Types of Nasal Surgery
Your nose surgery usually falls into one of two categories. Nasal surgery can be either a septoplasty or rhinoplasty. The beginnings of rhinoplasty started over 5,000 years ago in India. In fact there is still a type of rhinoplasty called the India or Hindu forehead flap rhinoplasty practiced today. Click here if you would like to read more about the history of rhinoplasty.
A septoplasty is internal nasal surgery only. Click here if you would like to read more about Septoplasty surgery. It is the least traumatic and invasive procedure. There is no external bruising and rarely any visible swelling. There is little and usually no external change to the shape of the nose. If the nose has a bend, it usually remains after surgery. People often find this difficult to understand. The explanation is it’s the internal bend (deviated nasal septum) that is responsible for the difficulty breathing and this is what is corrected during septoplasty. Although the external bend is often due to the internally twisted septum, it most commonly doesn’t become straight when the internal twist is corrected because it is held in place by the two plates of surface cartilage which aren’t changed. A rhinoplasty is needed to correct these plates. Frequently partial inferior turbinectomy (click here if you would like to read more about Turbinectomy) is done along with septoplasty. This minor procedure trims the fleshy swellings of the inner sides of the nasal passages. It improves nasal breathing by increasing the cross sectional area of the nasal channel.
Rhinoplasty is required to change the external appearance of the nose. Rhinoplasty is also known as Septorhinoplasty, as the internal foundation and cartilaginous support of the nose very often needs modification too. Rhinoplasty can be further divided into reduction rhinoplasty, augmentation rhinoplasty, blended rhinoplasty or revision rhinoplasty. Click here if you would like to read more about the revision rhinoplasty.
If you have never had a recognized injury or prior nasal surgery, you are likely going to have a reduction rhinoplasty. Cartilage and bone are removed, hence the word ‘reduction’. In addition, the nasal bone is filed down to reduce or smooth it. In the same way, your nose cartilage is reshaped or shifted, in addition to possibly being partially removed. There are also uncommon problems where a surgeon will actually shave down the nasal skin. One of these is called rhinophyma. Click here to read more about rhinophyma.
Most people know about nasal casts after rhinoplasty or a ‘nose job’, and many are aware of nasal packing. Less commonly known is the use of internal nasal stenting. This method has mostly replaced nasal packing. After Rhinoplasty your nose is weakened and has much reduced intrinsic strength. This fragile state slowly improves over many months after your rhinoplasty. Your nose is supported from the inside by thin plastic sheets. They can’t be seen, unless you tilt back your head and look carefully up your nostrils, then the leading tips of the stent can be seen about half an inch inside your nose.
As the name suggests, tissue is added to your nose when augmentation rhinoplasty is required. These surgeries are often more complex and require more surgical time. When your nose has been damaged, the addition of either cartilage and/or bone becomes necessary. Previous surgery and nasal fractures are most often the cause of the loss of support to your nose. Overly aggressive cosmetic rhinoplasty can weaken and/or remove too much of the natural internal support. Most often the nasal symptoms are; difficulty to breath, nasal pain and nose crusting, along with the external nasal deformity. Externally this loss of nasal support causes your nose sometimes to twist, shrink, collapse or sink in.
The chest incision heals well and seldom is an issue. With women it is placed directly below the breast, hidden in the crease.
The area just above the tip of the nose, the supratip, can collapse causing a deformity called a ’boxer’s nose’. Its similar to the changes to a boxer’s ears where there has been many cartilaginous breaks resulting in a ‘calliflower ear’. Another name for this nose deformity is a ‘saddle nose’. Just under the nose, the area called the columella can retract, resulting in unpleasant look we surgeons call, not surprisingly, columellar retraction. Again this arises from loss of nose tissue. Here its the cartilaginous septum that is gone, usually due to again aggressive nose surgery. Usually in the form of a septoplasty. Another problem after rhinoplasty is a septal perforation. Internally tissue loss can cause a hole to form in the center partition of the nose called the septum. This can produce a spectrum of symptoms from, if you are fortunate, nothing; all the way to chronic, difficult to treat nasal pain, nose crusting and bleeding.
The incision around the inner rim of the ear can barely be seen months after surgery.
Tissue can be found from several places in your body and used to replace what is missing. A principle of plastic surgery is to replace ‘like tissue with like tissue’. That means cartilage is replaced with cartilage and bone with bone. Most commonly it’s cartilage that is needed. The best cartilage is nasal cartilage. However sadly it often not available, as loss of this cartilage is the reason the problem began in the first place.
The next place nose surgeons use is either your ear or rib. The cartilage here is of a different quality and this can pose some technical challenges. The harvesting of your ear cartilage is surprisingly not noticeable afterwards. The cartilage removed is from an area that fortunately causes very little change to the shape of your ear and has no effect on your hearing. Rib cartilage leaves a scar under your breast from 2 to 3 inches long. Less commonly bone is needed. It can be take from your hip, rib or skull. By the very nature of harvesting it, the surgery leaves you a scar and sometimes a slight skin depression at the donor site.