Getting The Natural Rhinoplasty Look

Getting The Natural Rhinoplasty Look
Rhinoplasty, nose-shaping surgery, is one of the most
common plastic surgery procedures of the face. It can have
a dramatic effect on one's facial appearance due to the
prominent position of the nose on the face. While
rhinoplasty surgery has been performed for over 100 years,
modern rhinoplasty techniques create noses that are more
natural and can hold their shape over time.

Historically, rhinoplasty surgery was associated with after
surgery appearances which were 'overdone'. This type of
reductive rhinoplasty produced noses that were short with
up-turned tips(pugnose appearance) and with low bridges.
Even if the nose did not appear this way immediately after
surgery, this appearance developed months or years later.
This nasal appearance was the result of removing too much
of the natural structures of the nose. Taking the bridge of
the nose down too low (bone and cartilage) or shortening
the tip of the nose excessively (all cartilage), while
immediately looking good, weakens the support of the nasal
framework. Over time, as scar forms and tissues heal and
contract, the nose gradually 'falls' and assumes an
unnatural appearance. It may look too small, too upturned,
or too narrow and pinched at the tip.

The importance of maintaining as much of the support of the
nose is better appreciated today. The nose is like a house,
the framework must be maintained to keep the roofline
intact. Contemporary rhinoplasty is more of a rearrangement
of the framework structures with only small removals of
cartilage or bone. In this way, the nasal dorsum (line
along the bridge to the tip) remains smooth but at a good
height, the end of the nose is lifted but not too high, and
and the nasal tip is narrowed but is not made into a single
point.

Besides less cartilage and bone removal, the natural
rhinoplasty makes use of adding support through cartilage
grafts as necessary. Supporting the nasal tip through
columellar strut grafts, small hand-carved grafts for
better tip definition, spreader cartilage grafts to the
middle vault to improve breathing, and adding height at the
very top of the nose where it joins the forehead (radix)
with small crushed cartilage grafts are some of the ways to
help build and strengthen the framework of the nose. These
cartilage grafts are usually acquired from the septum of
the nose (which may be simultaneously straightened) or from
the back of the ear.

Natural rhinoplasty techniques are a combination of
preserving critical nasal tissues, skillfully rearranging
the different zones of the nose, and the three-dimensional
eye to visualize how to get to the final nasal result. It
is usually best done through an 'open approach' with a
resultant indetectable scar across the columella. (strip of
skin between the nostrils) Natural noses fit each patient's
face more proportionately and never have that 'operated'
appearance. While tedious to perform, I find the long-term
results rewarding and the need for secondary revisional
surgery reduced.

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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