Patients seeking revision rhinoplasty in NYC
NEW YORK, NY – There is a steady stream of patients seeking revision rhinoplasty to fix a bad nose job, which is all too common. Primary rhinoplasty is often considered the most difficult procedure in cosmetic surgery. It seems simple, right? Just shave off a bump and reduce the tip a little. Not so fast. That is when an uninformed surgeon finds himself in trouble, as each and every nose is a little different. The nose has paired nasal bones, which make up only the upper third part. The middle portion has two cartilages called upper lateral cartilages that insert, not into, but beneath the nasal bones, plus the nasal septum in the middle dividing the two sides. Below that is the nasal tip. These paired horseshoe shaped cartilages may sit in a variety of positions and have different shapes as well as strength. The nose is a multi-faceted three dimensional structure that has many fixed parts as mentioned above, plus varying ligaments and muscles holding these parts together.
To make it even more confusing, modifying any individual part of the nose affects the nose in many ways. Reducing a hump not only accomplishes that, but the gap needs to be closed for an aesthetic result, so we do “osteotomies,” which means closing the open roof to pull in the upper lateral cartilages, which in turn narrows the middle vault as well. This may be a desirable additional change or may require something such as spreader grafts to prevent over-narrowing and an “inverted-V deformity.”
When I review the operative reports from prior surgeons, I often see techniques that a true rhinoplasty expert abandoned years ago. Surgeons need to keep abreast of the latest techniques. Unfortunately, some surgeons take that too seriously as well, and leave too much behind to avoid creating a “pinched” nose. Or, perhaps they learned at a meeting that you should put certain grafts into a nose so they put them in without forethought of what they are really trying to accomplish. If it sounds like I am confounding this issue, I am. The real students of rhinoplasty are the experts, who after 20 or more years in practice are still sitting in the front row of a meeting trying to learn even more from their peers. See some actual before and afters