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Following are some of the more common
reasons patients are dissatisfied with their previous
rhinoplasty surgery:
The Pinched Tip : A pinched
tip results from over-contraction of the cartilage,
or from the cartilage not being placed back into a proper
position. Sometimes just removing a little bit of cartilage
will correct the problem by allowing the pinch to open
up. If this is not adequate, the cartilage that is removed
can be placed in the rim to fill out the and correct
the pinch.
The Hanging Columella : When
the tissue on the underside of the nose that separates
the two nostrils hangs down, this is called a hanging
columella. This happens when doctors remove too much
maxillary spine or caudal septum. A hanging columella
is repaired using a graft from the septum placed between
the medial crus cartilage, which brings the columella
down or by directly excising the ala-rim higher.
The Drop (Rounded) Tip :
If the tip of the nose has dropped after previous nose
surgery, a so-called "tip graft" made of of
septal cartilage can be inserted to lend support. Frequently,
a graft must then be added to the columella (between
the two nostrils) to further support the tip.
The Crooked Nose : If the
bridge of a nose is crooked as a result of previous
surgery, a graft can be placed over the depressed area
to simulate straightening of the nose without having
to break the bone. The graft is usually taken from either
the lower cartilage on the side of the nose, or from
the septum between the two sides of the nose.
Crooked Nasal Bones : If
the nasal bones themselves are crooked, and not just
the spine of the nose, it is probably necessary to carefully
re-break the bones along the upper side of the nose
(the maxilla, or upper jaw bone). Once they are broken,
they can be manipulated into a more desireable position,
splinted into place, and allowed to heal in a straighter
position.
The Scooped Nose : A scooped
nose occurs with over correction or inadequate support
of the spine of the nose. Correcting the scooped nose
is one of the most difficult secondary corrections.
To correct this, grafts are used to add support and
build up the nose. The grafts or implants can be derived
from cartilage (taken from the nose or ear), rib, silicone,
or Gore-Tex. A very carefully fashioned layered graft
made from the septal cartilage between the nose or from
the cartilage in the ear usually suffices.
High Tip : If the tip of
the nose is too high, it can be lowered by removing
the foot process of the medial crus cartilage and more
cephalic lower lateral cartilage or dorsal septum.
The Wide Nose : A
wide nose can refer to just the bridge of the nose being
wide, or the entire nose. A wide bridge can be caused
by shifting back of the fractured bones, or by failure
of the surgeon to narrow the nose in the first place.
For the wide Caucasian nose, a very judicious defatting
of the nasal tip in the sebaceous area, combined with
a removal of lower level cartilage and a separation
of the upper lateral cartilage from the septum will
often suffice. Occasionally, a dorsal onlay graft is
necessary.
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