Rhinoplasty Improve The Proportion And Appearance Of Your Nose

Rhinoplasty Improve The Proportion And Appearance Of Your Nose

As you are examining the patient, create a mental problem list with solutions followed by documentation on your nasal analysis sheet, such as: 1) external valve collapse secondary to over resected lower lateral crura with a plan of open rhinoplasty with lateral crural strut grafts using conchal cartilage, 2) internal nasal valve collapse secondary to a narrowed middle vault and supra alar pinching with moderate inspiration with a plan of bilateral spreader grafts and supralar batten grafts using conchal cartilage, and 3) bilateral alar retraction with a plan of bilateral conchal composite grafts. If structural grafting is necessary, decide what material may be used. A thorough knowledge of the types of autologous septzl, conchal, costal cartilage, and calvarium and alloplastic grafting is needed as well as harvesting techniques. This is only an initial plan as you are creating your algorithm. It will change as you get closer to surgery.

As you are examining the patient, create a mental problem list with solutions followed by documentation on your nasal analysis sheet, such as: external valve collapse secondary to over resected lower lateral crura with a plan of open rhinoplasty with alar batten grafts using conchal cartilage, internal nasal valve collapse secondary to a narrow middle vault and supra alar pinching with moderate inspiration with a plan of bilateral spreader grafts and supra alar batten grafts using conchal cartilage, and bilateral alar retraction with a plan of bilateral conchal composite grafts. If structural grafting is necessary, decide what material may be used. A thorough knowledge of the types of autologous (septal, conchal, costal cartilage, deep temporalis fascia, and calvarium) or alloplastic grafting is needed as well as harvesting techniques.

Another important detail is to ascertain if the patient has nasal obstruction. Determine if the nasal obstruction was present preoperatively. If the obstruction is a result of the surgery, a number of questions need to be answered. Did the patient have reductive rhinoplasty surgery? Have the patient point out where the obstruction is. Is it static or dynamic? Does it present with normal or deep inspiration? What alleviates and worsens the nasal obstruction? What are the characteristics of the nasal obstruction? Was septal surgery performed?

My fellowship director, J. Regan Thomas, MD, told me something that I will never forget “You have not learned anything about rhinoplasty until you have performed at least a thousand procedures and followed them for many years.” This statement epitomizes why fellowships are so valuable. Some of the needed experience and potential pitfalls are circumvented by first hand observation, which includes studying the analysis, judgment, techniques, complication management, and most importantly, results from a seasoned rhinoplasty surgeon. The training catapults you years ahead of your colleagues that are not fortunate to have postgraduate training.