A Guide on the Different Types of Rhinoplasty
- 22 August 2016
- Dr. Nidal (Nick) Masri
Getting a nose job is not as simple as finding a cosmetic surgeon and requesting for one. There are several reasons why people want to get a rhinoplasty, and these are not only confined to physical appearance. In fact, a vast number of people who undergo rhinoplasty do so because of breathing problems.
As such, there are also different types of rhinoplasty that cater to both a patient’s aesthetic and functional needs.
Read on to find out more about the reasons why people undergo rhinoplasty, as well as the different types of nose surgeries that will best suit your needs.
Common functional concerns in rhinoplasty
Physical abnormalities that obstruct breathing are the usual functional problems that necessitate rhinoplasty. Congenital defects and physical trauma also fall under this category. With rhinoplasty, you can correct these abnormalities and achieve the nasal contours that allow you to breathe properly and feel confident in your appearance.
The septum is the part of the nose that separates the nasal cavity into two passageways. It extends from the upper part of the nose—where it connects to the skull—down to your two nostrils.
Unfortunately, the septum can become deviated when it shifts to one side of the nasal cavity rather than creating two equal passageways. This creates an S- or C-shape that can block airflow and eventually damage the soft tissues in the nose.
During rhinoplasty, your cosmetic surgeon reshapes either the bony upper portions of the septum near the top of the nose or the cartilaginous lower portion, depending on the area where it has deviated. In cases of caudal septal deviation—where the septum moves off the anterior nasal spine—your surgeon will need to realign its base to correct the problem.
Turbinates are long, thin bones that extend outward from either side of the septum within the nasal cavity, ending in small, curled, and knob-like shapes. These can become swollen due to allergies and other irritants. There are even cases when turbinates become constricted because of a deviated septum that pushes it to one side. This causes the turbinate in the other nasal passageway to grow larger to compensate for the constricted turbinate, resulting in further breathing obstruction.
Rhinoplasty surgeons can remove tissue from these turbinates to reduce their size. Another option is to fracture a portion of these turbinates away from the septum to set them in place and create large passageways to improve breathing.
Just like enlarged turbinates, nasal polyps are often a result of allergies and irritation. These soft, jelly-like growths can be excised using a snare instrument during rhinoplasty. However, they have a tendency to grow back, necessitating the simultaneous use of anti-allergy drugs.
Nasal fractures can cause breathing obstructions due to a crooked or misshapen nose. There are many types of nasal fractures, depending on severity. While rhinoplasty can usually correct these fractures, the help of a specialist may be needed for more serious types of fractures, especially those that can cause permanent damage to the brain and palate.
Common cosmetic concerns in rhinoplasty
More often than not, rhinoplasty is done for cosmetic purposes, that is, to enhance the appearance of your nose and complement the rest of your facial structure. The type of rhinoplasty used to correct these imperfections depend on the area of the nose that is affected—the upper, middle, or lower vault. Rhinoplasty can involve adjustments to one or more vaults in order to achieve the patient’s desired nose shape while keeping the proportions in check.
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Bumps in the radix
The radix is the upper bony portion of the nose. In cases where it is too large, there may appear to be a bump on the nose. On the other hand, when the radix is too shallow, it can cause a depression and a bump.
Your surgeon can use rhinoplasty to carefully shave away some portions of the radix. As for depressed areas, your surgeon may add volume to these areas using a portion of your own cartilage harvested from other areas of your nose. This creates a straighter slope on your radix.
If your nose slightly deviates to one side, your rhinoplasty surgeon can straighten it by reducing some bone or cartilage or by physically shifting the tissues. After the surgery, you may need to wear a splint to hold your nose in place while it heals, just like what is needed in the case of a broken nose.
Lack of tip rotation
Tip rotation refers to the upward or downward turn of the tip of the nose. Cosmetic problems with the tip of the nose stem from the fact that it either lacks definition or is overly defined, as in a nose with a bulbous tip. With a rhinoplasty, the tip of the nose is adjusted by reshaping the cartilage and paying close attention to the base of the nose, as this affects tension and rotation.
