From mild research, I've read about techniques applied by plastic surgeons in the past on the subject of rhinoplasty, including "excisional rhinoplasty" which is the complete removal of certain segments cartilage/bones to create a new shape.. However, I have heard that this technique over time can weaken the nose. Do you apply a new technique? Such as using the patient's own cartilage/bone to "stabilize" the new noses construction? Thank you for your time!
Excisional Rhinoplasty? Your Techniques
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Rhinoplasty is not just about removal but also about rearrangement and replacement and even addition. Rhinoplasty is THE most complex of all surgeries due to numerous factors with the most important being scar tissue and healing changes over years after surgery.
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Excisional Rhinoplasty? Your Techniques
Some older techniques involve removal of certain pieces of cartilage that then rely on scar contracture to shape the nose. Sometimes, these maneuvers look good for some time, but then may start to show irregularities or asymmetries. More modern techniques are based on maneuvers that preserve the structure and stability of cartilage and may be more reliable, with more predictable outcomes, in the long term.
Excisional rhinoplasty..... Technique?
By and large I do not perform excisional rhinoplasty procedures. I perform open rhinoplasty where I do not remove much tissue if any at all. I would rather preserve cartilage and tissue by doing graduated reduction of any dorsal nasal hump(s). The goal in modern rhinoplasty is not to remove or destroy tissue but to reshape and AND RESTORE NASAL CONTOUR Excisional and/or transectional procedures are something of the past.
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Excision rhinoplasty technique is just referring to a reduction rhinoplasty, such as a hump removal.
On some occasions we use the patients own cartilage that was removed and we insert it as structural support
when needed to improve the functionality of breathing through the nose. The most common of
these are spreader grafts placed in the mid vault of the nose to prevent collapse of the upper level of the cartilage.
Techniques in rhinoplasty
Rhinoplasty surgery is individualized to each patient's anatomy and desired results. There are numerous techniques available to change the shape of the bone and multiple cartilages in the nose, including resecting some portions or using grafts to reinforce certain areas or change the appearance. Discussion with a board certified plastic surgeon is extremely important before undergoing any surgery.
Rhinoplasty is considered the most difficult of all facial plastic surgical procedures (well, before total face transplants were performed). Every rhinoplasty is different, requiring different techniques. The most important point which your question addresses is the underlying structural support that is left remaining after rhinoplasty. As the nose heals, the overlying skin will "shrink-wrap" around the bony and cartilaginous skeleton. Depending upon the individual nose, additional support can be used in the form of cartilaginous grafts. You should choose your rhinoplasty surgeon most carefully, and your surgeon should be well versed in all of the techniques necessary for natural, long lasting rhinoplasty. Good luck and be well.
Excisional or Reduction Rhinoplasty
Rhinoplasty surgery has come a long way in the last 20 or 30 years. It was previously believed that removing cartilage and bone was the way to a good cosmetic rhinoplasy result, the "excisional rhinoplasty". Current techniques in rhinoplasty surgery now involve an assessment of the patient's actual anatomy, go figure! Based on that assessment and the patient's goals we come to a surgical plan that will most likely provide the best result. This plan may include reduction or excision of some structures, enhancement, reconstruction or grafting of others. Your surgeon should be able to discuss the plan with you and let you know almost exactly what your goals and anatomy require. Good luck!
It is not uncommon to remove tissue when narrowing the tip or reducing the size of the nose or rotating the tip. These techniques are excisional in nature. I prefer to suture define the tip and only remove when necessary. Often times I will combine excisional techniques with supportive ones as there is a fine balance in rhinoplasty between reduction and support. Typically, in most patients both components may be required to receive the most optimal results.
Old School Technique of Excisional Rhinoplasty
What you described as an 'Excisional Rhinoplasty' technique is also referred to commonly as a 'Reductive Rhinoplasty' technique. Both terms imply that portions of the underlying nose framework (cartilage and bone) are removed in an attempt to reshape the nose. As you pointed out, removing critical portions of the nasal framework can indeed compromise the structural support of the nose and lead to unwanted weakening. These noses often look scooped, pinched and over rotated once healed. In general, this is consider more of an old school rhinoplasty technique.
The new generation rhinoplasty surgeon tries to preserve as much of the underlying cartilage and bone as possible while reshaping these structures to create the desired refinement. In many cases, this involves cartilage grafting techniques you alluded to above. In most rhinoplasty surgeons' opinion, this is a safer, more effective approach to reshaping the nose.
Many years ago large amounts of cartilage and bone were frequently removed from the nose which resulted in a low profile line with an over-rotated, pinched tip. Today, with state of the art rhinoplasty, we remove far less of the underlying structure, changing contour and maintaining a strong, well-defined nose.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.