Rhinoplasty (Greek: Rhinos , "Nose" + Plassein , "to shape") is a surgical procedure which is usually performed by either an otolaryngologist-head and neck surgeon, maxillofacial surgeon, or plastic surgeon in order to improve the function (reconstructive surgery) or the appearance (cosmetic surgery) of a human nose. Rhinoplasty is also commonly called "nose reshaping" or "nose job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. Rhinoplasty can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.
History
Reconstructive nose surgery was first developed by Sushruta, an important Ayurvedic physician in ancient India, who is often regarded as the "father of plastic surgery." Sushruta first described nasal reconstruction in his text Sushruta Samhita circa 500 BC. He and his later students and disciples used rhinoplasty to reconstruct noses that were amputated as a punishment for crimes. The techniques of forehead flap rhinoplasty he developed are practiced almost unchanged to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October, 1794).
The precursors to the modern rhinoplasty surgeons include Johann Dieffenbach (1792-1847) and Jacques Joseph (1865-1934), who used external incisions for nose reduction surgery. John Orlando Roe (1848-1915) is credited with performing the first intranasal rhinoplasty in the U.S. in 1887.
Prior to the 1970’s, all rhinoplasty surgeries were performed via the intranasal approach, which is often called closed rhinoplasty. However, in 1973, Dr. Wilfred S. Goodman published an article entitled "External Approach to Rhinoplasty" which helped initiate a shift in rhinoplasty techniques to what has become known as the open rhinoplasty. The open rhinoplasty technique was further refined and popularized by Dr. Jack Anderson in his article “Open rhinoplasty: an assessment”. The open approach to rhinoplasty gained in popularity during that time, but it was used mainly for first-time rhinoplasty surgery and not for revision rhinoplasty.
In 1987 Dr. Jack P. Gunter, who trained under Dr. Anderson, published an article describing the merits of the open rhinoplasty approach for secondary rhinoplasty. This was a major shift in the approach to treating nasal deformities that arose from a previous rhinoplasty.
Surgical procedures and types
Surgical approach: Open vs. closed
Rhinoplasty can be performed under a general anesthetic, sedation, or with local anesthetic. Initially, local anesthesia, which is a mixture of lidocaine and epinephrine, is injected to numb the area and temporarily reduce vascularity. There are two possible approaches to the nose: closed approach and open approach. In closed rhinoplasty, incisions are made inside the nostrils. In open rhinoplasty, an additional inconspicuous incision is made across the columella (the bit of skin that separates the nostrils). The surgeon first separates the skin and soft tissues of the nose from the underlying structures. The cartilage and bone is reshaped, and the incisions are sutured closed. Some surgeons use a stent or packing inside the nose, followed by tape or stent on the outside.
In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone, as a graft, to strengthen or change the shape of the nose. Usually the cartilage is harvested from the septum. If there isn't enough septum cartilage, which can occur in revision rhinoplasty, cartilage can be harvested from the concha of the ear or the ribs. In the rare case where bone is required, it is harvested from the cranium, the hip, or the ribs. Sometimes a synthetic implant may be used to augment the bridge of the nose.
The incisions for a rhinoplasty are hidden inside the nose, with the exception of a small incision across the base of the nose, depicted by the dotted line.
The incisions allow the surgeon to see the size and shape of the cartilages and bones on the inside of the nose, so that they can be altered.
Here, the scissors are pointing out the lower lateral cartilage (in blue), which is one of the cartilages that gives the tip of the nose its shape. The red line shows the location of the planned incision across the bottom of the nose.
Once the skin has been lifted from the bone and cartilage framework of the nose, often the first task is to remove a hump, if one is present. Part of the hump is made of bone, and part of the hump is cartilage.In the photograph, the black line shows the desired profile. The nose is made of bone above the scalloped grey line and cartilage below that line. The part of the hump made of bone is shaded red, and the part of the hump made of cartilage is shaded blue.
The soft cartilage of the hump is removed with a scalpel, and the bony hump is often removed with a chisel, shown at the top of this photograph. "Osteotome" is the medical term for a chisel. This photograph also shows the copper hammer that is used with the osteotome.