The projection of the nose is the distance that it extends outward from where it meets the upper lip to its tip. Over-projected noses may appear larger in proportion with other facial features, while under projected noses may appear too shallow for your face.
Your cosmetic surgeon can reduce your nose’s projection by trimming a portion of the cartilage at its tip. To increase projection, your surgeon may realign the cartilage, push it forward, and suture it into a refined position. In some cases, your surgeon might even use a cartilage graft if there is not enough cartilage at the tip of the nose.
The ala are the outer edges of the nostrils. In the case of wide or flared nostrils, your rhinoplasty surgeon may do an alar adjustment in conjunction with width reduction. By removing a portion of nasal tissue, your cosmetic surgeon can change the level of tension that is creating excessive flare in the nostrils.
Types of rhinoplasty
Aside from refining the shape of the nose, some rhinoplasty types are geared towards correcting physiological complications that might disrupt a person’s ability to breathe properly. The following types of rhinoplasty are designed to meet a range of functional and aesthetic needs.
Among all the types of rhinoplasty, reduction rhinoplasty is the most common, as it can make your nose more proportionate to the rest of your facial features. It can specifically address problems such as an elongated nasal tip, the presence of bumps on the bridge of the nose, and excessively flared nostrils.
In reduction rhinoplasty, your cosmetic surgeon removes small amounts of bone or cartilage to achieve your expected results. If you want to reduce the size of your nostrils, your doctor can do an alar base reduction, wherein the surgeon creates a wedge-shaped incision and removes small tissues from the area where the nostrils meet the cheeks. He then closes it with sutures to create the desired nose contour.
Other doctors use advanced computer programs to plan the reduction rhinoplasty and simulate the appearance of the patient’s nose after surgery in order to create more accurate results.
Enlarging the nose may not be everyone’s cup of tea, but those who think that their nose is smaller in proportion to the rest of their face can get an augmentation rhinoplasty. In this rhinoplasty type, the dimensions of the nose are increased. Your cosmetic surgeon performs bone or tissue grafting to build up the nasal tip and bridge, usually using cartilage from other parts of your nose like your nasal septum.
But in cases when a patient does not have enough tissue in this area, the doctor may use cartilage from the rib bone and other areas of the body. Synthetic materials and other biological tissues may also be used.
Just like in reduction rhinoplasty, your doctor might use a computer software to create a two-dimensional or three-dimensional projection of the final rhinoplasty results. The primary elements that are typically assessed are the height of the bridge, the projection of the tip, and the need for any lengthening of the nose.
Also known as secondary rhinoplasty, revision rhinoplasty is designed to correct the effects of a previous surgery. This might be done when the patient is unhappy with the appearance of his nose after the first rhinoplasty. A more important reason is when breathing problems occur after the initial rhinoplasty, hence having a significant impact on the patient’s overall health and comfort. A secondary rhinoplasty may also be needed when the patient suffers from traumatic injury after getting a nose job.
In this procedure, the open rhinoplasty technique is done to expose the deeper layers of tissue and allow for greater visibility of the nasal structures. In some cases, it may be necessary to replace lost tissue and cartilage through grafting. Refinement of scar tissue is also done, as too much cartilage can impact the appearance of the nose and make it asymmetrical. Your surgeon might need to reposition these or even remove excess tissue in order to narrow the nostrils or reduce the bridge of the nose.
It is important to note that aside from being a risky procedure, revision rhinoplasty does not guarantee satisfactory results, so patients can end up being more disappointed than they were before since they may not be able to undergo another revision rhinoplasty.
Ethnic rhinoplasty refers to procedures performed on individuals of African-American, Afro-Caribbean, Asian, Hispanic, and Middle Eastern descent. Since these patients traditionally have softer nasal contours, cosmetic surgeons take special care to preserve the unique features of their nasal shape, such as the lower and wider bridge of the nose, wider nasal tip and nostrils, relatively soft support to the tip of the nose, and thicker nasal strip and nostrils skin. The facial proportions are also considered.
