According to statistics compiled by the American Society of Plastic Surgeons in 2014, rhinoplasty, or nose reshaping, is one of the most commonly performed cosmetic plastic surgery procedures in the United States. In the more than twenty-five years that I have been a board certified plastic surgeon and otolaryngologist, I have performed over 5,000 rhinoplasty procedures and have seen, first-hand, the subtle yet dramatic rhinoplasty results that can be achieved by lifting and defining the tip of the nose, lengthening or shortening the bridge, or narrowing the nostrils. But while rhinoplasty procedures can do a great deal to subtly change the overall aesthetic appearance of the face, they can often have an even more profound effect when used to address congenital defects that can result in functional as well as aesthetic difficulties.
Structural nasal deformities can be associated with a wide range of congenital conditions, including syndromic craniosynostosis and, most commonly, cleft lip and palate. When the basic anatomy of the nose is altered in this way, the patient can potentially experience difficulties in breathing and speech development, so early intervention is important. Moreover, addressing these concerns can often be more difficult than performing cosmetic rhinoplasty procedure on adults, since the ongoing structural changes that accompany the patient’s growth make a long-term, sequential approach necessary. Generally, I prefer to begin when the patient is 4-6 years of age, follow up (if necessary) with an intermediate stage at 9-12 years, and conclude with a final repair when the patient reaches adolescence.1
During a reconstructive rhinoplasty procedure, both functional and aesthetic components can be addressed simultaneously using a variety of specialized plastic surgery techniques. In order to allow for full visualization of the nasal structures, more precise sculpting, and grafting with more predictable results, I prefer to use an external approach during any reconstructive or cosmetic rhinoplasty procedure. The central septum, dorsum, and nasal tip can all be accessed simultaneously and the various components of the nose harmoniously sculpted to achieve the best possible configuration. Cartilage grafts, taken from the patient’s nasal septum or (in rare cases) from the cartilage behind the patient’s ear, may also be necessary during a reconstructive rhinoplasty procedure to provide additional structural support, camouflage an existing deformity, or enhance tip or dorsum aesthetics. Specialized “alar spreader grafts” can also be used to improve air flow while enhancing the profile or disguising a concavity.
Every patient is unique and every rhinoplasty procedure, whether cosmetic or reconstructive, needs to be specifically tailored to the individual patient’s needs and post-surgical goals. This is why I always sit down with my patients prior to any procedure for an in-depth consultation that generally includes computerized facial imaging to give patients a chance to view their potential surgical results and to give me a detailed template to which I can refer during surgery. If you are interested in discussing how facial plastic surgery can help you, or have any questions about any of the procedures that I perform, please contact me, Dr. Fernando Burstein, to schedule a consultation. Don’t forget to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.
- Burstein, FD.: Aesthetic and Reconstructive Rhinoplasty, A Personal Perspective. Atlanta Medicine, Journal of the Medical Association of Atlanta. 2006 May; 7(3):23-26.