Live Consultation Rhinoplasty Las Vegas
Dr. Stile: Hi, I'm Dr. Stile, and welcome back to our excellence in cosmetic surgery series. What we'll be talking about today is rhinoplasty surgery, or cosmetic surgery of the nose. What we're going to do is take you through an actual consultation with one of my patients. During this consultation, you'll get to learn more about what a rhinoplasty procedure actually is, what the possible benefits for you are, and whether or not you are a candidate for this surgery. Let's go and visit with my patient now.
Our patient today is Amber, and she presents to my practice with some very typical ideas about what she wants changed with her nose. We're going to go through this consultation in a step-by-step manner, first, addressing her specific concerns, and then looking at some patients that are very similar to Amber who I've operated on in the past. That will be followed up by some diagrams that will help illustrate how this operation is actually done.
When we look at a nose, we look at it in three components actually. Let's look at you, Amber. We have the dorsum, which is made up of two parts. There's a boney part, it's starts right here at the nasion, and basically ends at the mid-part of the dorsum. This part is very rigid, and is part of the facial skeleton. From the mid-part of the dorsum down to where the tip begins are the upper-lateral cartilages. They give a little bit, unlike the nasal bones. However they are still part of this unit that makes up the dorsum or the nasal bridge.
The third component is the lower-lateral cartilages. All of these structures are paired structures. Nasal bones, upper cartilage, and then lower-lateral cartilage. We have to address all three of these structural components if we want a result that's harmonious.
Our other, and most important concern is that the nose that Amber gets as her result is one that fits her face. We don't want her to have what we consider an operated on look, or something that is disproportionate to her.
We'll be taking an otherwise attractive woman and making her less attractive if we don't follow these principles very carefully. What I'm going to do next is go over some patients that are like you, and have had similar concerns, and we'll talk about what we did for those patients, and similarly what we'll do for Amber during her surgery.
What's important when you look at this patient is that, this patient has a pleasant face, and her nose is not one that would stand out in the sense of saying, you know what, if she addressed her nose in the cosmetic sense, she would look significantly better. What she wanted was a dorsum that was more harmonious with her tip and follows the aesthetic lines of her face.
If we look at her post-op picture here, what we see is that her nasal tip is significantly smaller, and the dorsum and tip are more harmonious, and do follow the aesthetic lines of her face.
If we look at her from a side-view, which we see in this picture here, that small hump that she had a concern about is no longer present in the post-op picture. We took this down to a more ideal line. The other significant feature to note here is that her nasal tip, which was previously almost at a right-angle has been somewhat lifted here to an angle that's probably greater than 100 degrees. What this does is give her nose a more feminine profile. It also makes her upper lip less obscured. We also released the depressor muscle in this patient, which also keeps her nasal tip from been animated with speaking, smiling, and other facial expressions. That's referred to as a dancing tip.
Another example of these principles is seen in this patient here. What we have is an attractive woman. When you look at her pre-operative photo right here, what you see is a wide nasal dorsum and a tip which almost looks like it's disharmonious with the dorsum, it's almost disjointed so to speak. When you look at her post-op picture here, however, what you see is no transition between the dorsum and the tip on interior, posterior, or frontal view.
When we look at her profile shot once again, what you have is a small prominence on the dorsum, which is no longer present in her post-operative picture. And once again in this patient, the angle of her nasal tip has been slightly lifted to give her a more feminine view and a less obscured upper lip. Both of these patients were very happy with their result, specifically because their issues were addressed and corrected in manner that was satisfactory to them, but also that they retained their appearance, and did not have a result that seemed artificial, or over-corrected.
In discussing how the procedure's actually done, it's important to know that there are two approaches for this procedure. There is an open approach, where incision is made in the columella to reveal the structures that we talked about, the nasal bones and the upper and lower lateral cartilages, and there is a closed approach where no incision in the outer nose skin is made and the actual procedure is actually carried out through small incisions on the inside of the nose.
It allows me better control and direct visualization of the structures that I'm operating on, and I'm going to explain what that means to you. Basically, if you lift your chin up slightly, a small step pattern incision is made on your columella, and then two further incisions are made on the inside of your nostrils. Once this incision heals, it'll be very difficult, even under direct visualization, to see it.
The incision does very, very well. In this illustration here, the incision is once again demonstrated. There's that stair step pattern, and then the incision is carried out on the inside of the nostrils. What this does is it allows me to directly visualize the three structures that we spoke about earlier. Nasal bone, upper cartilage, and the lower cartilages, which make up the tip.
What I do first usually is address the upper cartilages. First, I address the small bump on the dorsum, and what I use is a series of wraths or small files, and I take this down to my ideal line. Once that is done in a sequential fashion where I repeatedly take down the dorsum just slightly and re drape the skin and look at it, once I am happy with that, the next thing I do is narrow the nose, and that's done by an in fracture technique, which is basically tapping on the nasal bones with a small chisel and physically breaking them, moving them in where we call is a green stick fracture because it's not a through and through, complete fracture, but it's a fracture enough that's controlled and allows me to decide how thick or how wide the nasal dorsum should be.
The last step of this procedure is actually working on the height of the nasal tip, and the width of the nasal tip. What I would do for you Amber is remove the upper part of these cartilages, to make the tip start a little bit lower. And create something that we call a super tip break, which means the transition between the dorsum and the nasal tip, that'll be more defined for you, it'll give you a more delicate nose, and a less boxy, or bulbous appearance.
The last step in this procedure, after removing the top parts of these lower lateral cartilages is bringing the nasal tip together, these two cartilages closer together, using a series of stitching techniques that will make the tip narrower.
So, in review, what we do is, take the dorsum down to the ideal angle or ideal profile, bring the dorsum in to make the nose narrower and more harmonious with the tip, lower the start off point on the tip by removing the upper part of the lower-later cartilages, and then narrowing the tip using a stitching technique.
Finally the nose is closed with very small permanent stitches on the outside that are removed about a week out. The patient is next sent home with a splint and tape. The splint comes off at one week, and we usually re tape our patients for an additional week after that. The stitches come out at this time as well.
Your nose will look significantly better immediately after surgery. You will have some swelling, however. It usually takes between three and eight months for patients to appreciate their full result. Some patients even take as long as one year.
All procedures are done in our facility, which is a state licensed, ambulatory surgery center. Our patients receive general anesthesia for this procedure, and the procedure itself usually takes between one and a half and two hours based on complexity. Our patients go home the same day, and are seen a week after in the office. At that time, the splint is removed, as are the stitches.
Most patients are re taped for an additional week of support and molding. If you have any questions about rhinoplasty procedure, you can call us at area code 702-243-9555, or you can email us via our website, at www.DrStile.com. Until next time, be well.