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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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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Narrowing the Broad Nasal Dorsum in Ethnic Rhinoplasty

It is common for many Asian and African American female patients to come to my office requesting that their nose be narrowed. Traditionally these patient often are very happy with the appearance of their face, but find that the dorsal nasal lines are not appreciated in photographs. Quite often I hear the comments, "Dr. D I hate my nose in photographs!...Can you help me?"

The question then is how to narrow the ethnic nose while maintaining it's ethnic proportion and look. I find that the nasal dorsum can be effectively narrowed with medial and lateral osteotomies to produce a very elegant contour and dorsal nasal line. If a patient wants further augmentation of the dorsum, for the placement of eye or reading glasses, then the dorsum can be augmented with rib cartilage and temporalis fascia.

It is becoming more common in my practice for women to come in wanting their nasal dorsum corrected. It common that we then harvest rib cartilage through their previously made breast augmentation incision. Often women use this operative time to exchange their saline breast implants for silicone breast implants. We are finding more women who also wish to undergo their first breast augmentation at the time of their rhinoplasty.

Narrowing of the ethnic nasal dorsum is a procedure that needs to be done with great care in order to maintain the ethnicity of the original nose.


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Aesthetic "Ethnic Rhinoplasty" & Septal Deviation.

The management of the ethnic rhinoplasty can be very challenging in the face of significant septal deviation and airway obstruction. Typically, if patients have had trauma to their nose they can damage both the nasal bones as well as the cartilage components of their nasal structures.

Often patients require a septoplasty to repair a significant deviation as well as spreader grafts to straighten and reinforce the septum. Occasionally an onlay graft of crushed cartilage can be used to define certain points of the nose to make it more aesthetically pleasing.

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