World’s Best Rhinoplasty Beverly Hills Style Part Three:

World’s Best Rhinoplasty Beverly Hills Style Part Three:

Let’s continue with our series on Rhinoplasty with some specific areas where the nose can be improved. The major anatomical areas of the nose are:

The Nasal Tip:

When people speak about the nose being long or short, in length, they are really describing the angle of rotation of the nasal tip as it meets the upper lip. In long noses, the tip is under rotated from the ideal 105-115 degrees with the later more appropriate for women rather than men. When the tip angle of rotation is 90 degrees or less, the tip is seen as hanging…almost like you could touch it with your tongue. The opposite is also true when the tip is over rotated with and angle greater than 115 degrees giving the nose a short, “pig nose” look.

Rhinoplasty can change the angle of rotation closer to the ideal utilizing various surgical techniques from onlay cartilage tip grafts to trimming the anterior septal angle. If there is an excess of tip cartilage, this cartilage can be re-shaped or reduced to achieve a more streamlined appearance. Tip cartilage shape, symmetry and rotation are the major issues that need to be assessed before a specific and effective Rhinoplasty plan can be formulated.

The upper lateral Cartilages:

The area immediately adjacent and above the nasal tip is referred to as the Supratip and consists of the upper lateral cartilages that combine in the mid line with the superior (upper aspect) of the nasal septum to form the nasal dorsum or bridge. This area can be indented (concave), flat or Convex (stick out) and there can be quite a bit of asymmetry between the two sides of the nose in this area. In addition, the nasal bridge can have a bump, depression or be crooked to one or both sides resulting in an overall C or S nasal shape. The cartilage in this area can be shaped and trimmed for added symmetry and shape. During Rhinoplasty, the nasal bridge can be thinned horizontally and the vertical height can be either reduced or increased to address the specific flaw.

The nasal bones:

The next area of the nose is made up or the right and left nasal bones that join the bony portion, of the nasal septum, in the mid line to create the uppermost area of the nose and nasal bridge. As the cartilage area below it, the nasal bones can be wide, asymmetric, high or low to the face. The bones can be rasped using a nasal rasp to reduce and shape the bone or the bones can be surgically broken and fractured to move their alignment (called osteotomies). There are numerous types and ways to create nasal fractures but I prefer the lateral method where the nasal bones are fractured where they attach to the face. The nasal bones should be splinted for 1 week with a nasal cast and our patients are advised to avoid physical contact that may shift the nasal bones for 1 month post Rhinoplasty. We do not use nasal packing for Rhinoplasty even when the nasal bones are fractured except in cases where deviations in the nasal septum have been removed….in which case a small piece of telfa is placed in each nostril overnight and removed the next day during the first post op Rhinoplasty visit.

The nasal septum (inside the nose and separates right from left nasal cavity):

The nasal septum has little effect on the outside shape of the nose except in extreme cases of septal deviation leading to loss of structural support to the overlying tip, upper lateral cartilages and nasal bones. The most common septal manipulation, in my practice, is the resection of the anterior septal angle to allow rotation of the nasal tip. Next most common manipulation is to remove deviated portions of the septum to improve air flow in the nose. It is normal to have cycling and reduced airflow through one side of the nose alternating to the other side every 90 minutes or so…but becomes a problem when one side of the nasal airway is always reduced or blocked. In these instances a septoplasty to remove the hard cartilage or bone obstruction can increase the airway space. Septoplasty can be carried out alone or as part of a Rhinoplasty.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
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