Rhinoplasty has a history spanning over a century, with solid silicone currently being the most ideal filler material. Experts explain that the multitude of rhinoplasty techniques offers hope to many individuals with flat noses. So, how can rhinoplasty be performed safely and effectively for various nasal deformities?
Rhinoplasty ranks among the most frequently performed cosmetic surgical procedures, primarily addressing saddle nose deformities and mildly low nasal bridges. A saddle nose manifests as a downward-sloping nasal bridge resembling a saddle, an upturned nasal tip, and nostrils pointing upward. This condition may be congenital or acquired due to syphilis, trauma, or medical interventions.
Generally, saddle nose deformities are classified into simple and complex types, with severity categorized as mild, moderate, or severe. Mild: Low nasal bridge with normal nasal tip height. Moderate: Low nasal bridge and tip, with noticeable bridge depression. Severe: Marked depression of both bridge and tip, often accompanied by nasal bone and septal deformities.Simple saddle nose can be corrected using methods such as medical silicone implant rhinoplasty or artificial bone rhinoplasty. Complex saddle nose typically requires modified complex saddle nose correction techniques or transverse nasal dorsum extension methods for optimal results.
Rhinoplasty Surgical Methods
1. Marking.Draw the nasal midline using the nasolabial folds and the inner canthi of both eyes as reference points. The starting point is the midpoint between the inner canthi and the line connecting the eyebrows.
(2) Vestibular incision: Make a slightly medial incision on the upper third of the columella, extending to the highest point of one nostril margin.
(3) Butterfly incision: Make a slightly medial incision from the highest point of one alar base, through the columella, to the highest point of the opposite alar base.
(4) Combined vestibulocollum incision: Make an incision along the junction of skin and mucosa at the highest point of one nostril, extend it along the junction of the columella and nasal septum to the base, traverse the junction of the columella and upper lip, return to the highest point of the opposite nostril, and then connect the incisions on both sides of the columella. Naturally, in rhinoplasty, we should prioritize incisions that cause minimal damage and offer excellent concealment.
3. Preoperative Preparation. Trim nasal hair. Mark the midline starting point with a tape marker. Disinfect the dorsum, lateral nasal areas, and nasal cavities. Pack the nasal cavities with cotton balls.
4. Anesthesia. Using a 2% lidocaine solution, inject along the tangent line from the nasal tip to the nostril, with the height line extending from the nasal tip to the nasal root. Advance the needle while injecting the anesthetic. Then withdraw the needle, redirecting it from the nasal tip toward the columella. Advance the needle while injecting the anesthetic, positioning the needle tip against the maxillary alveolar bone. Withdraw again toward the nasal tip, redirecting toward one side of the alar base while advancing and injecting.
5. Incision. Incise the skin or periosteum to subcutaneous tissue along the pre-planned incision line. Use ophthalmic scissors to evenly dissect the nasal tip tissue. Shift to the midline of the opposite nasal bridge, advancing and dissecting simultaneously until reaching the junction of nasal cartilage and bone. Lift the scissor tail and transect the deep fascia of the nasal dorsum horizontally.then advance the scissors to 1mm above the golden point. With the left hand, stabilize the area to be dissected on both sides of the nasal dorsum. Separate the scissor tips while retracting toward the nasal tip. Apply even force during dissection, maintaining an appropriate tunnel width. If implanting an L-shaped prosthesis, after reaching the nasal tip, redirect the scissors toward the columella and dissect vertically down to the alveolar bone.
6. Implant Placement. Insert a 2mm-wide, 1mm-thick stainless steel guide into the dissected tunnel. Grasp the pre-shaped implant with hemostatic forceps and advance it along the guide. Withdraw the nasal guide, then use hemostatic forceps to position the implant appropriately. Grasp the columellar portion of the nasal model and insert it into the dissected columellar tunnel.
7. Contour assessment and incision compression. Due to the loose tissue at the nasal root, swelling is common after rhinoplasty, obscuring the immediate outcome. Therefore, apply bilateral gauze compression for 3-5 minutes to control bleeding and reduce swelling.Once the shape is satisfactory, suture the incision with 5/0 or 6/0 cosmetic sutures. Clear blood from the nasal cavity with saline-soaked cotton balls, check for any nasal cavity perforations, then apply a small amount of chlortetracycline eye ointment to the incision. The nasal implant is placed beneath the deep fascia of the nasal dorsum and generally remains stable, so no impression splint or adhesive tape is needed for fixation.