What is the Best Technique for Nose Surgery or Rhinoplasty?

Hi, I am Dr. Sandeep Bhasin a Cosmetic Surgeon from Care Well Medical Centre Today I will discuss Nose surgery called Rhinoplasty

Rhinoplasty can be defined as a surgery that is conducted to change the shape of the nose or improve its ability to function.

Let’s see the types of Rhinoplasty

Rhinoplasty can be categorized into two forms :

Aesthetic Rhinoplasty:

 It is done to improve or change the shape of the nose.

Functional Rhinoplasty:

If there are breathing problems in the nose then Functional Rhinoplasty is done. The procedure of Functional Rhinoplasty is conducted for symptoms like a blocked nose, sinusitis, or nasal polyps.

We also need to understand that there isn’t a concept of a perfect nose. These procedures can only enhance facial characteristics and improve nasal functionality if there are symptoms mentioned above.

So, I begin with Clinical and Radiological investigations of my clients planning for Rhinoplasty. I look at the structure of the nose and any difficulty in breathing if they are facing it.

Techniques of Rhinoplasty

Rhinoplasty can be classified into two types, based on technique viz. Open Rhinoplasty and Closed Rhinoplasty.

• Open Rhinoplasty is more useful for Cosmetic Nose Reshaping
• Closed Rhinoplasty is better for Breathing difficulty etc.

Open Rhinoplasty

In open Rhinoplasty, an incision is given on the skin, so that the entire skin over the nose can be raised.

This incision is called a trans-columellar incision, this gives the surgeon a clear view of the nasal skeleton. All this can be achieved through an undisturbed alignment, and it also improves the result of the surgical process through the trans-columellar incision.

Open Rhinoplasty is quite useful for aesthetic Rhinoplasty where significant improvements can be done for the tip, dorsum, and the shape of the nose.

Closed Rhinoplasty

As compared to open Rhinoplasty, closed Rhinoplasty is done without opening a part of the skin, and a special incision is made inside the nose. This procedure is useful for functional Rhinoplasty. It is also called endonasal Rhinoplasty, where a surgeon makes a parallel concealed incision for no external scarring to occur.

This procedure limits the visibility of the surgical process and needs to be done through a narrow opening in the nostrils.

Thus, we have defined Rhinoplasty and its types.

Grafts and Rhinoplasty

So, if you plan for Nose Reshaping what would you need?

If I plan to change the shape of the nose I will need some material to redefine it. This material can be taken from the body itself or from an artificial source.

• If it is taken from the body, it is called Autologous Graft.
• If it is taken from an artificial source it is called Graft.

Autologous Graft is usually taken from 3 sources

• Nasal Septum Cartilage
• Ear Cartilage
• Rib Cartilage

Now cartilage is like a soft and flexible tissue, which helps to give support and shape to the nose.

If we use Artificial Material or Implant it is usually taken from:

• Silicone Implant
• Gortex

Let us understand a common thing that is performed in Rhinoplasty, and some doctors do practice it. Grafts are used to improve the shape of the nose, to do this, surgeons use cartilage that is taken from the Nose, Ear, or Ribs to correct nose deformity, and get the nose in a good shape.

Not all nose jobs require grafts, these are only used for structural support or to create a better breathing space for the nose. Grafts are predominantly used for specific locations like the tip of the nose, the bridge, and the mid-third part of the nose.

A graft is a tissue that is taken from another part of the body, in terms of nose grafts, it can be cartilage, bone, or soft tissue that is used to improve the structure and shape of the nose.

Synthetic materials like Silicon or Goretex are also used instead of Grafts & these are called Implants.

So what are these Grafts meant to do?

Well, they may help in:

• Improving the shape of the nose or Contour
• Improving the structure of the Nose as the Height of the nose Supporting weak tissues etc.

Grafts are made through pieces of cartilage and shaped as per the shape of the nose to reinforce or replace weak tissues with stronger ones. There are two types of grafts – Contour Grafts and Structural Grafts. A Contour Graft is used to smoothen the surface or appearance of a nose.

These are put on the bridge side of the nose where it looks low,  there is a depression, or we need to change the shape of the tip. Structural grafts are used when there is a requirement for support for the nasal tip, or if there are breathing issues due to a very thin bridge.

So  Now we can use either the Graft or an Artificial Implant  for Rhinoplasty

Great !!!

Which one should a patient opt for?

Let me tell you the advantages and disadvantages of both:

Let’s begin with Implants which are made from Silicone or Gortex. Well, if you know something about Cosmetic Surgery Industry you would have heard about Silicone Implants in Breast Enhancement.

So the same Silicone is used here.  The advantages of Silicone Implants are:

• The surgery time is short as we are using premade Implant to improve the nose shape.
• The immediate result of the Implant is great . The nose shape looks excellent.

Let’s compare this with normal Grafts,  which we take from the Client’s own bodies.

Well here:

• The Surgery time is much longer at least 3-4 hours. As we have to design the shape from the body’s own tissues.
• The immediate results and shape are moderate not as great as the Implants.

So it looks that Implants such as Silicone are the Best Choice. Right?

But Wait !!!

I am going to reveal to you something that you should understand before you fix your Rhinoplasty if you do not wish to repent later.

So the deep Secret which is not often revealed is here:

• The Implants i.e Silicone etc. though look great, but in 2-3 years get infected or move from their position and a second surgery would be needed
• If you are willing for this; a second surgery or any infections in the future, then you should think of an implant.

For most of My patients, I tell them not to go for Implants. I use Natural Grafts only.

Why?

Because we care for you. We have seen some patients operated on somewhere else with Silicone Implants a few years back, coming to us with pus, drooling from their nose or some complications needing another Surgery for the Nose.

So My friends, be aware & avoid Implants as they are foreign bodies and can get infected.

I choose Grafts mostly from Nasal Septum. In some cases where we need more Structural support, I prefer to look into Ear Cartilage or Rib Graft.

Well, we have moderate to great results, but I do not have to handle problems such as Infection or Implant displacement.

Conclusive Facts

Cosmetic surgeries can be easier than Rhinoplasty wherein the complete surgery can be done in 30-40 minutes. But, for a Rhinoplasty procedure, it could take 3- 4 hours. Results with the graft are better than Rhinoplasty, but after 3-4 years it becomes necessary for the patients to remove the grafts as there could be an infection.

In our clinic, we normally recommend Autologous Rhinoplasty, wherein cartilage can be used from the nose, ears, or from ribcage. If a patient wants to undergo surgery with grafts, then our clinic goes ahead with the procedure.