RHINOPLASTY

Rhinoplasty is a topic that has a long history and in many has been made overwhelmingly complicated.  Surgery to the nose has been described for thousands of years in various form.  The main purpose is to change the shape of the nose or correct blockage caused by the structure of the nose. There are a few other reasons we may perform a rhinoplasty such as to close a hole in the middle partition of the nose (septum).

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Rhinoplasty vs septorhinoplasty

 

You will find that the terms of rhinoplasty and septorhinoplasty are used.  The main difference is that a SEPTOrhinoplasty is a nose job that also involves surgery to the septum. The septum being the middle partition of the nose.

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Open vs Closed approach

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You will also encounter terms such as open and closed.  The difference is that an open approach a small cut is made in the flesh between the nostrils.  Traditionally you will find many surgeons saying a closed approach is minimally invasive and a smaller surgery.  This is not desperately accurate.  Everything done by an open approach can be done by a closed approach and some surgeons do in fact use a closed approach to every case.   As such, a closed approach can be every bit a major procedure as an open approach, and vice versa. The scar of the open approach (if done properly) is small and barely visible on close inspection. Ultimately, your surgeon will guide you on which approach is best for your individual case and why.

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Primary vs revision (secondary) rhinoplasty

A primary rhinoplasty is when someone has surgery to the nose for the first time.  In this setting the materials of your nose are usually very healthy and normal.  This is the BEST chance to get the surgery right.  Each time surgery is done to the nose, it introduces more scarring and damage to the nose making subsequent surgery more difficult and more unpredictable.  A revision or secondary rhinoplasty is when surgery has been done before.

 

Reconstructive rhinoplasty

This term is used variably.  Essentially this indicates that some part of the noses structure needs rebuilding.  For example, if someone has had a bad injury or infection in the septum (middle partition), the cartilage will be thoroughly destroyed or dissolved.  Therefore, it will need to be re-built (reconstructed). If someone is undergoing a revision rhinoplasty, it may be reconstructive as well due to many of the structures being destroyed in the previous surgery.

 

Grafts (septum, rib, ear)

In a primary rhinoplasty, usually there is enough cartilage (gristle) in the septum to harvest in order to manipulate the shape of the nose.  On occasion a patient might have had a septoplasty or previous injury/infection, where there will not be much gristle or at least good quality gristle left in the septum.  In those patients we may need to harvest cartilage from the ear or the rib.  

 

Ear cartilage can be taken without changing the shape of the ear.  It is VERY rare for the ear to change shape. The cut to access the gristle can be done from behind so the scar is not easily visible.  The ear cartilage has a natural curve and is flexible.  This means that it is good material for cosmetic work but does not have the strength to support the structure of the nose.  That is, if the septum needs reinforcing or rebuilding, the ear cartilage does not have the strength for it.  Occasionally, the site where the cartilage is harvested can be sore long term, usually this is because of a sharp edge left behind in the remaining cartilage.

 

The area where the rib meets the breast bone is made of gristle rather than bone.  This can be safely harvested through a small cut on the right of the chest.  If you like to wear bikinis, the surgeon can make the incision just under the breast.  Theoretically there is a risk of injury to the lung when we harvest rib cartilage, however, this is incredibly rare and it is something I have yet to encounter.  During the harvest process, we can also take some fascia (fibrous covering material) that lines the muscle and/or cartilage. These materials can very useful during the surgery.  People do tend to find the chest wound to be painful for 1-2 weeks.  This is due to the muscle that is cut or pulled during the harvest. Long term, some people complain of numbness around the chest wound. If the septum or bridge of the nose needs to be rebuilt, this is the ideal material.  The quality of rib cartilage does vary from patient to patient. Some patients have cartilage that has partly or mostly changed to bone (this is termed ossified).  This can be difficult to deal with but not impossible.  If someone has had a lot of injuries to the chest, like race car drivers or martial artists, then typically the rib cartilage will not be of a good quality.

 

Cadaveric Rib

If someone is not comfortable with the idea of the harvesting their own rib cartilage, there are donated rib cartilage products available.  There are irradiated rib materials, that is cartilage taken from a donated body and sterilised with radiation.  There is nothing living in this material but provides the cartilage framework to support the structure of the nose.  However, this material has a tendency to get dissolved and absorbed by the body more commonly than when using your own rib or when using frozen rib. In addition, irradiated rib in notoriously brittle.

 

Fresh frozen rib material is also available from donated bodies.  In this product the material is washed and frozen such that again there is nothing alive in it.  This material is the next best thing to using your own rib (provided your rib cartilage is normal).  It is not brittle and less likely to get absorbed by the body compared to irradiated rib. These ribs have to be ordered in per patient, so requires some coordination.

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Preservation vs Structural vs Hybrid

You will find these terms getting thrown about increasingly.  More so in Europe than in the UK. The term preservation does sound attractive.  Varying sources use this term in different ways.