Result at the end of reduction rhinoplasty surgery


CASE ONE  22F


This young professional lady wanted a very conservative hump reduction.
Tip projection has been reduced
Naso-labial angle changed
Double break introduced to the shortened columella.
Critique: Supratip region to be followed carefully during the first year of healing.
Patient Satisfaction 10/10 ! 

 

CASE TWO 27M

 

Young male


In this case of exaggerated dorsal hump 
The naso-labial angle and the Nasal spine -septal cartilage junction has been addressed
Slight up rotation of nasal tip
External approach markings and repair are evident

Irish men who have suffered nasal trauma and suffer nasal blockage and cosmetic deformities are excellent patients as they generally have realistic expectations and we meet, advise and operate on them every week.

This young man suffered several nasal injuries and once he decided he needed a functional and cosmetic improvement … he had several meetings at my clinic where his exact requirements were noted and a surgical plan was made and executed.

Half the Rhinoplasty referrals in our practice now are for Revision Rhinoplasties.

Our observations:

By and large the practice of Cosmetic Nasal Surgery in Ireland is conservative and the unsatisfactory results from the patients point of view are commonly due to acts of omission rather than commision … meaning that most patients complain that enough was not done. This is not a bad thing as surgical intervention within a surgeons comfort zone is only to be applauded.

Cartilage depletion is thankfully not that common when the previous surgery was performed by Ireland based and Irish-trained surgeons who generally have a commendable conservative approach. This is also the reason why we do not see Frontal Sinus disease to the same extent as in some other countries where a large proportion of Sinus surgeons perform radical Endoscopic Sinus Surgery leading to scarred fronto-nasal duct area and consequent Frontal sinus complications..


Recently I have come across several candidates of Revision Rhinoplasty where the clinical situation is muddled by the use of Non-Surgical Rhinoplasty techniques employing fillers and injectables. Skin vascularity and subcutaneous tissue planes and their thickness in these cases are difficult to evaluate. At present I am employing a wait and watch policy to allow these tissues to settle down as the fillers get absorbed, before offering surgical intervention and Revision surgery. In an ideal world only surgeons equipped to perform primary and revision rhinoplasty would practice these non-surgical techniques so that they can offer the next step up when the fillers and injectables are inadequate or inappropriate.

Nasal valve compromise is a common finding in Revision Rhinoplasty.

One of the most respected rhinoplasty surgeons of our generation, a surgeon from east coast USA, once disclosed that he does not accept other surgeons cases for revision surgery as it exposes his reputation to work done by others.

Surgeons Reputation in Rhinoplasty surgery is built over decades and protected with Zeal … but the surgeons who have developed the requisite skill set needed to rectify mistakes, their own and others, should make them available to patients who suffer both functional and emotional distress if the primary surgery is not a success.

The septal deviation of the lower part of the cartilaginous nasal septum is generally the septal deviation that blocks the nasal airways.


Such DNS (Deviated Nasal Septum) is readily corrected, with improved airway, when the septum is repaired through the Septoplasty. 


In some cases the higher part of nasal septum is also deviated, making the uppermost part of the triangular airway very narrow and disrupting the natural laminar flow of air through the nasal cavity.


This compromised area is also the culprit in some cases of failed Septoplasty where the Nasal Valve Compromise has either not been recognized or not been addressed adequately.


In Cosmetic and Functional Rhinoplasty “Spreader grafts” are sometimes employed to keep the ULC-NB(Upper Nasal Cartilage-Nasal Bone complex) adequately separated from the antero-superior (Dorsal) part of nasal septum – along the slope of the nose.