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Rhinoplasty
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Over 8,000 Rhinoplasties

Rhinoplasty | Nose Job | Nose Surgery | Sydney

Rhinoplasty

Rhinoplasty is a surgical procedure performed to repair or reshape the nose. It can improve the size, shape and the angle of the nose and create a proportion with the rest of your face. It is also performed to correct structural problems with the nose.

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There are two main rhinoplasty techniques:

Open Rhinoplasty

Open rhinoplasty, also called external rhinoplasty, is an approached of rhinoplasty in which a small incision is made on the nose, over the columella between the nostrils, in addition to several other incisions inside the nose. The transcolumellar incision improves the surgical access to the nasal framework by allowing the surgeon to fold the nasal skin upward. This provides better visibility on the entire nasal framework, in its natural undisturbed alignment. Open rhinoplasty can be performed in patient with thick or thin nasal skin. It is indicated in the following conditions:

  • Major augmentation with tip, columellar, spreader and/or shield grafts
  • Correction of complex nasal deformities such as cleft lip, palate nasal deformity and deviated septum or nasal trauma
  • Revision rhinoplasty
  • Excision of nasal tumour
  • Treatment of internal nasal valve dysfunction
  • Nasal tip modification
  • Surgical repair of septal perforations
  • Rhinoplasty in non-Caucasian ethnic groups

Closed Rhinoplasty

Closed rhinoplasty, also known as endonasal rhinoplasty, is an approach of rhinoplasty where all the surgical incisions are made inside the nose without any external incisions. Closed rhinoplasty is employed for the correction of aesthetic deformity of the nose as well as for the management of anatomic nasal airway obstruction.

Asian Rhinoplasty

The nose is a very important facial feature which makes a big impact on the beauty of the face. More people feel that the shape of their nose is not apt according to the other facial features of the face and if rightly re-shaped it can increase the beauty of their face significantly. This can be done through plastic surgery by a procedure called rhinoplasty.

The shape of the nose is different in different ethnic groups. Asians as compared with Caucasians have a shorter, wider and less projecting nose. Thus Asians ask for augmentation of the nose structures rather than reduction as is usually the case with Caucasians.

Rhinoplasty involving augmentation procedure for the nose is called Asian rhinoplasty. It can be done for anyone requiring the nose to be longer or with a more projecting tip. It is done either by making incisions inside the nose (closed Asian rhinoplasty ) or by making a small incision in between the nostrils (open Asian rhinoplasty). For augmentation the patient’s own cartilage is taken from the ear, ribs or nasal septum or synthetic biocompatible materials can be used.

Each patient’s facial feature is unique and all have different expectations from the surgery. Thus a computer imaging will be done to explain the changes possible and how you would look with the surgery. You should have realistic expectations from the surgery. In rare cases infection of the implant or displacement of the implant may occur and will be closely monitored in the follow up after the surgery.

Ethnic Rhinoplasty

The nose is a very important facial feature which makes a big impact on the beauty of the face. More people feel that the shape of their nose is not apt according to the other facial features of the face and if rightly re-shaped it can increase the beauty of their face significantly. The shape of the nose is different in different ethnic groups. Ethnicity affects the skin thickness, size of the nostrils and strength and shape of the nasal cartilage.

The term ethnic rhinoplasty refers to cosmetic nasal surgery in people of different ethnic groups. It is done either by making incisions inside the nose (closed ethnic rhinoplasty) or by making a small incision in between the nostrils (open ethnic rhinoplasty). For augmentation the patient’s own cartilage is taken from the ear, ribs or nasal septum or synthetic biocompatible materials can be used.

Asians as compared with Caucasians have a shorter, wider and less projecting nose. Thus Asians ask for augmentation of the nose structures rather than reduction as is usually the case with Caucasians.

African American individuals frequently have a flat nasal bridge with a wide poorly projecting tip. Ethnic rhinoplasty in these patients aims at elevating the dorsum of the nose and improving the projection of the tip.

Hispanic and Mediterranean individuals frequently have a dorsal hump over the nasal bridge with a broad drooping tip. Ethnic rhinoplasty in these patients involves the removal of the hump with a narrowing and elevation of the tip.

Each patient’s facial feature is unique and all have different expectations from the surgery. Thus a computer imaging will be done to explain the changes possible and how you would look with the surgery. You should have realistic expectations from the surgery. In rare cases infection of the implant or displacement of the implant may occur and will be closely monitored in the follow up after the surgery.

Dr. Howard De Torres performs rhinoplasty on individuals of all ethnic backgrounds. He has the required expertise in terms of both skill and experience to provide his patients with optimal results.

Nose Implants

Nose implants are used in nasal reconstruction for correction of aesthetic deformities or nasal obstruction caused by trauma, autoimmune disease, cancer or infection. An ideal nose implant should be inert, non-toxic, non-carcinogenic, sterilisable, easy to sculpt, easily camouflaged, adequate volume and strength, allow favourable interaction with surrounding tissue, maintain its shape and form over time and should resist trauma, infection and extrusion. Moreover, it should be readily available, inexpensive and also easy to remove, if required. However, an ideal implant does not exist. Thus a favoured implant is one which satisfies most of these qualities and suits the individual’s requirements.

Various materials can be used for nasal reconstruction. These may be harvested either from the same patient (autograft), from a donor (homograft) or manufactured from synthetic or semi-synthetic materials (alloplast).

Autograft

Autograft may be harvested from the cartilage (septal, conchal, costal), bone (iliac crest, calvaria) or soft tissue (fascia, dermis) of the same patient. These are most often preferred over other implant materials as there is no risk of incompatibility, rejection or toxicity.

Nasal septal cartilage is the most preferred autograft material for nasal reconstruction, when available in sufficient quantity and quality. The advantage with nasal septal cartilage is that it can be harvested from the same surgical site. Conchal cartilage is the second choice for cartilage as it is available in larger quantities than septal cartilage. However, costal cartilage is usually not preferred as the harvesting of the rib is associated with significant donor site morbidity and a high rate of resorption or warping (twisting) after implantation. Bone graft is also not preferred usually because of its various drawbacks. Soft tissues such as fascia, dermis and fat are sometimes used for volume augmentation, to hide minor irregularities or also over other implant materials as an onlay graft.

Homograft

Homografts include irradiated rib cartilage and cadaveric dermal grafts. Rib cartilage is preferred by some surgeons for structural grafting whereas cadaveric dermal grafts are used as onlay graft or to hide minor irregularities.

Alloplasts

Alloplasts are now being increasingly used as nasal implants. They are made up of synthetic polymers and include the following:

Silicone implants

Silicone implants are made up of silicone rubber and have been in use for many years. However, their use is limited by the high rate of extrusion and excessive mobility because they do not interact with the host tissue due to their non-porous nature. In Asians, who possibly have thicker skin, they have shown some good results.

Expanded-polytetrafluoroethylene (e-PTFE) implants

e-PTFE is a micro-porous polymer with the pore size of about 22 micrometres. This allows for some host tissue ingrowth, sufficient enough to stabilize the implant while still allowing for graft removal if required. e-PTFE is soft and flexible and thus is primarily used for volume enhancement but it is not recommended as a structural graft.

Porous High Density Polyethylene (PHDPE) implants

PHDPE implants are made up of PHDPE polymer which is easy to sculpt into a desired shape. Moreover, PHDPE polymer contains pores with sizes ranging from 100-250 micrometres which allows for significant host tissue ingrowth. Thus they are used for both nasal soft tissue augmentation and for structural support. Moreover, they are also used for implants for other areas of the face and are available in various shapes and sizes. The only disadvantage is difficulty in removal of implant, if needed.

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