Rhinoplasty is one of the most commonly performed cosmetic surgeries in Korea together with double eyelid surgery. Rhinoplasty includes augmentation, reduction, narrowing nostril sill, tip plasty, correction of nasolabial angle and so on.
Patients who have realistic goal with rhinoplasty are good candidate. Patients who pursue the perfect shape than is expected from the surgery should be avoided. In most cases, far better profile can be obtained and restoration of self-esteem ensues. It is recommended for patients to take surgery after the completion of nasal growth.
Preoperative detailed consultation with specialist cannot be too emphasized much. It is essential for the patients to have doctors’ thorough explanation about the surgical techniques, available implants, possible sequelae, and complications. Cessation of smoking and medications causing bleeding tendency is recommended from 2 weeks before the surgery.
For augmentation rhinoplasty, autologous tissues including bone, cartilage, soft tissue and implant (silicon, goretex) are available. For tip plasty, autogenous conchal cartilage and septal cartilage can be used. Donor site morbidity is minimal in functional and cosmetic aspects.
Upper 1/3 of the nose is composed of one pair of nasal bone. Lower 2/3 of the nose comprises two pairs of cartilage. Hump on the junction between the bone and cartilage may be removed and smoothed for the better nasal profile. In case of broad nasal dorsum, narrowing and humpectomy including bony portion should be considered first, then 2ndary augmentation rhinoplasty is necessary. If the hump is small, surgery can be operated under local anesthesia. However, if the narrowing of the nasal dorsum is indicated or other procedures are necessary, general anesthesia is inevitable.
Alar flaring makes one look crude. Alar width should be similar with the intercanthal distance in the asthetic nose. Alar resection can narrow the alar base and correct the alar flaring. Augmentation rhinoplasty and tip plasty can be performed at the same time with this procedure. Inconspicuous scar is made just above the facial-alar groove.
Traumatic or congenitally deviated nose can cause airway problem. Corrective rhinoplasty with septoplasty can solve these functional and aesthetic problems simultaneously.
Patients are not aware of their deviated nose right after the trauma owing to the swelling. If the patients were hurt on their nose when they were extremely young, they don’t tend to recognize their deformity. Incomplete or imprecise closed reduction of the nasal bone fracture is another frequent cause for the delay of the treatment. For the corrective rhinoplasty, osteotomy is often needed via piriform aperture or percutaneously. In case of percutaneous osteotomy, 3 to 4 mm of tiny incisions are necessary, however scar is inconspicuous.
General anesthesia is inevitable because osteotomy and manual infracture of the nasal bone are often necessary. 1 to 2 days of hospitalization period is required. If concomitant septoplasty is planned, curved septal cartilage is resected and used for the tip plasty or augmentation of the dorsum. Sometimes, silicon or goretex implant can be inserted for the better profile. However, rib bone and/or cartilage should be utilized for the correction of severely deviated S-shape nose resulting from the repeated fractures or depressed nose. In addition, corrective rhinoplasty is of benefit to the large nostril sill, retracted or hanging columella, and narrow nasolabial angle.
Postoperative swelling goes peak at the postoperative 2nd to 3rd day. Periorbital swelling and bruise are not infrequently encountered. Ice massage and head elevation can reduce the edema. Packed gauze in the nose is gotten rid of 3 to 4 days after the surgery. Even after the removal of the nasal packing gauze, discomfort and uneasy feeling of nasal obstruction may last several more days.
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