Reduction of the Nasal Dorsum in Aesthetic Rhinoplasty & Airway Reconstruction.

Airway obstruction is a common problem. Airway obstruction can exacerbate allergies and can significantly impair a good night's sleep. Quite often, the surgical maneuvers that are used to correct the airway are also manauevers that can improve the appearance of the nose.

When patients undergo corrective airway surgery, often a deviated septum is straightened, the inferior turbinates are reduced, and the internal and or external nasal valves are supported. Post-operatively, patients are required to have nasal stents stay in the nose and an external splint placed on the nose if a fracture of the nasal bones is required. The nasal stents remain in placed for 5 to 7 days and the external splint remains in place for the same time period.


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Narrowing a Broad Nasal Dorsum in Aesthetic Rhinoplasty

Great care must be taken when adjusting a deviated septum and when narrowing the broad nasal dorsum in aesthetic rhinoplasty. It is important that the width of the nasal dorsum maintain appropriate proportion with the medial canthus of the eyes as well as the nasal base. This allows appropriate proportions and maintains the aesthetic balance of the nose.

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Rhinoplasty & Airway Reconstruction

In nasal airway surgery, it is a great compliment when involuntarily the patient closes her mouth and breathes through her nose in the post operative photograph.

One of the more interesting observations in my patients is the ancillary findings on physical examination. Usually, I appreciate an unintentional open mouth smile in my post-operative photographs. However, for airway reconstructions, I am most pleased when the mouth is involuntarily closed. In these cases, I am convinced that the nasal airway is patent and the airway surgerywas successful.

At this point in my career, I have found that an optimal view of a deviated septum and it's correction with spreader grafts is best obtained via an open rhinoplasty incision. This approach allows separation of the lower lateral cartilages, visualization of the entire septum, and an optimal view through which to perform septoplasty. The harvested septum is then used for spreader grafts to support the internal nasal valve. I have been very happy with the use of septal cartilage for lateral crural strut grafs to stabilize the external nasal valve.

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