Rhinoplasty

Excerpt

Rhinoplasty is one of the most popular surgeries worldwide. In the United States alone, more than 200.000 were performed in 2018, rendering it the third most conducted plastic surgery in the country.

The procedure has significantly changed over the years since the first aesthetic procedure described by John Roe in 1887. This long evolutive process was not only technical but also and more critically, philosophical. In pursuance of better and more consistent results, the reduction-only concept in nasal surgery was progressively substituted with a more proportional approach, using a combination of careful reduction and grafting. Such advancements were possible mainly due to a better understanding of the anatomical structures and by the works of great surgeons like Joseph and Sheen. They described a number of techniques that we still use today.

Despite this shifting of the paradigm, rhinoplasty remains presently one of the most complex surgical procedures in Plastic Surgery. As a central landmark of the face, nasal proportions and symmetry are directly linked to facial beauty. Technical difficulties, the wide range of different techniques described, and the struggle to achieve consistent results can be challenging even for very experienced surgeons.

The anatomical variations of inner structures and different thicknesses of soft tissue envelopes contribute to the difficulty of making “the same nose in every patient.” Furthermore, there’s no such thing as an “ideal nose” since a nasal configuration that may suit one patient’s face might be very different for another.

Rhinoplasty is not exclusively a cosmetic procedure. The surgery also aims to maintain nasal function or improve it if the patient has reduced airflow due to an obstructive process. This adds to the complexity of the operation as internal nasal structures have to be modified in order to correct functional issues.

All of these factors combined can explain why rhinoplasty is also such a rewarding surgery, which can provide highly favorable outcomes.

A correct selection of surgical patients, along with thoughtful preoperative analysis and planning, are critical steps for enhancing rhinoplasty results and also preventing secondary procedures.

In this chapter, we will review many relevant aspects of aesthetic nose surgery, focusing on closed rhinoplasty, so that the reader can have a general understanding of the subject and develop a logical and insightful approach to it.