Does my Nose Look Like a Complicated Rhinoplasty Case? (photo)

Hi Why,   Rhinoplasty is considered to be the most difficult of all facial plastic surgery procedures.  As a patient I would not "worry" about whether the surgery is complicated or not, but rather make sure that I have done my due diligence and chosen my rhinoplasty surgeon carefully (it does not matter whether an open or closed approach is used, it matters that your surgeon has artistic vision!)  I never take anything for granted with any rhinoplasty operation.  That having been said, it does look you have excellent anatomy to begin with, and that an experienced rhinoplasty surgeon should give you a great result.  Good luck and be well.   Dr. P

Avoid open rhinoplasty.  I NEVER open unless it is a traumatic reconstruction or a cleft lip/nose case that is already essentially open.  Any surgeon that is competent at rhinoplasty should be very comfortable doing this closed.  Key points to your rhinoplasty include reduction of the dorsum(including bony vault and upper lateral cartilage reduction by sharp technique and possibly "auto-spreader sutures or spreader graft), a cephalic trim which is a removal of the upper protion of the lower lateral cartilages, and VERY importantly a columellar strut/septal extention graft.  The reason for the columellar strut/septal extention graft is to give you supported auto-rotation of your tip AND IMPORTANTLY to give you more "columellar show."  The columella is the skin part of your nose between your nostrils.  It is the part that is cut in open rhinoplasty and preserved in closed rhinoplasty.  on profile there is not enough of your columella visible and a well placed graft will correct this and enhance you nasolabial angle and tip.  To perform this type of graft effectively septal cartilage must be used so septal harvest is indicated.

 

 

The other very important thing about the columella is that it contains two arteries and a venous drainage system feeding the nose.  If this is cut , healing is much slower and swelling will take about one year to resolve.  This is the main reason that surgeons like myself never open the nose.  The other main reason not to open is that it is very difficult to judge the aesthetics of the rhinoplasty without having the columellar relationship intact.  Other reasons not to open include columellar notching from the scar, scar contraction pulling the tip down, higher incidence of wound complication etc.  I hope this helps!

 

All the best,

 

Rian A. Maercks M.D.