Dr. Mordcai Blau – Gynecomastia Surgery Blog

Rhinoplasty by Dr. Mordcai Blau

The nose is a primary factor in determining facial aesthetics. The central location combined with the visual prominence on the sagittal, coronal, and transverse planes supports this observation. Rhinoplasty is an aesthetic procedure requiring great precession. Rhinoplasty is divided into two main procedures, closed or open. The main difference between closed and open rhinoplasty is the incision used and the exposure of the nasal framework. ⁽¹⁾ The closed technique is a fast and efficient method for addressing certain anatomic nasal deformities, specifically those requiring reduction procedures. ⁽¹⁾ The open technique offers advantages in terms of direct visualization and control. These advantages make the open technique superior for the correction of tip under projection and severely deviated noses. ⁽¹⁾

The surgeon will give a thorough physical evaluation, which facilitates surgical planning. Key steps in this evaluation are evaluating the entire face for shape, size, symmetry, and proportion. The nasal tip will be evaluated for size, shape, position of the tip defining points, skin quality, and skin thickness. The septum, turbinates, internal and external valves will be examined. The surgeon will use diagnostic and analytical techniques including anatomic, functional, photographic, and computer imaging. ⁽¹⁾ Standard photographic procedure is to take a front view, worms eye (inferior aspect ⁽²⁾), three-quarter (right and left) views, and a profile view (in repose and smiling).

Figure 1. Face Profile – sagittal plane

Tip projection is defined as the distance from the tip of the nose to the most posterior point of the nose-cheek junction. ⁽¹⁾

Figure 2. Nose profile – sagittal plane

The preoperative exam should include a thorough evaluation of the shape, size, location and inherent strength of the medial, middle and lateral crura of the alar cartilages. ⁽¹⁾

Figure 3. Anterior aspect nose, coronal plane

The arterial supply of the nose comes from two sources: 1. dorsal nasal artery (anterior ethmoidal), which is a branch of the ophthalmic artery and supplies the proximal nose and subdermal plexus of the tip; 2. two branches of the facial artery, the angular artery and superior labial artery, both of which supply the nasal tip area.

Figure 4. Gray’s Anatomy Figure 514 ⁽³⁾

Figure 5. Grey’s Anatomy Figure 508 ⁽³⁾

Based on Dr. Mordcai Blau’s recommendation, a cold compress should be applied for 48 hours postoperatively, to minimize bruising and swelling. The head should remain elevated while resting and during sleep. The patient should sleep on their back. Heavy exercise and sexual intercourse should not be performed for three weeks postoperatively. Alcohol, and consumption of NSAIDs (non-steroidal anti-inflammatory), vitamin E, is prohibited for one week. Pain medication is usual prescribed for a transient period.

Figure 6. Projecting tip reduced, dorsal lowering

Figure 7. Dorsal lowering, reduced tip projection, shortening of the caudal septum, correction of cranial, lateral asymmetry

Figure 8. Dorsal lowering, removal of a dorsal hump

References

1. Aston, Sherrell J, Steinbrech, Douglas S and Walden, Jennifer L. Aesthetic Plastic Surgery. s.l. : Elsevier Limited, 2009. ISBN: 978-0-7020-3168-7.

2. Standring, Susan. Gray’s Anatomy The Anatomical Basis of Clinical Practice. 40. s.l. : Churchill Livingstone ELSEVIER, 2008. p. xxiii. 978-0-443-06684-9.

3. Gray, Henry. Gray’s Anatomy. 15th Edition. New York : Barns & Novle Books, 1901, 1995.