Rhinoplasty means surgically changing the shape of the nose. The operation consists of carefully planned nasal incisions with elevation of the skin and soft tissue from the underlying cartilage and bony framework. Any "excess" bone or cartilage is removed, and the remaining tissues are rearranged or reshaped to make the nose fit with the remaining facial features.

Frequently, patients seek rhinoplasty solely for the purpose of cosmetic improvement and to make the nose appear more appropriate to the rest of their facial features. However, patients sometimes have some component of nasal breathing problems in addition to the cosmetic issue. Frequently, the nose becomes more and more disfigured as the patient ages, which leads to progressive nasal breathing problems. In addition, internal nasal deformities occasionally lead to headaches and sinus problems. The factors that should be considered before any rhinoplasty operation include the patient's height, age, skin thickness, and ethnic background, as well as the configuration of the rest of the facial features. Our goal is to change the nose so that it "fits" with the rest of the facial features, giving a natural appearance. Our philosophy about rhinoplasty generally involves drawing attention away from the nose that is disharmonious with the remainder of the facial features, and changing it to a nose that appears to "fit" the face. Such a change automatically draws the observer's attention to the patient's eyes rather than to the nose.

The computerized imager is an important communication tool to allow both patient and surgeon to arrive at a reasonable goal. Patients, in general, want a nose that fits harmoniously with the rest of the face, and the computerized imager is invaluable in demonstrating this effect. We use a digital computer imager, instead of video imaging, to provide the highest possible resolution and the most lifelike image.

In general, repair of nasal defects resulting from trauma is more difficult than cosmetic repair. Usually, trauma results from accidents or injuries which have occured in the past. Frequently, however, the patient does not recall how fractures of the nasal cartilage or the bone or both occurred. Often, only the cartilaginous skeleton of the nose has been fractured, and the patient is unaware of the injury. In some cases, nasal injury may occur when an infant is delivered. Whatever the cause, nasal trauma, as evidenced by fractures observed during operative procedures, is much more common than is appreciated, even by patients themselves. Noses that have undergone such trauma are more difficult to repair because of fractures in the supporting framework. In selected cases (approximately 10 percent of all rhinoplasties), a revision, or a secondary procedure, may be required to achieve operative success after rhinoplasty. In most cases, however, we are able to achieve success with only one operation.

Rhinoplasty: Nasal Fractures

Fractures of the nasal bones frequently lead to both aesthetic and functional deformities of the nose. Although the treatment of nasal fractures is not generally an emergency, fractures are most easily repaired between two and six weeks after the injury. If the patient desires, additional changes in the size or the shape of the nose can be made simultaneously when the nasal fractures are corrected.