The nose consists of two bones and five cartilages.
- two nasal bones – one on either side at the top
- two upper lateral cartilages – one on either side
- two Lower lateral cartilages – at the tip
- one septum – in the middle
Likewise, rhinoplasty is divided into full rhinoplasty, dealing with the nasal bone and cartilage, and tip rhinoplasty, which deals only with the cartilage.
In tip rhinoplasty, only the end cartilages of the nose are operated on. The cartilages are usually trimmed and made narrower to pinch in the nose and/or sewn together to narrow or elevate the tip. Nose tip surgery can be performed under local anesthesia as an outpatient procedure. Recovery takes one week, though the nose can be swollen for months.
A full rhinoplasty involves breaking the nasal bones at their juncture with the cheek in order to bring them together and narrow the nose. This is necessary every time a hump is removed from the nose, as this causes a flattening of the top of the nose, as in a boxer’s nose, which then needs narrowing. Tip cartilage is also operated upon to get a narrower shape that matches the narrower bone. Full rhinoplasty is done under general anesthesia as an outpatient surgery. Recovery takes one week and requires a cast to keep the bones in place. Patients need up to one year for full healing.
The art of rhinoplasty
Even though many plastic surgeons are proficient at the technique of rhinoplasty, few actually perform them, as they seem to lack the art required for this cosmetic surgery.
As opposed to some other cosmetic procedures, the plastic surgeon really needs to have an artistic appreciation of the relationships between the nose and other parts of the face such as the chin to perform a successful rhinoplasty. Rhinoplasty involves changes in millimeters of bone and cartilage, causing changes of great amplitude in the face. There are a number of ratios and relationships the plastic surgeon learns during training, but in the end it comes down to having an eye for the result the cosmetic patient wants, not what the plastic surgeon wants!
It is imperative that the cosmetic surgeon spends the time to really understand what it is the patient wants and expects to avoid disappointment. Using medical imaging can sometimes help the patient understand their options better.