Articles on Cosmetic Surgery

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.
• 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.

Planning excision of a nasal hump .
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.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.

 

Taping the nose, in preparation for the metal splint

Preparing for the metal splint: the nose is first covered with paper tape in a manner to help maintain the nose's new shape.

 

 

Metal nasal splint in place

After taping, the metal splint is designed and cut and shaped, and it is placed on the nose.

 

 

Metal nasal splint has been taped on the nose

The metal splint is then covered with the tape, to hold it in place. The operation is now completed. The dressing will be removed in one week.