Rhinoplasty Surgery Results
One of the most difficult surgeries a cosmetic plastic surgeon can perform is a rhinoplasty, or nose surgery. This cosmetic procedure is difficult for most plastic surgeons for a number of reasons:
- Not many opportunities to perform rhinoplasty in cosmetic plastic surgery training
- Wide anatomic variation between individuals and races
- Need for the plastic surgeon to have an artistic eye
- Need for precision surgery
- Cartilage by nature will warp after surgery—degree of warping is unknown
- Healing process of the nose is special
Since most cosmetic surgeons find rhinoplasty surgery exacting, they will typically perform the surgery themselves and not allow a resident or fellow in training to do the surgery. But this is how surgeons learn how to perform surgery—by performing the surgery under the watchful eye of a teacher.
One of my professors told me that I should not charge my patients for the first 20 rhinoplasties, as I would be learning along the way!
Even if the plastic surgeon has seen many cases, nose surgery requires exactness to the millimeter. Few cosmetic surgeons will give the knife to someone else for that level of precision.
Plastic surgeons do learn how to perform rhinoplasties through their experience with:
- Trauma cases in which the nose is damaged and has to be repaired
- Anatomy classes and rhinoplasty teaching courses with cadavers
- Surgery on clinic patients who have rhinoplasty performed by plastic surgery fellows at a discounted price
Finding an experienced surgeon is even more important than usual for rhinoplasties.
Anatomical variation in the nose
We all know the wide variation that exists in noses. We talk of the Roman nose, the Middle Eastern nose, the African nose and the Asian nose.
Racial variation in noses is due to differences in the amount of bone and cartilage in the nose as well as the flexibility of the cartilage. The African nose, for example, has less rigid cartilage than the Caucasian nose.
The differences in anatomy have a direct effect on the nature of healing and the cosmetic results.
Artistry in nose surgery
There are well-researched angles and relations between the different parts of the nose and the nose and surrounding structures of the face. These relations can be measured and provide a certain amount of standardization in the plastic surgeon’s approach to nose surgery. Despite this, an “artistic eye” is essential for to prevent a less-than-great result.
Precision in rhinoplasty
Some of the changes that can occur with rhinoplasty surgery are a matter of millimeters of bone or cartilage being added or removed. Even one millimeter makes a difference in the shape of the dorsum (top) of the nose, influencing whether you will have a straight top or a curved nose.
In some surgeries, one adds cartilage to one place and removes it from another to achieve the desired result. Being exact is imperative in rhinoplasty surgery, as there is little room for error.
Cartilage in the nose has a tendency to warp, much like the way a piece of wood warps.
At times, the very ability of cartilage to warp is used to the plastic surgeon’s advantage, such as in cases of otoplasty (ear surgery).
In rhinoplasty, though, warping is usually a problem and unwanted. The surgeon cuts and sutures the cartilage to the desired shape, and then warping comes along and changes everything. The degree of warping, and even whether it will occur in a particular patient, is unknown and unpredictable.
The healing process
All parts of the body heal in the same way, by formation of scar tissue. However, in nose surgery, where minute amounts of cartilage and bone are being removed or replaced, the very same scarring can cause a cosmetic nullification or worse of the rhinoplasty. You remove a cartilage hump and the excessive scarring adds another hump. You remove the scar and more forms!
Steroid injections are sometimes required to slow down the scarring, but nevertheless, 10% of cosmetic rhinoplasties need a touch-up surgery.
As with all other areas, the more surgeries you have in one area, the more scar tissue forms and the more difficult subsequent surgeries and their healing processes are.