After the main part of the hump is removed with an osteotome, files are used to smooth out the remaining bone. The files are also called rasps, and they come in different shapes, orientations, and grades.Some surgeons use rasps to remove the entire hump, foregoing use of the osteotome.
A common complaint is that the tip of the nose is too wide. Many surgical techniques are available to narrow the tip of the nose, depending on what is causing the excess width.In this photo, a suture is being placed to narrow the tip of the nose. The red line outlines the edge of the tip cartilage, which is narrowed when the suture tightens the fold of the cartilage at its apex. The suture is in light blue, ending in the needle, which appears white in the photograph. The cartilage is being held in place with tweezers, which are shaded green.
If the position of the nasal bones gives excess width to the upper part of the nose, the bones are moved inward, to a more narrow position. This skull shows in blue the position of the bones in the nose. For orientation, the eye sockets are outlined in red.
To narrow a nasal bone, two cuts are made in the bone with a tiny chisel: one cut starting at the yellow dot and extending up along the green arrow, and another cut starting at the blue dot and extending out along the black arrow. The piece of bone thus loosened from the skull is pushed inward, narrowing the nose.These chisel cuts are made from underneath the skin, so there is no scar in the area after healing.
At the end of the procedure, after the incisions are closed, the nose is dressed, to hold it securely in place as it heals.This photo shows the nose just before the dressing and splint are placed. The purple marks on the nose guided the surgeon in making accurate cuts in the bone during surgery.
Preparing for the metal splint: the nose is first covered with paper tape in a manner to help maintain the nose's new shape.
After taping, the metal splint is designed and cut and shaped,
Chicago Cosmetic
Conveniently located in Downtown Chicago's vibrant River North neighborhood, Chicago Cosmetic Surgery and Dermatology is a ...
Dental Implants, Wisdom Teeth Removal, Oral Pathology In Chicago
Lincoln Park Institute For Oral & Cosmetic Surgery Offers Dental Implants, Wisdom Teeth Removals, Treatments For Facial Trauma, Bone Grafting, TMJ Disorder Treatments, Ridge ...
Chicago Plastic Surgery - Cosmetic Surgeon Chicago - Dr. Ghaderi
Dr. Ghaderi is a St. Charles plastic surgeon who specializes in helping Chicago area plastic surgery patients to enhance their appearance and self confidence.
Chicago Cosmetic Surgery Procedures & Illinois Plastic Surgery
The best Chicago Cosmetic Surgery Procedures in Illinois, Dr. Jenifer Hein & Dr. Ann Marx offer a variety of cosmetic procedures to patients. Call 1-800-DEFY-AGE
Chicago Plastic Surgery | Cosmetic Surgeons | Chicago, IL
Three of Chicago's top double-boarded cosmetic & plastic surgeons specializing in Smartlipo, breast augmentation, liposuction, and plastic surgery in Chicago, IL.
Cosmetic surgery Chicago
Plastic, Reconstructive and Cosmetic Surgery, Dr. Turowski MD, Ph.D., FACS, Chicago and suburbs
Cosmetic Surgery Office in Chicago, Illinois Cosmetic Plastic Surgeon ...
Dr. Pensler is a Chicago, Illinois plastic surgeon specialist for breast augmentation liposuction rhinoplasty facelift blepharoplasty gynecomastia breast implants, plastic surgery ...
Jay M Pensler, MD - Cosmetic Surgery Chicago
Jay M Pensler, MD 680 N Lakeshore Drive Suite 1125 Chicago, Illinois 60611 312.642.7777
Cosmetic Surgery Chicago Illinois - Cosmetic Surgeons Chicago IL
Considering cosmetic Surgery in Chicago Illinois? Learn about saline breast implants and silicone breast implants. Find out if liposuction or a tummy tuck is best for you. Find a ...
Plastic surgery, cosmetic procedures, Chicago, Illinois
A medical practice in Chicago, Illinois (IL), Loop specializing in non-surgical cosmetic surgery procedures and skin maintenance procedures as an alternative to plastic surgery.