Rhinoplasty [Greek – rhis (nose), plassein (to shape)] refers to a group of plastic surgery procedures, related to nose. It includes cosmetic rhinoplasty, septorhinoplasty, reconstructive rhinoplasty and rhinoplasty for birth defects. The nose consists of a bone and cartilage (osteo cartilaginous) framework, which is draped by skin on outside and lined from inside by mucosa. The upper part of this framework consists of bone and the lower portion of cartilage. Shape of the nose is mainly due to osteocartilaginous framework.
Cosmetic Rhinoplasty This includes procedures, which aim at improving the shape of nose, so that it looks aesthetically better than the previous (pre-operative) appearance. There are two common approaches to performing cosmetic (aesthetic) rhinoplasty, ‘closed’ or ‘open’.
Closed Rhinoplasty: In this approach, the incisions (cuts) are made inside the nose, in lower part of lining mucosa, just inside the nostril openings. Through these cuts, the skin and soft tissue covering envelope is separated from the underlying osteocartilaginous framework. The necessary changes in shape and dimension are then made to this framework. Soft tissue envelope is then re-draped over the modified framework and the small cuts in lining mucosa are closed with the help of absorbable sutures. This new shape of nose is supported with the help of nasal packing for around two days and external splint (support) for around seven days.
Open Rhinoplasty: This approach involves addition of a small cut in the skin of columella (thin vertical bridge between the nostril openings). This cut then connects the inner, mucosal cuts on either side. This allows the skin of entire tip of the nose to be everted, thus giving a better, open view of cartilages of the tip. As a result, more precise shaping can be carried out.
Septo-Rhinoplasty This procedure is carried out, when, in addition to the cosmetic issue, there is a functional problem, such as difficulty in breathing due to nasal blockage. Here, in addition to the above mentioned procedures, septal modifications are carried out through the same approach (closed or open), to remove the blockage. Reconstructive Rhinoplasty This operation is closely linked to the origins of plastic surgery. This procedure is carried out in a patient, who has had loss of a portion of nose or complete nose, unlike a patient for cosmetic rhinoplasty. Inner lining, osteo cartilaginous framework and outer soft tissue and skin envelope are reconstructed in a stepwise manner. Reconstruction can be single or multiple staged, depending on complexity.
Rhinoplasty for birth defects Similar to reconstructive rhinoplasty, this procedure is carried out when there is apparent or real loss of a portion of the nose, due to a birth defect. In a large number of cases, however, the reconstruction can be carried out with the help of local tissues, without borrowing tissues from elsewhere in the body.As a safe approach, only the best rhinoplasty surgeons should be entrusted with performing this procedure.