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.
This includes procedures, which aim to improve the shape of nose, so that it looks aesthetically better than the previous (preoperative) 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. No cuts are made in the skin of nose. 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 redraped 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 2 days and external splint (support) for around 7 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 nose to be everted, thus giving a better, open view of cartilages of tip of the nose. As a result, more precise shaping of tip can be carried out. This also allows a different view of nasal septum. Remainder of the procedure proceeds as before. Nowadays, most surgeons are carrying out rhinoplasty by open approach. This allows a better view and more precise approach, especially in cases of severe deformities. The trade off is a small scar in columella, which in most cases, is not visible.
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 in breathing. No additional cuts in external skin are necessary. Due to addition of a step (septal modification), the procedure lasts longer (usually half to 1 hour more).
This operation is closely linked to the origins of Plastic Surgery. Sushruta (600BC), the greatest surgeon of all times is credited with carrying out first such procedure. 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. This loss of portion or complete nose could be due to road traffic accident, other mode of injury or assault, burns, tumour or surgery for removal of tumour, etc. Reconstruction can be carried out at same sitting (in case of tumour resection) or variable time after injury. Inner lining, osteo cartilaginous framework and outer soft tissue and skin envelope are reconstructed in a stepwise manner. The tissues for this reconstruction can be taken from various areas in body, such as forehead, rib, iliac (hip) bone, ear etc. Reconstruction can be single or multiple staged, depending on complexity.
Similar to reconstructive rhinoplasty, this procedure is carried out, when there is apparent or real loss of a portion of 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. An example is rhinoplasty in a case of cleft lip nose deformity.
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