Rhinoplasty techniques and advantages and disadvantages of different materials

In the previous series, we discussed that the ideal shape of the nose differs depending on the individual face shape. A northern Mongoloid face can appear more attractive with a higher nose bridge (higher nasal root), whereas the southern Mongoloid face with rounded and relatively youthful impression looks better with a shorter vertical length of the nose. The shape of the nasal tip is very important in both face types. In particular, the southern Mongoloid face looks more attractive with a lower nose bridge and the nasal tip determines the overall impression of the nose. The nasal tip should be elevated along with the nose bridge in a northern Mongoloid face. Let us take a look at different techniques used in creating a desirable shape of the nasal tip.

 

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Incisional approach

As incisions are made inside the nose in closed rhinoplasty, this procedure can be better described with the term “endonasal approach.” This procedure may have been called “closed rhinoplasty” as scars form only inside the nose. The endonasal approach can be further divided depending on where the incision is made in the alar cartilage or nasal mucosa. The incision can be made along the boundary of the nasal mucosa, or along the boundary of the alar cartilage or in the middle of the cartilage. This method has been commonly used for raising the nose bridge due to convenience and simplicity, however, recently it is used less frequently as there is more focus on correcting the nasal tip.

Image 1. From left; closed rhinoplasty(endonasal) incision, extended endonasal approach, and open rhinoplasty approach.

 

Open rhinoplasty uses endonasal incision and columella incision. This method is convenient as it allows direct visualization of the nasal tip cartilage. It allows repositioning and correction of the nasal tip cartilage as well as supplementing the cartilage. There are various methods of columella incision. The incision can be placed in the terrace form at 1/3 of the height of the columella or in a V-shape to prevent the linear scar. In most cases, I use a V-shaped incision at the nasolabial angle where the columella and upper lip meet. The red lines marked in Image 1 show the sites of the incision.

The extended endonasal approach is used to minimize columella incision and extend endonasal incision. This basically allows the extent of dissection similar to that of open rhinoplasty. Dissection may be difficult in patients with thin and small nasal tip cartilage. It may be convenient for raising the nasal tip but is not useful for lowering the nasal tip. This method is followed by swift recovery and little scarring due to almost no incision made in the columella.

 

Image 2. Extended endonasal approach. As with open rhinoplasty, cartilage dissection can be carried out in most cases.

 

-To be continued-