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The rhinoplasty procedure has improved dramatically in the last thirty years. Modern rhinoplasty techniques make outcomes more predictable and allow many changes in nasal anatomy that were difficult to achieve with older techniques. Rhinoplasty planning has also improved over the last thirty years. Many factors are taken into consideration when planning a rhinoplasty in addition to the patient’s goals.

When planning a rhinoplasty, both aesthetic and functional aspects are considered. Many patients seeking rhinoplasty do not have a functional problem. The primary reason for seeking rhinoplasty in this group of patients is to improve the appearance of the nose. There are many anatomical reasons patients seek rhinoplasty. Many of these reasons are inherited family traits that can vary widely even in members of the same family. In some circumstances these family traits may be acceptable or desirable in one gender, while at the same time be less desirable in the opposite gender. In some circumstances the anatomical characteristics are so distinguishable, and are a part of that person’s identity, that complete correction is not desirable. Many factors are considered during rhinoplasty planning, including existing nasal anatomy, gender, facial shape, ethnicity, familial characteristics, skin thickness, and of course, patient goals.

The primary structural elements that provide shape to the nose are cartilage and bone. The internal anatomy of the nose is very complex, and understanding nasal anatomy is difficult without the utilization of images and diagrams. During the consultation, images and diagrams are utilized to understand the desirable anatomy, the specific anatomy of the patient, and the techniques available to change the appearance of the nose. There is no single plastic surgery operation to improve nasal anatomy. Every operation is different based on the specific anatomy of the patient and the goals of the patient.

The shape of the nose can be understood by comparison to a camping tent. The tent has a frame which is overlaid with a covering that reflects the shape of the frame. In order to change the shape of the tent, one would need to change the shape of the frame. The covering would then change shape to reflect the change in the shape of the frame. Similarly, the shape of the nose reflects the nasal skeleton (the frame) underneath the skin. In order to change the shape of the nose, the nasal skeleton is changed. The skin then “re-drapes” (adapts) to the new nasal skeleton shape. This means the shape of the cartilage and bone is changed which results in a change in the shape of the nose.

Analysis of anatomy for rhinoplasty falls into two general categories that dovetail (are interdependent) to some degree. Nasal dimensions, including width, length, and projection, is the first. The width of the nose is the dimension measured from side to side at the base of the nose as observed directly from the front. The length of the nose is the dimension measured from the glabella (the space between the eyes) to the tip of the nose. The projection of the nose is the dimension of the nose as viewed in profile. There is significant variation in these dimensions that are aesthetically acceptable depending upon many factors.

The second general category is nasal shape. When analyzing nasal shape, two distinct anatomic entities are considered. These two anatomic entities are the nasal dorsum (top of the nose) and the nasal tip. Both can usually be changed with rhinoplasty. Reshaping the nasal dorsum requires changing cartilage (lower part) and bone (upper part) in most patients. Reshaping the nasal tip requires reshaping of the cartilage, which may include cartilage graft(s) harvested from other areas. The nasal dorsum and the nasal tip are changed to some degree in almost every rhinoplasty.

A prominent nasal dorsum (hump on nose) is a common reason that patients seek rhinoplasty. This is commonly an inherited anatomical characteristic. A prominent nasal dorsum is considered a masculine characteristic and reduction can dramatically change the general appearance. Problems associated with the nasal tip are another common reason a patient seeks rhinoplasty consultation. Correction of an overly broad nasal tip, or a prominent nasal tip, or drooping nasal tip can likewise significantly change a patient’s appearance. Changing both the dorsum of the nose and the nasal tip can dramatically improve a patient’s appearance.

The rhinoplasty details are dictated by the patient’s anatomy and the patient’s goals. For each patient, the specific details of the rhinoplasty are discussed after nasal analysis at the consultation.

To make an appointment for a free rhinoplasty consultation, call Herring Plastic Surgery at 910.486.9093.