The Art of Refinement: Mastering Rhinoplasty at Weniger Plastic Surgery
The Precision of Rhinoplasty: A Surgeon’s Perspective
Rhinoplasty is one of my favorite procedures for several reasons. First, it is technically demanding. These surgeries demand very fine, detailed work with little margin for error. Rhinoplasty surgery involves intricate anatomy, and these structures need to be handled with great care. Also, because of this, technical skill is arguably more important than in some other surgeries. Furthermore, it goes without saying the nose is right in the middle of the face and impossible to hide, so the stakes are high.
The Importance of Strategic Planning in Rhinoplasty
For all of these reasons, rhinoplasty surgery requires significant planning. Nose jobs are not the kind of cases where you can “figure it out as you go”. In my opinion, every goal of the surgery needs to first be confirmed with the patient and then listed in order of priority. Then, the most important part of the surgery is done before the surgery even starts: the development of a detailed surgical plan that assigns each specific surgical maneuver to achieve each goal.
In noses, maneuvers on one part of the nose affect other parts of the nose, which in turn affect other parts of the nose. Therefore, it is not only crucial to plan what techniques will be used to achieve each goal but also the order in which those maneuvers will be executed. In this way, rhinoplasty (when done thoughtfully) is like a chess match where the player needs to think several steps ahead.
Understanding Different Types of Rhinoplasty
There are basically 2 kinds of rhinoplasties. Most rhinoplasties are done to make noses smaller. This is what most people think about when they think “nose job”. By far, the most common request is to lower the “hump” on the nose and make the profile straighter or slightly slope upwards toward the tip. This is the simplest and most classic maneuver and can be achieved through several techniques.
The second most common request (in my experience) is to narrow a wide or bulbous tip. Ideally, I want to create a more defined tip shape with certain angles and shadows to make the tip as sculpted as possible. Most often, people requesting this also want an overall narrower, more chiseled nose.
The Art of Building and Refining: Advanced Rhinoplasty Techniques
The opposite type of nose job is one that actually makes all or parts of the nose larger, or more specifically, more projected out from the face. This is most common in ethnic groups with flatter noses with flat, wide bridges, wide tips, and wide or flared nostrils.
Other patients have tips that droop off the end of the nose and make the nose look too long. These cases require building up the nose by enlarging or strengthening the cartilage frame under the skin. This is accomplished by harvesting cartilage from the septum of the nose, the back of the ear, or even part of a rib!
Parts are then literally carved out of this cartilage and used to build up a new frame- like an erector set. These pieces are attached together to build up the dorsum (bridge), project and sharpen the tip definition, adjust the nostril shape or position, and even improve breathing.
Navigating Anatomic Challenges in Rhinoplasty
Sometimes, there are anatomic limitations to what can be done with certain noses. Some noses have particularly thick skin. Because this thick skin covering the cartilage framework is like a thick comforter on a bed, changes in the framework that would be easily appreciated under thin skin (like a sheet) will be hidden under this thick covering.
On another note, some older patients have little elasticity left in their skin, so making the nose small by decreasing the size of the underlying frame can loosen the skin on the nose. Occasionally there are patients who have scars from previous surgeries, such as skin cancer removals or scars from traumas, that limit what can safely be done for cosmetic improvements in the nose. A very frank discussion between patient and surgeon is crucial to ensure that everyone appreciates these limitations and results that can be expected.
Dedication to Excellence: The Weniger Approach to Rhinoplasty
Not all rhinoplasties are performed with such deliberate care, foresight, and planning. Some of these techniques that I have alluded to represent advances in techniques over the years. It takes a lot of time and dedication to stay up to date with these techniques.
Not every surgeon has the particular interest in rhinoplasty needed to stay on top of all the ways to achieve the best results predictably. Not every surgeon enjoys the pressure, demands, and tiny margin for error in rhinoplasty. Unfortunately, this truth contributes to the relatively high rate of revisions in rhinoplasty.
Certainly, even in expert hands, there will be some results that could use improvement. Nonetheless, the unique dedication to and love of this surgery can set some surgeons apart with the largest set of techniques to address each patient’s unique concerns. Certainly, with rhinoplasty, one size does NOT fit all!