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                   Dr. Azizzadeh Primary

What is Rhinoplasty?

Rhinoplasty is among the most widespread types of plastic surgery practiced today. It is also one of the most complicated to perform. Rhinoplasty can be used for a wide range of adjustments in the shape of your nose. It can increase or decrease the size, alter the tip or bridge or nostrils, even modify the angle between your nose and upper lip. Rhinoplasty is not only useful for aesthetic purposes, but can be used for more practical and essential corrections. Birth defects, injuries and even breathing complications can be resolved with Rhinoplasty. This article will outline the basics of the procedure, who it is best for, how it is conducted and what you can expect if you undergo treatment. Each person is an individual though, and details for the procedure will vary based on each patient and each surgeon. It is important that you talk to a doctor or surgeon about Rhinoplasty before you decide to get surgery. You will read more about that after you explore the anatomy of the nose in the next section.

Anatomy

The nose is, of course, the organ we use to smell. It also helps to filter dangerous gases and debris from entering the lungs and plays an important role in how we experience food and taste. Its anatomy is more complicated than one might expect.

The nose has two main components, the outer nose, and the inner nasal fossae. The external part, the nasus externus, is the triangular element of the nose we see on the outside of a person’s face. Its summit, also called its root, connects to the forehead and its foundation is comprised of the nostrils, also called anterior nares. These are divided by an anteroposterior septum, the columna. Inside the nostrils, hairs called vibrissae trap foreign substances as they are inhaled, preventing them from being carried into the lungs. This filtration system is essential in maintaining respiratory health. The lateral sides of the nose diverge in angle a great deal between different individuals, and the middle line between them is called the dorsum. The place where the lateral surface ends is called the ala nasi.

The most external layer of the nose is called the interument, while inside are other chief structures including the mucous membrane and various vessels and nerves.

The nose is constructed out of an amalgamation of bones and cartilage, which are manipulated by muscles. The bony part of the nose is the upper part and consists of the superior maxillary. There are five cartilages, four laterals, two upper and two lower. The fifth is called the cartilage of the septum.

The two upper cartilages are positioned directly below the region of bones. They are triangular and flattened. The frontal margin is thicker than the posterior and emerges from the septum cartilage. The hind margin is connected to the superior maxillary nasal process and bones. The inferior margin is attached to the lower cartilages with fibrous tissue; the two surfaces of the margin are turned in opposite directions, one outward, and the other inward in the direction of the nasal cavity.

Moving on down the nose, we can discuss the lower lateral cartridges. What do these look like? They are thin and flexible, positioned below the upper cartilages and turned inward creating the walls of the nostrils. The part of the cartilage which forms the inner wall is thickest. Joined to the opposite cartilage in a symmetrical fashion it creates part of the columna. The septum mobile nasi is constructed out of its protruding rounded border, augmented by the thick integument and subjacent tissues.

The outer wall of the structure has a curvature pertaining to the ala of the nose. Narrow behind, it is oval and flat and joins with the nasal process of the superior maxilla. The connecting tissue is a membrane of tough fiber. This fiber contains several cartilaginous plates. These plates are also known as sesamoid cartilages or cartilaginous minors. This part of the nose connects to the upper cartilages and the cartilage of the septum on the top. Underneath it forms the ala, consisting of thick, skin-covered tissue. The two lower cartilages have a notch between them adjacent to the nose’s protrusion.

The overall shape of the septum cartilage is a four-sided figure. It is thinner in the middle then at the limits. It forms the final separation between the nasal fossae. The thick part joints with the bones of the upper nose and is connected to the anterior margins of the upper cartilages. It also joins at the base to the internal parts of the lower cartilages. As with many other parts of the nose, this connection is made up of fibrous tissue. The posterior margin of the structure is attached to the perpendicular lamella of the ethmoid. The inferior margin is associated with the vomer and the palate processes of the superior maxillary bones.

In some people, particularly in the young, this structure can be protracted backward, causing the septal cartilage not to reach the nasal septum’s lowest region, the septum mobile nasi. Physicians call this occurrence processus sphenoidalis. The septum mobile nasi is enabled by a fibrous membrane to move freely.

The symmetrical muscles of the nose which are located under the integument are named the pyramidalis nasi, the levator labii superioris alaeque nasi, the dilatator naris, anterior and postior, the compressor nasi the compressor narium minor, and the depressor alae nasi. The integument is thin over the sides and dorsum and only connected limply to the subjacent components. It becomes thicker and more compact at the tip of the nose. You may notice a fair amount of visible follicles on the tip called sebaceous follicles. The mucous membrane that forms the lining of the nose inside joins continuously with the artery of the skin and with that lining the nasal fossae.

Lastly, the arteries are called the lateralis nasi, from the face, and the inferior artery of the septum from the superior coronary. These arteries carry blood to the alae and septum. It is through the nasal branch of the ophthalmic and the infra-orbital that the dorsum and sides are supplied though. The veins end in the facial and ophthalmic.

