A woman in her late teens who was bothered by the shape of her nose. Her main concern was a dorsal hump and her second concern was the shape of her nasal tip. The third concern was her nose being crooked. She is shown before and again, one year after an open rhinoplasty.
Discussion: Studies show that the happiest patients after rhinoplasty are those with a dorsal hump, possibly because the correction is seen more quickly. Tip refinement continues to improve for 3 years after surgery and is impacted by the thickness of the nasal skin- if the skin is thick it is difficult to see any detailed shape changes. Her skin is relatively skin and as the swelling diminishes the created shape is better revealed.
It is difficult to fully correct a deviated nose because of residual forces in the nose that want to return to the original bend of the cartilage. We were fortunate in her case to make the nose dramatically straighter, but this is not always predictable or possible.
Her chin is “weak”, falling behind an imaginary line dropping down from the lips (“Riedel’s line” which connects the most prominent points of the upper and lower lips and is a good guide to the most aesthetic projection of the chin) and her facial balance could be improved even further with a chin implant.
A woman in her early 20’s who is bothered by a dorsal hump and drooping of the tip when she smiles. She also has some deviation of her nose. She is shown before and again, 4 months after an open rhinoplasty. The open rhinoplasty places an incision across the base of the nose that fades with time and allows us to open up the nose more completely for surgery and add more structure and precision to the nose. She is thrilled with her improvement and we can expect the tip to continue to gain in refinement over the next 3 years as the swelling continues to resolve.
A woman who first came to see us when she was 18 and had an open rhinoplasty an a chin implant. She came back to see us 9 years later, because the implant shifted slightly, which is more common when an implant is place through an incision inside the lower lip. I replaced this with a new implant placed through an incision under the chin, which allows us to anchor the implant so it will not move. She is shown then 6 months after this second procedure. So the postop views are 9 years after the rhinoplasty and 6 months after the chin implant replacement.
A woman in her mid 20’s who is bothered by a dorsal hump and by fullness of the tip. She is shown before and again, 6 weeks after an open rhinoplasty. The tip will continue to improve in refinement over the next 3 years as the swelling slowly decreases and unveils the structure that we have created at her tip. She is already thrilled with her early result. She has a “weak chin” with her chin point being behind “reidel’s line”, a line drawn connecting the lips. But she has some facial asymmetry and was concerned that a chin implant might draw more attention to this.
Update: Our patient is now seen 4 months after surgery. Swelling continues to diminish and the tip has gained in refinement. Swelling in the tip will typically continue to improve for 3 years after rhinoplasty
A woman in her mid 20’s who is bothered by a dorsal hump as well as a nose which is too long for her face. She has issues with breathing as well with internal valve collapse. She is shown before and again, 6 weeks after an open rhinoplasty with septoplasty and placement of spreader grafts to correct her “vestibular stenosis” or collapse of the nasal valve area. Spreader grafts are a kind of internal “breasth rite strips” . Her breathing is corrected and she loves the improved but natural appearance of her nose after surgery.
One Year Update: The nose continues to gain in refinement as the swelling in the tip slowly diminishes for the first three years after surgery.
A student in her later teens who is bothered by a small dorsal hump and poor projection and definition of the tip. She is shown before and again, 6 weeks after an open rhinoplasty. The tip will continue to appear more refined over the next 3 years as swelling slowly diminishes.
A woman of color in her mid 20’s who is bothered by a dorsal hump and drooping of the tip. She is shown before and again, just 6 weeks after an open rhinoplasty. Already she has a nice improvement in her contour. The nasal tip will continue to improve in refinement and appearance for 3 years as swelling slowly diminishes.
Update: At 18 months The nose continues to gain in refinement as the swelling in the tip slowly diminishes for the first three years after surgery.
A Hispanic woman in her middle 20’s who feels that her nose is “too big” for her face and does not like a dorsal “bump”. She feels that her nostrils are too big and the tip is drooping and too flat. She has had a septoplasty elsewhere in the past.
She is shown just 6 weeks after an open rhinoplasty with reduction of the dorsal hump and nondestructive tip rhinoplasty, combined with an anatomic chin implant placed through a submental incision. The tip will continue to soften and improve in definition as swelling resolves over the next 3 years. Already she has a more elegant and refined profile.
Update: Our pt is now seen 9 months after surgery and shows continued refinement as the swelling slowly diminishes. The “dorsal lines” show an elegant and straight nose from the front. The side view shows a slight elevation of the tip above the dorsum and an natural, elegant appearance.
A student in her early 20’s who had nasal obstruction before surgery which caused her to snore at night and wake up with a dry mouth in the morning. She is also bothered by a dorsal “hump” and a drooping appearance of the tip of her nose. She was diagnosed with vestibular stenosis or collapse of the internal nasal valve. This can be improved temporarily with Breath-Rite” strips but can be improved surgically with the placement of “spreader grafts”. This is a strip of cartilage in the shape of a match stick that is placed between the top of the septum and the upper lateral cartilages to prevent collapse when a patient inhales through the nose. She is shown before and again, 5 ½ weeks after an open rhinoplasty with placement of spreader grafts. Her breathing is normal now and she loves the early improvement in the shape of the nose. The nose will typically continue to develop more refinement over the next 3 years a s swelling slowly resolves.
Update: At nearly 1 ½ years after surgery, the nose has gained a more refined look at the tip, as the swelling slowly diminishes and the underlying structure that we have created at the time of surgery is better revealed. We can expect this to continue to improve for about 3 years.
A 13 1/2 year follow-up on a woman who was bothered by the appearance of her nose. This was before computer simulation and I have sketched out the changes that we wanted to make in a side view. She had deviation of the septum a marked collapse of the internal nasal valve ( a Breath rite strip is used to temporarily improve this sometimes). She is shown before and again, 13 1/2 years after an open rhinoplasty with bilateral spreader graft placement as well as placement of a columnellar support strut from the septum to stabilize her nasal tip. Her nose is no longer blocked and she loves the natural appearance of her nose after surgery. The dorsum is straight and the tip is refined in appearance.