Rhinoplasty-Tip Definition

Rhinoplasty procedures vary on a continuum from very significant changes to minor changes. There may be many characteristics of a nose that the surgeon or patient would like to maintain.

It is common in rhinoplasty procedures for the tip to be adjusted to a more defined appearance. Defining the nasal tip can often be performed by removing excess lower lateral cartilage, defining the domes of each upper lateral cartilage, and the addition of a tip graft. The degree of tip definition should be proportional to the remainder of the nose and the facial characteristics.

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Rhinoplasty

Rhinoplasty is a commonly performed procedure. One of the more commonly requested reasons for a rhinoplasty is a nasal tip that drops when a person smiles. Typically, these patients have a dorsal hump as well as a nasal tip that lacks projection.

To surgically correct this, the nasal dorsum is resected, the caudal septum is resected, and a columellar strut is placed to improve tip projection. To allow the nose to appear more feminine, the nasal tip needs to be elevated so that the columella-labial angle is greater than approximately 100 degrees in the female.


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Rhinoplasty

Rhinoplasty is one of the more commonly performed aesthetic procedures. Patients may have one of several reasons for improving the appearance of their nose. Patients typically undergo rhinoplasty procedures at the same time that they undergo corrective airway surgery.

One of the more common reasons for aesthetic rhinoplasty is to define or narrow the nasal dorsum or to refine the nasal tip. When the nasal tip is improved with cartilage resection and/or tip defining sutures, the nose often takes on a softer or more feminine appearance.

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Rib Graft Rhinoplasty & Airway Reconstruction

Rhinoplasty is one of the more common procedures performed in my aesthetic practice. Some of the more common aesthetic reasons for wanting to improve the appearance of the nose include: 1) dorsal hump, 2) wide dorsum, 3) deviated nose, and 4) nasal tip that lacks support.

When cartilage is needed to straighten a deviated nose or to provide tip support, then rib cartilage is often the best quality and of ample quantity to perform the correct maneuvers.

When correcting the dorsal hump, it is important to make sure that the nasal tip has adequate projection and tip support.

While patients are placed in a splint for one week post-operatively, I have patients tape their nose for 4 weeks post-operatively. Following the four weeks when patients return to exercise, patients should tape their nose at night.

Post-operatively, patients may choose to undergo hyperbaric oxygen therapy to improve their swelling post-operatively.

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Rib Graft Rhinoplasty & Airway Reconstruction

 

Correction of a high deviated nasal septum often requires the placement of a spreader graft to straighten the dorsum. Rib grafts allow an ample amount of sold cartilage to keep the deviated nasal septum straight and buttress the internal nasal valve. When these maneuvers are performed, they improve the airway as well as improve the aesthetic contours of the nose. Tip defining sutures and lateral crural strut grafts can help provide improved tip definition.

Typically, the rhinoplasty consultation takes two sessions to make sure that the surgeon and the patient are on the same page with regard to the correct aesthetic look. I routinely ask patients to bring in photographs of noses that they like so that we can try to match as closely as possible their desired aesthetic look.

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Rhinoplasty & Airway Reconstruction

Rhinoplasty continues to be one of the most rewarding aspects of my practice. Not only is it rewarding to improve one's breathing, but also to improve the appearance and shape of one's nose. For complex rhinoplasty requiring maneuvers to increase tip projection or augment the radix, I prefer the use of rib graft and temporalis fascia.

I find that one needs ample cartilage for spreader grafts, columellar strut grafts, and lateral crural strut grafts to correct the common parenthesis deformity of the lower lateral cartilages. I am very thankful to have had great training from an excellent mentor.


Brian P. Dickinson, M.D.

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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