FOURTH QUARTER 2000, VOLUME 14, NO 4

Your nose: form versus function

IN THIS ISSUE

Feel better and look vibrant with a facelift

Your nose: form versus function

Ask the Surgeon / Health Tip / What’s New

What is it? A blemish or beauty mark?

If you feel that your nose is not in harmony with the rest of your face or if you are having complications breathing through your nose, you may be a candidate for nasal surgery. Surgery can be performed to correct the function of the nose, to correct the form or cosmetic look of the nose, or a combination of these two. In exploring the different indications for nasal surgery you will be more aware of what can be done to improve both the form and function.

Function
Many patients have facial plastic surgery on their nose to alleviate obstruction to the nasal airways; this type of surgery is called septoplasty. Your facial plastic and reconstructive surgeon will first look at your nasal septum. The nasal septum is a partition, or wall, that divides the inside of the nose into a right side and a left side. It sits right in the middle of the nose. You may have heard the term, deviated septum. When someone has a deviated septum the wall between the two sides of the nose is crooked; this can obstruct the flow of air through the nose. Side effects may include septal spur headaches, occurring from pressure of the nasal septum on the linings inside the nose; persistent nosebleeds; and sinusitis.

The crooked portions of the septum are often removed from the nose. Sometimes the removed septal cartilage is straightened or trimmed and then replaced, and sometimes it is just left out of the nose, if the crooked portion was taken from an area that will not affect the nasal structure. If you are in need of septoplasty, your insurance may pay for some or all of this operation.

Polyps and tumors will also affect the ability of a patient to breathe properly and should be removed. If an obstruction is not corrected, it can cause further problems, such as sleep apnea or recurrent nasal infection.

If a patient presents with weakened nasal tissue–where there is not enough cartilage in the septum to support the nose–your physician may decide to build up the nose with a cartilage graft. In some patients, the weakened tissue affects the nasal airways, or may cause aesthetic concern.

Form
Potential patients for rhinoplasty–nasal surgery to improve the appearance of the nose–often request to improve symmetry, to increase or decrease the size of the nose, to reduce a hump, to shape the tip or bridge, to narrow the span of the nostrils, or to change the angle between your nose and upper lip.

Initially, your facial plastic and reconstructive surgeon will discuss your expectations and motivations for planning nasal surgery. It is important to realize that rhinoplasty will offer improvement, not perfection.

Next, he or she will thoroughly examine the external nose. The nose is a frame- work of bone and cartilage that is covered by skin. The upper-third of the nose is made out of bone, and the lower two-thirds of the nose is cartilage. Your surgeon will feel your nose to determine the balance of cartilage and bone beneath. Then, photographs will be taken from several angles and analyzed.

nose
If you are looking to improve your profile, an important part of the evaluation may include looking at your chin. A weak chin makes a nose appear larger. It may make more sense to get a chin implant to achieve balance, rather than rhinoplasty–or both. Your surgeon will tell you what is possible, such as alternatives you did not think of; what will bring about optimal results; and what to expect in the process of obtaining those desired results.

For most procedures of the nose, the surgeon works through incisions. For cosmetic procedures, the incisions are usually made just inside the rim of each nostril. The surgeon can shave away excess bone and cartilage to reduce a hump, reposition cartilage and bone to narrow the nose, and sculpt the nasal tip. When manipulating the nostrils, incisions may be made across the base of the nose, as well.

To narrow the width of the nose, the nasal bone is fractured, in a controlled way, so that the bones may be moved inward. Increasing tip projection or correcting a depression in the bridge may be done with a cartilage graft, as discussed with fixing weakened nasal tissue.

After correcting the framework of the nose, the skin is re-draped and the incisions are closed with absorbable sutures.

Insurance companies may cover the functional surgery but will not pay for procedures that are purely cosmetic.

Cosmetic and reconstructive procedures require a recovery time. You can expect some mild swelling and bruising. Any discomfort or pain can be alleviated by medication prescribed by your surgeon.

Whether you are looking to correct a medical condition regarding your nose or to enhance your appearance, there is a procedure or combination of procedures available to address your needs.