Rhinoplasty: Reshaping the nose
	By Dr. Jeffrey A. Fialkov M.D., F.R.C.S.C. www.plasty.ca View Dr. Fialkov's profile

Plastic surgery of the face, perhaps more than any other region of the body, demands the utmost precision and skill of the plastic surgeon. Foremost amongst available facial cosmetic procedures, both in popularity and in the degree of precision demanded of the surgeon is rhinoplasty, or septorhinoplasty, literally: reshaping the nose. The need for precision in rhinoplasty surgery arises as a result of a number of factors:
		Before and After Rhinoplasty

1. The nose is one of the most prominent facial features. It is in the centre of the face, and if disproportionately large, small, wide or asymmetrical, it can distract an onlooker from other facial features such as the eyes, and dominate an aesthetic “first impression”.

2. The nose itself is small relative to other body features. Moreover, features of a nose (the tip, the bridge, the nostril size, etc.) are measured in millimeters. What may seem like a very large bump on the nasal bridge to the self-conscious patient may only measure 4 or 5 millimeters in its abnormal dimension. For this reason, the correction of these disproportions and asymmetries must be carried out as accurately as possible to maximize the predictability of the results of surgery.

3. The normal function of the nose (respiration, warming and moisturizing air, as well as resonance for speech) depends on the precise dimensions and structural relationships between internal parts of the nose. In order to maintain and/or improve these, the surgeon requires a knowledge and appreciation of these dimensions, which, again are measured in millimeters.

The rhinoplasty surgeon may use a number of tools to optimize his or her accuracy and precision during the surgical procedure. Pre-operative photographs, measurements and a careful physical examination to determine a plan for surgery are only some of the measures the surgeon may take to optimize a patients result.

Furthermore, a technique known as “open” septorhinoplasty may be utilized by the surgeon, depending on the complexity of the reshaping, in order to better visualize the underlying nasal structural tissues (namely cartilage and bone). This approach requires the use of a small incision at the bottom of the nose (the small skin bridge between the nostrils known as the columella) which is not used in the “closed” approach. The operation usually takes a little longer than a closed septorhinoplasty but may, depending on the situation, improve the precision. Swelling may also take longer to resolve with an open approach.

At the completion of the procedure, the surgeon will apply special tapes and a splint to the nose. This is generally thought, by the patient, to act much as a cast would to hold the “broken” nasal bones in place. This is not quite the case. Although the nasal splint may be used to stabilize the nasal bones after they have been shifted, the dressing (including the underlying tapes) is also used to conform or drape the overlying skin around the new underlying cartilage and bone structure. This too is a measure taken by the surgeon to optimize the precision and predictability of the results. If you imagine, for a moment that as a patient you have a bump on the bridge of your nose that is 5mm in height, and bleeding under the skin can result in scar tissue (under the skin) measuring 1 or 2 mm, it is not hard to imagine that without closing off that potential space under the skin after removing the bump, you’re results may be only 3/5 of what you had hoped for.

Inherent in the detailed nature of rhinoplasty surgery is the possibility of imperfections. In the hands of a qualified plastic surgeon, however, this risk, as well as those risks inherent in any surgical procedure is minimized, and the likelihood of patient satisfaction is optimized.

Dr. Jeffrey Fialkov is Assistant Professor of Plastic Surgery at the
University of Toronto and a staff Plastic Surgeon specializing in facial
surgery at Sunnybrook Health Science Centre