Rhinoplasty #181
You can see a natural looking, and less distracting nasal appearance in our beautiful teenage patient, only four months following rhinoplasty surgery. She was bothered by her dorsal hump and wide nasal tip appearance. After 22 years of performing rhinoplasty, we feel our approach to sculpting the nasal tip leads to natural looking tip appearances.
We prefer an open approach in nearly all of our patients who require tip work, or tip-plasty. This part of her surgery was performed after her septoplasty with harvest of cartilage for later grafting. The nasal tip is transformed into a tripod by dividing the lower lateral cartilages and suturing the medial crura to each other in the midline: With the soft tissue flap still retracted with a pledget, a forcep is placed intra-nasally at the soft tissue triangle which is lifted anteriorly to delineate the angle where the medial crus meets the lateral crus, and a marking pen is used to delineate this position bilaterally. The Brown-Adson forcep is used to retract the vestibular lining into the nose, and the Converse scissor is used to separate the vestibular lining from the undersurface of the lower lateral tip cartilages. In her case, the lower lateral cartilages were divided at their angles, and the medial crura are sutured to each other, approximately 4 mm posterior to the division point, with one 5-0 polydioxanone suture (PDS). The nasal tip is now a tripod where the medial crural complex is the central limb, and both lateral crura are the other two limbs. This maneuver typically results in a change in the spatial relationship between the medial and lateral crura such that the anterior portion of the lateral crura may overlap as the lower lateral cartilages medialize with angle division. This maneuver results in tip narrowing, and her tip is then reinforced with a columellar shoring strut graft (C-Strut).
Her hump was removed with right and left Joseph saws, and the lower 2/3 of her hump was cartilage and was removed with a 15-blade. Lateral osteotomies were performed to "close her open roof", and then her upper lateral cartilages were sutured to her dorsal nasal septum before her surgery was completed.
Patient Review:
“Dr. Joseph is amazing and his staff as well! Gloria and Paloma were so sweet and comforting. My first visit there they all made me feel so comfortable and Dr. Joseph listened to what I disliked about my nose and what I hope could be changed. He exceeded my expectations! After my surgery he gave me his personal cellphone number so I could contact him if I had any questions or concerns. From the first visit he’s always been attentive and I appreciate that! I am now 6 months post-op and I could not be happier with my results. 100% recommend Dr. Joseph! You will not be disappointed!”