14 October 2013
“ I hate the shape of my nose !” is a frequent lament heard from people who have a problem with the appearance of the nose.
The shape of the nose is mainly due to the bony and cartilagenous skeleton, over which is draped the skin of the nose.
To effect change in the shape, the skeleton has to be altered to allow the skin to drape over the new shape.
A common problem is the dorsal hump, which is due to a prominent bony bridge of nose, and which can be made smaller, to get rid of the “ hump”.
A second problem that causes grief to some is a broad tip of nose (“boxy tip”) , which is also “bifid” or split, with a groove in the middle of the tip of nose. This problem is due to large lower lateral cartilages of the nose, which are also splayed apart. Correction is by reducing the size of the lower lateral cartilages and bringing them together, often with the addition of a cartilage graft from the septum (the cartilage in the midline which splits the nose into two sides).
Surgery is also done to make a large nose smaller, a broad nose narrower and to change ethnic/inherited problems in the shape of the nose.
At times, the surgery is to improve breathing due to blocks caused by a deviated septum, which can be a long-standing problem or due to injury. “ Septoplasty” is surgical correction, which improves the air entry as well as the appearance of the nose.
Rhinoplasty needs meticulous assessment and planning.
While traditionally it was done using a “closed” approach, over the last 30 years, due to the influence of Dr. Jack Gunter, from Dallas, the “open” approach has gained popularity.
It takes time to see the full changes caused by the “ skeletal “ surgery of the nose, as the soft tissue (skin and fat ) has to “ shrink “ over the “ new “ skeleton. While change is evident by three months, a final result often takes up to a year.
The surgery done under general anaesthetic, produces significant improvement in function and appearance.
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