In an ethnic rhinoplasty, your surgeon uses specialized techniques to change the shape of the bone and cartilage inside the nose, narrow the nostrils, and graft cartilage from elsewhere in the body to extend the nasal tip. The grafts used can come from the patient’s own tissues such as rib cartilage grafts, or it can also be synthetic—like Medpore and Goretex—which are easier to place.
In addition to reshaping the nose, your surgeon will also strive to make sure that the ethnic rhinoplasty will correct any obstructions or abnormalities that can contribute to breathing problems.
With the nose being a highly vascular organ, one of the main worries in a nose injury is the massive amount of bleeding on both sides of the nasal septum. Blood clots might also accumulate around the cartilage, depriving it of blood supply and causing it to die. This is a medical emergency that requires prompt evacuation of the hematoma, followed by a post-traumatic rhinoplasty. Patients who suffered from an injury to the nose will benefit from a post-traumatic rhinoplasty, as it can correct both the appearance and the functionality of the nose.
Since post-traumatic patients often suffer from a broken nose, a post-traumatic rhinoplasty can straighten the nose and correct the nasal septum. However, the doctor may need to re-fracture the nose and re-set it in order to achieve the desired results. A simple broken nose can usually be corrected within 10 days of the fracture, but those with more serious nose injuries might have to wait six months or longer before undergoing extensive nose surgery.
Patients who have lost all or parts of their nose to accident, skin cancer, or other serious illness may need to undergo reconstructive rhinoplasty. This usually makes use of the open technique to allow full exposure of the nasal anatomy.
During a reconstructive rhinoplasty, the surgeon rebuilds the nose using skin grafts, flap techniques, and other advanced rhinoplasty methods. More often than not, this kind of rhinoplasty makes use of cartilage and Goretex implants. Once the implant has been placed on the bridge and/or tip of the nose, the nasal anatomy is put back together to ensure that the implant blends well to the contour of the nose.
Despite being an outpatient surgery, a reconstructive rhinoplasty is a complex procedure that may require multiple surgeries over the course of several months. Because it is highly specialized, patients should look for skilled cosmetic surgeons who possess extensive experience in this area.
As its name suggests, adolescent rhinoplasty is a nose surgery done among teenagers, especially those suffering from breathing problems. In general, surgeons advise teenagers to wait until their noses stopped growing before they undergo rhinoplasty. However, those who have nose trauma or breathing difficulties are exceptions to the rule. Adolescent rhinoplasty can also correct nasal bumps, slim down wide nasal bridges, correct a drooping tip, improve wide nostrils, restore nasal symmetry, and ultimately boost a teenage patient’s confidence and self-esteem.
Teenagers who want to undergo adolescent rhinoplasty have to wait until they are 15 or 16 years old to make sure that their nose and other facial features have finished growing. Emotional and mental maturity are also important factors in screening a patient, as teens should have a reasonable motivation for undergoing surgery at such a tender age. The surgeon must also take special care to protect the delicate nasal features while performing this surgery.
If there is a rhinoplasty for teenagers, there is also one geared specifically for the aging population. While it is true that the nose stops growing at around age 16, its shape may still change over time. For instance, the tip of the nose may begin to droop, while the nasal passages may start to get constricted, causing breathing difficulties. In such cases, an aging rhinoplasty can help correct these issues to enhance breathing and give the patient a younger and more rejuvenated appearance at the same time.
In an aging rhinoplasty, the tip of the nose is often rotated and re-projected in order to preserve a high dorsal profile. It also results in the reduction of humps and bony fractures in the nose, allowing patients to get rid of breathing difficulties stemming from nasal obstructions. The important thing here is to correctly diagnose the cause of nasal obstruction in order to create an effective treatment strategy.
If you are interested in getting a rhinoplasty in Miami, Schedule a Free Consultation with one of our highly experienced and board-certified cosmetic surgeons here at Face + Body Cosmetic Surgery. We will do our best to answer your concerns and help you decide whether or not a rhinoplasty is ideal for you.