A Natural Rhinoplasty Look for Today and Tomorrow

Reshaping of the nose through rhinoplasty surgery is one of the most popular plastic surgery procedures. It has a significant effect on one's facial appearance by putting in proportion the nose to other facial features. While rhinoplasty surgery has a long history, contemporary methods produce a more natural looking nose that holds its shape over time.

Historically, rhinoplasty surgery was associated with after surgery appearances which were 'overdone'. These older forms of reductive rhinoplasty often resulted in noses that were too small for the face, low bridges and up-turned tips. Even if the nose did not appear this way immediately after surgery, this appearance developed months or years later. This nasal appearance was the result of removing too much of the natural structures of the nose. Dropping the bridge of the nose too much (bone and cartilage)and lifting or shortening the nasal tip too much (cartilage) weakens the underlying support of the nose. Over time, as scar forms and tissues heal and contract, the nose gradually 'falls' and assumes an unnatural appearance. It may look too small, too upturned, or too narrow and pinched at the tip.

It is appreciated by todays plastic surgeons that maintaining as much support to the nose as possible is important. The nose is like a house, the framework must be maintained to keep the roofline intact. Modern rhinoplasty is about rearranging nasal structures rather than simply removing them. In this way, the nasal dorsum (line along the bridge to the tip) remains smooth but at a good height, the end of the nose is lifted but not too high, and and the nasal tip is narrowed but is not made into a single point.

Besides less cartilage and bone removal, the natural rhinoplasty makes use of adding support through cartilage grafts as necessary. Supporting the nasal tip through columellar strut grafts, small hand-carved grafts for better tip definition, spreader cartilage grafts to the middle vault to improve breathing, and adding height at the very top of the nose where it joins the forehead (radix) with small crushed cartilage grafts are some of the ways to help build and strengthen the framework of the nose. These cartilage grafts are usually acquired from the septum of the nose (which may be simultaneously straightened) or from the back of the ear.

Natural rhinoplasty techniques are a combination of preserving critical nasal tissues, skillfully rearranging the different zones of the nose, and the three-dimensional eye to visualize how to get to the final nasal result. These rhinoplasty techniques usually require that the skin be lifted off of the nose through an 'open approach', at the price of an indetectable scar across the columella. (strip of skin between the nostrils) Natural noses fit each patient's face more proportionately and never have that 'operated' appearance. The long-term results with these techniques are rewarding to both patient and plastic surgeon alike.

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Dr Barry Eppley is a board-certified plastic surgeon in private practice at Clarian North and Clarian West Medical centers in Indianapolis, Indiana. He writes a daily blog on trends in plastic surgery at www.exploreplasticsurgery.com

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