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Building a New Nose: Advancements in Rhinoplasty

Aesthetic RhinoplastyEver since Dr. John Orlando Roe performed an aesthetic rhinoplasty in 1887, the surgical procedure has progressively been developed further and further, now reaching the status of being one of the most refined plastic surgery procedures capable of achieving truly aesthetic and long lasting results.

Dr. Roe was an otolaryngologist who perfected an intranasal (closed) technique to surgically correct the appearance of a pug nose. He published his procedure in 1887, and he wrote a second article in 1902 that included photos. Facial plastic surgeons like Dr. Jacques Joseph, a man credited with being the father of rhinoplasty, expanded on Dr. Roe's method.

In 1898, Dr. Joseph was approached by a man who was embarrassed by his large nose. Dr. Joseph had been successfully reducing the size of large ears, and the man wanted to know if it was possible to use the same techniques reduce the size of a nose. Feeling that the surgery was possible, Dr. Joseph agreed to perform the surgery, but only after he practiced on cadavers. After a successful trial on cadavers, Dr. Joseph performed the surgery and shared his success with the Berlin Medical Society.

Tools of the Trade

For decades, most of the surgical maneuvers consisted of sculpting and excising cartilage and bone.  While creating thinner, more refined appearances, the problems of this approach is that it potentially weakens the structure and support of the nose, and as such can lead to problems of shifting and unnatural appearances in the long run.

What has changed with today's rhinoplasty, as performed by some of the top surgeons in the world, is the structural approach.  Where instead of removing and weakening, the approach is to strengthen the support of the nose, assuring not only aesthetic results in the short run, but more importantly, natural appearing unfaltering results in the long run.  There are a variety of techniques used by some of the more experienced rhinoplasty surgeons to achieve this support, starting from the "open" approach, and continuing through the use of such maneuvers as cartilage struts or bridges, tongue-in-groove securing to the stable septum, and others.

Open vs. Closed Rhinoplasty

Closed rhinoplasty involves incisions made on the inside of the nostrils. In an open rhinoplasty an incision is also made between the two nostrils along the bottom of the tip of the nose. This incision allows the skin to be lifted from the tip of the nose. Dr. Roe and Dr. Joseph both used closed rhinoplasty techniques.

The first use of open rhinoplasty dates back to 1921. Dr. Rethi used this approach to modify the nasal tip on his patient. In 1957, the open technique again received mention when Dr. Sercer praised the use of this method. Despite this, the method didn't catch on until the 1970s when Dr. Padovan did a presentation on the benefits of open rhinoplasty. Today, doctors still have their preferred method and will discuss that method with clients during the consultation.  However, for the "structural" rhinoplasty approach, it is essential to address the nose through an open approach for the maximum access and exposure, assuring the longest lasting, most natural results.

Spreader Grafts

Spreader grafts are rectangular strips of usually septal, sometimes ear, rarely rib, cartilage that generally measure two or three centimeters in length and three to five millimeters in width. The first noted use of these spreader grafts was in 1984 when Dr. Sheen discussed their benefits. They are used to add support to a nasal valve (important for breathing), help straighten a crooked nose, and/or to strengthen the nose to prevent it from curving as the nose heals.

Growing a Nose for a Transplant

The New England Journal of Medicine released a story involving a man from China whose nose was severely damaged in an accident. After infection set in, much of his nasal tissue and cartilage was destroyed. Through modern medicine, doctors are helping the man grow a new nose on his forehead that will be transplanted over his nasal bone.

The procedure involves slowly building the new nose using cartilage taken from the ribs and skin from the forehead and building the nose in layers, all while it is connected to a fresh blood supply. This keeps the nose healthy until it's time for the transplant. For patients who are disfigured from prior rhinoplasty attempts and subsequent infections, this is an exciting option for regaining self-esteem with a beautiful new nose.  Please realize however that this is not in any way a substitute for aesthetic rhinoplasty.

When Things Don’t Get Done Right the First Time

When a patient is not happy with the results from a prior rhinoplasty, it is more important than ever to seek out an experienced surgeon.  In revision rhinoplasty, usually the most important underlying goal is to restore structural support to the nose through an open approach.  Note that in some cases, when limited work needs to be done, it is possible to achieve a sufficient cosmetic improvement with small incisions and no need to use an open approach.  Cartilage from the septum and/or ear may need to be used to restore the natural anatomy of the nose, allowing for an aesthetic long term result.

When deciding on a rhinoplasty surgeon, looking at before and after pictures is one of the first things you should do. Check out these before and after videos of Dr. Epstein's rhinoplasty patients. Dr. Epstein prefers the open rhinoplasty technique. He feels it gives him better visibility of the nose's structure and maintains stability in the nose tip for long-lasting results. Discuss your rhinoplasty goals with the Miami rhinoplasty surgeon by calling his office at (305) 666-1774.

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