Rhinoplasty is cosmetic reshaping of the external parts of your nose. It is a top five commonly requested procedure in plastic surgery in the United States. Whether it is a hump reduction or shortening and lifting of the nasal tip, changing the shape of one’s nose can make a dramatic change in the appearance of one’s face. Because of the intricate and complex anatomy of the nose and its very visible position on the face, anything less than a near perfect rhinoplasty result will be evident.
Whether it is a residual bump, asymmetry of the tip cartilages, or differences in the shape of the nostrils, less than perfect results in rhinoplasty are not rare. One reason is that rhinoplasty surgery is not easy. I consider it the most difficult of all cosmetic facial surgeries. And the way tissues heal and shrink after surgery is not always predictable which can cause undesired results in even the best performed rhinoplasty.
Historially, rhinoplasty surgery was performed in a ‘closed’ fashion, meaning work was done by looking up inside the nose. You don’t have to be a plastic surgeon to realize that it is difficult to see up through the nostrils…and do exacting work on its delicate structures. As a result, the need for a second surgery after an initial rhinoplasty using a closed approach was not low, averaging a rate of 10% to 20% if not higher. It took a lot of years and a lot of rhinoplasty surgery cases to become really good at it. In other words, the learning curve was long and steep.
In contemporary rhinoplasty, improved methods have resulted in lower revision rates down around 5% or less. One of these newer methods is the conversion to the ‘open’ approach, meaning the skin is peeled back and the structures of the nose can be widely seen. The concept of peeling the skin off of the nose sounds horrifying to many patients. And justifiably so. But the reality is this is all done using just a tiny incision at the midway point of the skin between the nostrils. And when that scar heals, it is very difficult to impossible to see in most patients. This is a very small price to pay for improved rhinoplasty results. It is more accurate and predictable if you can see clearly see what you are doing.
As a result of using the open rhinoplasty approach, the changing of the shape of the tip cartilages has become much more predictable. The tip can be sculpted better with less removal or destruction of the tip support as was more commonly done with the closed approach.
Dr. Barry Eppley
Indianapolis, Indiana