Nasal Tip Plasty result ten days after surgery in a patient with extremely thin skin. External Approach Tip Plasty with following objectives :
Tip Softening
Tip De-projection
Tip- Up-rotation
Septo-rhinoplasty for function
Category: Uncategorized
Anatomy of Hump Reduction Rhinoplasty: Finesse in Rhinoplasty: The Nose Clinic in Ireland.
Hump Reduction is probably one of the most common requests for Rhinoplasty surgery in Ireland and quite often patients request a surgery that is restricted to the dorsal hump alone. The Finesse however is achieved only when all aspects of the nose are allowed to be harmonious and allow seamless aesthetic lines.
Notice above areas in this Before and After set where EAFPS guidelines for clinical photographs were adhered to
Slight de-projection of the nasal tip.
Naso-labial angle is less obtuse
A: Radix has been advanced
B: A smooth bone-cartilage transition
C: Supra-tip break
D: Columellar double break and the subtle healing scar of external approach few months after surgery.
Critique : A mm of reduction at the K area would enhance the result further. This however may be achieved with healing over the year.
Some areas have been covered to completely protect the identity of the person.
Rhinoplasty in a young person : 18 is not a magic number !
This 15 year old young lady had severely deviated nasal Cartilagenous septum that completely blocked her Right nasal airway. The bony septum was severely deviated to Left causing a Left nasal blockage. The Maxillary crest was positioned far towards the Right and the lower third of the nose in particular presented an asymmetrical structure. This lovely young lady who is an active athlete, was disadvantaged both Functionally and Cosmetically.
Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region. Some authors, however, have claimed a paucity of evidence that such untoward effects of surgery are frequent. Research has shown that surgical intervention limited to certain areas of the bony and cartilaginous nasal framework is less likely to affect natural growth patterns. There is a growing consensus toward early intervention, especially in a select group of patients, where deferring the surgery may turn out to be the poorer option in the short and the long term, and suggestions have been made that conservative guidelines may be employed to minimize the unwarranted results.
Reconstructed CT Scan of Nose & Paranasal Sinuses
3D Reconstructed CT Sinuses show the anatomy of bony septum and maxillary spine-crest
Anterior Rhinoscopy diagram in Clinic
CT Scan Of Nose & Paranasal Sinuses
Completely blocked Right nasal airway
Mostly blocked Left due to an Internal Valve Stenosis
Nasoendoscopy and Photo-documentation of the Airways
Understanding the external changes based on the infrastructure
IN-SITU “Extracorporeal Septoplasty” type steps were utilised to achieve this result.
To protect the identity patients eyes have been digitally morphed and area covered by text. Patient and mother have kindly consented to share these pictures on the blog as this particular case has several teaching messages for patients needing and surgeons offering Nose surgery at a young age.
Sometimes waiting for the pubertal mid-Facial growth spurts to finish around 18years is not the best option.
15 years old girl
Severely crooked nose
Severely blocked nose
Plan : Cosmetic & Functional Septo-Rhinoplasty
Because …
Deferring surgery here till she is about 18 years old would be the poor choice.
The chances of Revision surgery here are high as the mid-facial growth continues through the growth spurt
Improvement as reported by patient at four months after surgery
Breathing improved from 2/10 to 9/10
Appearance improved from 3/10 to 10/10
Rhinoplasty Aftercare : Professional standards of care during this anxious period.
Recovery from Rhinoplasty can be an anxious period especially if you do not have adequate access to your surgeon and their team.
The weeks approaching the surgery date :
You are informed about your journey and minimising the surprises allays your anxiety.
Your surgeon shows and describes examples of swelling, bruising and any scars from planned incisions. This is part of your second preoperative consultation routinely.
The day of Surgery. You are admitted on the day and routinely spend that night at the hospital. A very gentle pack is placed in your nostrils that literally slips out as your surgeon or a nurse removes it next morning
Day after the Surgery: after pack removal you rest for a few hours before you are taken home by a friend or a family member.
Day 2 – Day 7: You are advised to rest at home.
SLEEPING : Sleep propped up and with big pillows on your sides so as not to traumatise your nose.NOSE BLOWING & SNEEZING : You are advised not to blow your nose and keep your mouth open if you sneeze.
ITCH: You may use antihistamines if the face and nose get itchy.
BRUISING: is minimal with atraumatic techniques but skin characteristics make some patients more likely to get them.
PAIN: usually painless but you are prescribed pain relief
BLEEDING: oozing common first few days. Frank bleeding is rare and you must contact your surgeons team. You will have 24/7 access with a mobile number
SWELLING: usually peaks a few days after the cast removal … roughly 10 days after surgery and subsides gradually. Most of the swelling subsides from 3-6 months. Smaller changes are recorded upto 12 months and even afterwards as annual pictures show.
Day 7 (First postoperative review by surgeon ): The cast over the nose and any sutures or splints come out. This day also you should arrange an escort to drive you.
Day8 – Day 14 : Second week of rest
CARE OF COLUMELLAR SCAR: clean around the incision line but not on it directly. Keep covered in vaseline.
Day 28 Approximately : Second postoperative review
3 Months Review
6 months review
12 Month Review
Annual Review
Patients who have no concerns and do not wish to be followed up long-term are advised to contact us if and when required.
Clinical pictures are taken at every visit to follow the healing pattern
Individual routines may vary and if you have questions you must ask us
