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Here I have taken the trimmed cartilage and now I'm placing a five O
absorbable PBS suture at the dome to bend the cartilage into better shape.
Sometimes these domes have to be adjusted into better location or place.
Remember the shape of the tip of the nose is determined by the shape of
these cartilages, the strength of the cartilages, the size of these
cartilages and the nature of the skin overlying everything.

So the first part was to slightly trim these cartilages and now I'm bending
them into a better shape and you can immediately see as I'm suturing that
the right side of the tip is now narrower and has a better shape than the
left side.

The suture that I'm placing is a Five O PDS suture. This is an absorbable
suture, it's not a permanent suture. It holds the cartilage long enough in
place for the patient's own scar tissue to keep the cartilage in place and
retain the shape. I do not like permanent plastic sutures in the nose. I've
had to deal with complications of other surgeons who use permanent sutures,
with patients that have come in with infections, redness and swelling and
even puss in their nose. With perhaps very nice Rhinoplasty results that
now multiple years after surgery require exploration. Opening the nose and
trying to fine an infected stitch.

What I'm demonstrating here now is placement of the left side. You can see
that the right and left are very symmetric. They're both narrower than when
we started off and now the final suture technique will be to re-approximate
the left and the right together. The first suture was to narrow one side
and the second suture was the narrow the other side. The third one is
actually to bring both sides together and connect them so that they don't
drift apart.

I have seen noses that did not have this suture technique. Noses that have
come in for revision Rhinoplasty and I read the operative note and these
suture techniques were not used, so what ends up happening is the left and
the right side can drift apart from each other and very A-symmetric tip
results can occur.

Even with the best suture techniques and even with permanent sutures many
years later scar tissue can pull things apart and create slight A-
symmetries, but it's very important to create a uniform stable nice tip.
You can see that this is immediately achieved in a matter of seconds to
minutes on the operative table.

What's important to also note, is that in the old days, and unfortunately
some surgeons still today; instead of suing suture techniques, they remove
too much cartilage and compromise the tip of the nose and that can end up
in deformity and pinching and narrowing and telltale signs of a poor
Rhinoplasty. You can see that even with the swelling of the skin from the
local anesthesia and the surgery the nose has a nice shape to it. There are
nice brow tip aesthetic lines. I'm cleaning the nose now, washing it up and
the very final stage will be just closure of all the incisions, form the
inside and outside. Application of the nose dressing and cast.

While the downtime of the patient is only about a week. The patient can
return back to work or school even a few days later if they want too but
after about a week the cast comes off and the patients start enjoying their
new nose, while the swelling and scare tissue tends to resolve. The nose
will continue to improve for months and years to come, but the down time
typically is one week.

Doctor POV: Open Rhinoplasty (Part 8)

Temporary sutures are used at the conclusion of the rhinoplasty in order to finally shape the nose.

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