The nerves are derived from the facial, while the skin receives its branches from the infra-orbital, infratrochlear, and nasal branches of the ophthalmic.

This is by no means an exhaustive discussion of the nose’s anatomy. It may give you an idea what to ask your surgeon about though, or a better understanding of what your surgeon suggests to you.

Who Should Consider Rhinoplasty?

If you are looking to change your appearance, Rhinoplasty may help you achieve a look that is closer to your ideal, but it won’t necessarily perfect that look. It is important to approach Rhinoplasty with realistic expectations. Rhinoplasty will not necessarily change other peoples’ perceptions of you, but it may change your own self perception in a positive way. If you are seeking to improve your self image but understand that nasal surgery will not automatically solve all of your problems or bring you perfection, you may be a prime candidate for Rhinoplasty. It is also important that you be in good physical health before you consider surgery.

Rhinoplasty can help other people too. Those who wish to correct damage from an injury or from a birth defect or even fix a breathing problem may benefit from nasal surgery.

The best candidates for Rhinoplasty are usually adults. If you have a teenager wanting Rhinoplasty, you should consider waiting for them to finish puberty first. Wait till about 15 for girls, a couple more years for boys. This ensures that your child knows more or less their permanent appearance before deciding to alter it. It also gives them time to make the hormonal changes of puberty. If you are the one wanting Rhinoplasty for your child, you should make sure it is what they want, not just what you want.


Planning For Your Surgery

Before your surgery you will have a consultation with your surgeon. The surgeon will want to know the look you are trying to achieve. Drawing into consideration the physical characteristics of your nose and the rest of your face, the surgeon will offer his or her ideas as to what would be the best course of action. Different factors, such as the structure of your bones and cartilage of your nose, the structure of your face, the composition of your skin and your age can play into the outcome of the surgery. These factors may alter the possible result from your expectations, so it’s important for you to consider them as well.

There are different techniques that can be used in the surgery. The surgeon will talk to you about these as well as details of how the operation will be carried out: anesthesia, the location, the price of the surgery and the risks associated. You should be aware that few insurance policies cover cosmetic surgery. If you need the Rhinoplasty to do something more essential though, like fix a birth defect or assist in correcting your breathing, there is a good chance that your insurance will cover it. Make sure that you call your insurance company in advance and ask them to authorize the surgery before you commit.

It is critical that you communicate to your surgeon the details of your medical past pertaining to your nose. If you have already had nasal surgery or injured your nose in any way, even a long time in the past, you must inform the surgeon. Other topics to make sure you cover in your discussion are if you have allergies or breathing problems and if you are currently on any medication, vitamins, herbal supplements or recreational drugs. If you smoke, make sure you let the physician know.

Finally, if you have any questions about the surgery, this is the time to ask your surgeon. Don’t go into a surgery until you are fully cognizant of what you have decided to do and all risks associated.


Preparing For Rhinoplasty

There are instructions to follow before any surgery. For your Rhinoplasty your surgeon will direct you on what and when to eat and drink, whether you can smoke, and whether there are vitamins or medicines or supplements you should stay away from before the procedure. Even washing your face may have specific instructions. If you follow your surgeon’s directives, your procedure will be more safe and seamless.

Don’t forget to ask a friend to drive you back after your procedure is done. You may need to have them available to help you for several days to follow.


Where Will Your Surgery Be Performed?

Rhinoplasty can be performed in a variety of locations. These include a hospital, an outpatient surgery center or an office-based facility. Generally speaking it is most common for surgeons to use outpatient facilities to perform Rhinoplasty. These are more convenient and cost effective for everyone involved. If your surgery is particularly elaborate though, you may have to stay a brief time on an inpatient basis.


Types of Anesthesia

With Rhinoplasty and depending on the specifics of your case and your preferences, you can usually choose either a local or general anesthetic. General anesthesia means you will sleep through the procedure. A local anesthetic leaves you awake but partially sedated. Your nose and the area around it will be numbed though and you won’t feel any pain.


The Surgical Process

What is the actual Rhinoplasty procedure like? This is a relatively short surgery, generally taking only a couple of hours. Sometimes, if your procedure is particularly complex, your surgery may take a longer duration. While you are under anesthesia the skin of your nose will be removed from its structure of cartilage and bone. The cartilage and bone will then be shaped by your surgeon into the new shape that you have decided upon. This process can vary widely based both on what you want corrected and how your surgeon works. After re-structuring is complete, the skin will be placed back over the new shape.

Rhinoplasty can also be performed from inside the nasal cavities. This is usually used in less complex procedures. Sometimes a minute cut is made across the columella, which is the small membrane dividing the nostrils.

After your procedure is finished, your physician may put a splint on your nose to help it conform to its new shape. Other devices that may be used to help steady the septum are nasal packs or plastic splints inside your nostrils.