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Patients Articles
Rinhoplasty: a challenge for the plastic surgeon…
The aesthetic surgery of the nose, known as Rhinoplasty, is
directed toward the improvement of the nose’s shape, size &
general appearance. The surgeon’s objective is to get a
natural appearance of the nose that offers a harmonic balance
between the other facial structures. Today’s techniques are
more conservative than years ago, and it is possible to use
various access paths to the nasal structures.
Normally, it is recommended that the patient wait at least
until s/he is 14 or 15 years old, and preferably slightly
older in a man’s case, before undergoing this procedure. The
reason is none other than the underdevelopment of the nose in
the early years.
There’s no age limit for adults to undergo a rhinoplasty
procedure, as long as no risk or danger with the anesthesia
exists. Rhinoplasty is sometimes carried out together with a
facial lifting or along with another type of facial
rejuvenating procedure.
In many cases, nasal ventilation problems can be corrected at
the same time that a shape correction is being made. Among the
main indicators to undergo a rhinoplasty operation are:
·
The nose appears to be too long for the face.
·
When a hump is observed on the nasal dorsum
profile.
·
The appearance is too wide on a frontal view.
·
The nasal tip has a plunging or drooping
aspect.
·
The nasal tip is thick or broad.
·
The nostrils or nasal wings are very wide.
·
The nose is not in the center of the face or
its profile is broken.
·
The nose appears to be too short for the face.
·
A wound or previous traumatism has altered the
nasal morphology.
CLINICAL EXAMINATION:
In the clinical examination it is important to make a
psychological appraisal of the patient, in order to understand
what his/her wishes and expectations are, betting up for
moderate & reasonable corrections. The best candidates for
rhinoplasty are those people who are looking forward the
improvement of their appearance, not “perfection”. Besides
good physical health, the patient’s psychological stability
and a realistic attitude regarding his goals are matters of
vital importance.
The psychiatric and dismorphophobic patients are an indication
against surgery.
On the other hand, it is necessary to make an exhaustive study
of the balance and harmony of the face. The shape, position,
dimensions and volumes of the forehead, the orbitary frames,
cheekbones, lips and chin have to be carefully examined.
In the nasal profile must be evaluated, the nasofrontal angle,
the nasofacial angle, the tip, the columella-lobular complex
and the naso-lip angle.
In the profile view, the nasal root, the dorsum, the tip
(projection & width) and the alar-columella complex must be
appraised.
It is also necessary to be aware of the skin thickness. The
fine and translucent skin, characteristic of Caucasian
patients allows better showing of the cartilage, scraps, while
the thick skin, more common in our environment, and generally
associated with abundant fat, tends to be less elastic and
masks the underlying structures. The touching and pinching
between the fingers may allow one to appreciate the grade of
skin thickness.
The thickness of the skin that covers the nasal pyramid is
primordial to get an aesthetic and functionally correct
result.
The tip support is also an important aspect to evaluate to
obtain an adequate tip projection. By touching it, the surgeon
can tell the difference between a tip that has good support
and strength, and one with inadequate support. The one with
poor support is a candidate to get cartilage implants and in
case of not being able to obtain them from the septum or from
the ear, inert materials such as silastic implants or goretex
can be used.
Daniel Peñafiel S., M.D.
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