeon will
realign the bones and remove any excess bone shards that could
otherwise cause serious damage. This type of fracture is most
common after severe physical trauma, and in elderly patients with
brittle bones.
In some cases, severe trauma can cause damage to the bones behind
the nose, called maxillae. The maxillae are two bones that form the
Different types of fractures
require different types of
osteotomy, the practice of
rejoining and resetting
bones
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upper jaw and palate, and support nasal structures. These are known
as Le Fort fractures, and they are classified into three types.
Le Fort I fractures occur horizontally, damaging the jaw above the teeth
and across the nostril line. Le Fort II fractures damage the maxillae
beneath the eye sockets around the nasal bridge. A Le Fort II fracture
breaks bones in a pyramid shape, extending in an upside-down V shape
from the bridge of the nose to the corners of your mouth. Le Fort III
fractures extend across the orbital sockets, which are the bones that
surround your eyes.
Le Fort fractures are very serious. They can cause permanent damage
to the brain and palate, and require immediate attention. A plastic
surgeon may be able to treat these types of fractures while performing a
rhinoplasty, but may choose to work in conjunction with a specialist.
Cosmetic Rhinoplasty Procedures
When it comes to cosmetic
rhinoplasty, the ultimate goal is to
enhance the appearance of your
nose and provide a flattering
complement to your unique facial
structure. Cosmetic rhinoplasty
combines different techniques to
meet your specific goals.
When a surgeon evaluates the
nose, he or she will take note of
imperfections in the three
different vaults: the upper vault
(also known as the bony vault),
the middle vault, and the lower vault. In order to maintain proper
proportions in your final results, treatments can involve adjustments to
more than one vault, even if you only notice imperfections in one area.
There are several common techniques plastic surgeons use to help
patients achieve their desired nose size and shape.
When it comes to
cosmetic rhinoplasty, the
ultimate goal is to enhance
the appearance of your
nose and provide a
flattering complement to
your unique facial
structure
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Correcting the Radix
The radix is the upper bony portion of the nose. The radix and
underlying cartilage may be large, causing a bump. If the radix is
shallow, it can cause a depression and a bump. Your surgeon can
reduce the radix by carefully shaving away small portions. The surgeon
might add volume to a depressed area using a portion of the patient's
own cartilage harvested from elsewhere in the nose. By augmenting the
space just above the radix, a surgeon can create a straighter slope.
Straightening a Crooked Nose
If the nose is slightly crooked or shifted to one side, a surgeon can
straighten it by reducing some bone or cartilage, or by physically
shifting the tissues. As with a broken nose in need of functional
rhinoplasty, your surgeon may apply a splint to hold the nose in place
while it heals.
Tip Rotation and Reduction
If the tip of the nose lacks definition or is overly defined, it may lack
proper rotation. Rotation refers to the upward or downward turn of the
tip of the nose. When adjusting the tip of the nose by reshaping
cartilage, the surgeon will also pay close attention to the base of the
nose, as it affects the tension and rotation.
Olga is a patient of mine who was specifically unhappy with the tip of
her nose. She felt that it was "too bulbous," so we were able to reduce
the tip and slightly adjust its rotation. As a working actress, Olga felt it
was especially important to feel confident in the appearance of her
facial features.
"I would tell other patients that if you are 100 percent sure that a
rhinoplasty is what you want, find a qualified surgeon who can help
you," Olga said. "I had never really liked my nose, and eventually, I
decided it was time to go ahead and change it."
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Olga feels that the change in her nose is subtle, but she is still able to
notice a difference and is pleased with her results.
"I think I'm happier now," she said. "I did something I have wanted to do
for a while. It's not really about my appearance. It's more about how I
present myself."
Projection Adjustment
The projection of the nose is the distance that it extends outward from
where it meets the upper lip to its tip. If this tip projects too far, it can
greatly affect the overall look of the nose. Under-projected noses, on the
other hand, can look too shallow and may result in a nose that looks too
small in proportion with the other facial features.
To reduce the projection of the nose, a surgeon can trim a portion of the
cartilage at its tip. To increase projection, the surgeon may separate and
realign your cartilage, pushing it forward and suturing it into a refined
position. If there is not enough cartilage in the tip of the nose, the
surgeon might use a cartilage graft to supplement it.
Nasolabial Angle Adjustment
If you look at your profile, the nasolabial angle consists of two lines: the
line from the tip of the nose to the area above the upper lip, and the line
from the upper lip to the bottom of the nose, where the nostrils are
separated. The projection of the nose and the rotation of its tip affect the
degree of this angle. In most cases, the surgeon will seek to create a
90- to 95-degree nasolabial angle in male patients, and a 100- to 105-
degree angle in female patients. A combination of projection and rotation
adjustment techniques can refine this angle.
Width Reduction
Viewing the nose from beneath, the nostrils and the tip of the nose form
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a triangle called the pyriform aperture. To reduce the width of the tip of
the nose, a surgeon will adjust the pyriform aperture. By making the
angles of this triangle steeper at the point where the nostrils meet the
face, a surgeon can reduce the width of the nose.
Alar Adjustment
Alar adjustment is a surgical technique that reduces wide or flared
nostrils. The ala are the outer edges of the nostrils. Alar adjustment is
commonly performed in conjunction with width reduction. By removing
a portion of tissue, your surgeon can change the level of tension that is
creating excessive flair in the nostrils. The Weir technique is a special
type of Alar adjustment involving a specific type of incision. The
surgeon tissues to create a wedge-shaped void, and closes it with
sutures to create the desired contours.
Ethnic Rhinoplasty
Each race has unique aesthetic characteristics. While not every
member of a specific race shares these characteristics, those that do
sometimes elect to undergo plastic surgery to change them. Rhinoplasty
is a popular treatment among those whose ethnic characteristics
include a broad nose. Many patients of African and Asian descent
consider cosmetic rhinoplasty to reduce the width from one edge of
their nostrils to the other. It is very important that your surgeon
modulates his or her approach to the individual anatomic components of
your nose. Your surgeon should not change your nose beyond a point
that would drastically change your appearance.
Creating a Conservative Transformation
It is extremely important that your surgeon designs a conservative
surgical plan. Plastic surgery should never change the characteristics
that make a person unique. Instead, it should enhance a patient's
natural beauty.
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One of my patients, Isabelle, is of Cuban descent. She wanted to achieve
some refinements to the shape of her nose, but she did not want to lose
her unique appearance.
"I had some friends who were worried that my face would be changed,"
Isabelle said. "It isn't. I'm proud that it doesn't look like I had work done.
What I liked about Dr. Keyes was that he was able to make subtle
changes. He was able to keep my ethnic characteristics."
Meanwhile, too much work can cause a breakdown in tissues. You may
remember the deflated and tissuey appearance of Michael Jackson's
nose toward the end of his life. Because he had undergone so many
rhinoplasty surgeries, the cartilage that supported his nose eventually
deteriorated, causing it to collapse inward. The best way to achieve
long-term satisfaction through rhinoplasty is to find a surgeon who is
willing to pursue your goals with the most conservative approach
possible.
References & Resources
Source:
http://www.docshop.com/education/cosmetic/face/rhinoplasty/types
Author: Geoffrey Keyes, MD
Publisher: DocShop
The best way to achieve long-term
satisfaction through rhinoplasty is to find
a surgeon who is willing to pursue your
goals with the most conservative
approach possible