Reasons for Rhinoplasty / Descriptions of Problems
corrected by Nose Surgery
Information from board-certified New York Plastic Surgeon
Dr. Howard Bellin
Different Nose Surgeries & Problems Correctable by Plastic Surgery
Here are the common problems of the nose and how they are
treated.
Plastic Surgery for THE BIG NOSE
This is by far the most frequent problem. The surgeon starts by removing some
of the excess bone and cartilage along the top of the entire nose. Then he reshapes
the framework, either by making it straight or else by giving it a slight curvature.
Noses that are straight along the top usually look more natural, but this is
up to the individual patient. Of course, there are limits as to just how small
it can be made. If too much cartilage is removed above the tip, scar tissue
may heap up, usually resulting in a "parrot beak" deformity.
Plastic Surgery for the BUMP ON THE NOSE
In some cases, only one part of the nose is too prominent. If an unsightly
bump is marring an otherwise good-looking nose, it can be filed down (or shaved)
to create a smoother flow.
Plastic Surgery for the THE NOSE IS TOO WIDE IN THE BONY PORTION
The upper part of the nose between the eyes is constructed of bone and has
no flexibility. If this area is too broad, it can be slimmed down by cutting
the bones a cheek level and them moving them closer together to give a more
narrow appearance. But the bones must be moved equally of the nose will be crooked. Also, if the
bone is not cut close to the cheek, an unappealing "step" will occur on the
side of the nose.
Plastic Surgery for THE CROOKED NOSE
If the bones are simply out of place from a past condition (like a fracture),
the previous operation will reposition them quite effectively. But if
the lower cartilaginous portion is crooked, straightening it can be difficult
or impossible. The best chance is to take a strip of cartilage from the inside
of the nose and then to graft it along the indented portion. If the procedure
is successful, the nose should appear perfectly centered.
Plastic Surgery for THE NOSE TIP IS TOO LARGE OR BULBOUS
This is a common problem that can be improved by removing or reshaping the
cartilage in the nasal tip. By doing so, a great deal of the fullness is usually
refined. But the cartilage should be left essentially intact along the rim of
the nostril to prevent it from looking pinched.
Plastic Surgery for THE TIP IS POORLY DEFINED
The tip of the nose should be slightly separated from the upper part, and it
should also project slightly beyond the main body of the nose. The surgeon achieves
this result by operating on the tip cartilage. If done correctly, the nose will
not "fall" when the surgery has been completed.
Plastic Surgery for THE NOSE IS TOO WIDE IN THE NOSTRIL
AREA
The "wings" of the nose can be narrowed by cutting out a wedge-shaped piece from the outer base of each nostril. This is referred to as an alarplasty,
and it is one of the rare times that an external cut is made on the nose. If
the surgeon is careful, the ensuing scars hold be thin and hidden from view
in the natural crease of the nostrils. An equal amount must be taken from each
nostril or the nose will look crooked.
Plastic Surgery for THE NOSE IS TOO NARROW IN THE NOSTRIL
AREA
This is sometimes caused by an excessively done alarplasty (see previous operation).
The correction involves taking a full wedge of skin and cartilage from the rim
of each ear, and then grafting one of the wedges to the base of each nostril
to elevate and widen it.
Plastic Surgery for THE NOSTRIL RIM IS TOO THICK
The nostril rims can be slimed down by making incisions in the margins of the
nostrils and excising thin pieces of skin. Then the remaining skin is drawn
together and sutured, leaving a slightly visible scar.
Plastic Surgery for THE TIP OF THE NOSE HANGS DOWN
This is usually more of an illusion than a real problem. When there is a curved
bump on the nose, the eye tends to follow it down to the tip, which seems to
droop. When the bump is treated, the tip should assume a more normal appearance.
But if the tip really does hang down, it can usually be rectified by removing
excess cartilage. This should raise it into an attractive position. However,
when a careless doctor removes too much cartilage, the result my be a "piggy"
nose, causing the nostrils to look wide and open.
Plastic Surgery for THE AREA BETWEEN THE NOSTRILS HANGS
DOWN
This part of the nose is called the calomel, and it can be corrected by simply
shaving off some of the cartilage that is causing the problem. Thus the columella
should be elevated to its proper position.
While this condition is uncommon, it can normally be improved without difficulty.
The only danger is an excessive removal that results in an ugly condition called
retracted columella.
Plastic Surgery for THE AREA BETWEEN THE NOSTRILS RETRACTS
This particular problem can either be natural condition or a bad result from
a previous operation if it was done improperly. It can be corrected by grafting
cartilage (or inserting a piece of silicone) to bring the calomel back to normal.
Plastic Surgery for THE "SKI JUMP" OR "SADDLE NOSE"
When there is too little tissue along the top of the nose, the middle appears
caved in or crushed. This condition is especially prevalent on Orientals and
blacks, and it is almost always treated by taking cartilage from the inside
of the nose and using it to build up the affected area.
Some doctors prefer using silicone implants (not injections) or bone grafts
from the patient's hip or rib to create the same kind of change; these are acceptable
alternatives.
Incidentally, the "saddle nose" can also result from removing too much tissue
during other types of rhinoplasty or surgery to the septum.
Plastic Surgery for THE POOR RESULT FROM A PREVIOUS RHINOPLASTY
Unfortunately, not every plastic surgeon possesses the same degree of competence;
even in the most capable hands, unexpected and less-than optimum results can
sometimes occur. Many of these problems have already been discussed.
In rare cases, the damage will be permanent. But more often a poor job can
be improved through a second operation. If the original surgeon makes the correction
he should do it for free. But if the nose looks horrible, the patient may prefer
to find and pay someone else (preferably an expert in cosmetic reconstruction).
The fee for any of these procedures should be $7400 to $8,900. If
two or more are performed at the same time, there will not usually
be any additional charges.
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