Dr Barry Eppley is a board-certified plastic surgeon in private practice at Clarian Health in Indianapolis, Indiana. He writes a daily blog on trends in plastic surgery at http://www.exploreplasticsurgery.com
Rhinoplasty (nose surgery) is one of the top requested cosmetic procedures for both men and women in plastic surgery. The prominence of the nose and its significance to the appearance of the face makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are dependent upon an understanding of the complex framework of bone and cartilage that make up the nose. Rhinoplasty surgery changes the shape of this framework which is revealed through the overlying skin.
Think of your nose as a house. The shingles are the overlying skin, the framework and timbers are the cartilage and bone, and the drywall the nasal lining. The septum supports the highest roof angle of the nose. (cartilage) What makes anyone's nose look the way it does, like a house, is a reflection of how the framework is structured and the roof (skin) that drapes over this framework. As plastic surgeons we think of the nose as 4 areas, the upper 1/3 which is bone, the middle 1/3 known as the middle vault which is all cartilage which is straight, and the lower 1/3 or the tip of the nose which is a combination of scroll-shaped cartilages that come together over the septum and is what gives everyone their unique tip shape. (which is the most different between any two people) The fourth area is the skin, which dependent upon its thickness, can show the underlying framework well if it is thin but can hide much of it if it is thick.
When we alter the nose we are changing the way the framework (bone and cartilage) is joined together and is shaped. Many structures can be altered to effect an outer appearance change such as dropping down the roofline (getting rid of that hump), makes the upper nose less wide by moving in the lower bone walls, refining the tip by rescuplting tyhe shape of its scrolled cartilages, or even making the roofline higher by adding implants or cartilage to it.
Due to the complexity of how all of these framework structures come together, most rhinoplasties today are done 'open'. While open rhinoplasty used to be controversial, it is now the most common way rhinoplasty surgery is performed today. An aopen approach simply means that the skin is lifted off of your nose over the tip so its anatomy can be directly seen. To no surprise, you can shape better what you can see better. This results in a nearly invisible scar at the middle of the strip of skin between the nostrils. (known as the columella) This is a very small price to pay for a better rhinoplasty result!
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