Rhinoplasty literally means “to shape or mold” (-plasty) the nose (rhino-). This operation is one of my favorite operations to perform, and one of the most common operations I perform. Whether or not the intent is to optimize the appearance or reconstruct the nose, my objectives and aesthetic goals are generally the same. That is, to improve the overall shape and harmony of the nose, and to improve breathing through, the nose. Improving the shape of the nose depends on a surgeon’s skill, style and preferences, a patient’s desires, the patient’s healing tendencies, compliance with postoperative instructions, and the patient’s starting point. Improving the function of the nose relies on minimizing the resistance of inhaled air through the nose.
There are two major valves that could potentially inhibit breathing through the nasal airway. The first valve is called the external nasal valve and it basically means your nostril. A lot of people might notice that their nostrils are asymmetric. It is more common to have asymmetric nostrils than symmetric nostrils. This is because the septum terminates as the barrier between your two nostrils. Any deviation of the septum, which is common, leads two an obliquity of your columella, which separates your nostrils. If one nostril is bigger than the other, chances are there is more airway resistance through this side than the other. In addition, when you inhale through your nose, there is an increased velocity of air moving through your external nasal valve. Much like the way a shower curtain pulls in towards the stream, when there is more flow, there is less pressure and this can cause the nostril to collapse. This is particularly common in fair skinned Caucasians. Correction of external nasal valve collapse can be accomplished through correcting a deviated septum, and reinforcing the soft tissue that creates your nostril. We can use your own cartilage to achieve this.
The next, and more challenging and common cause of airway and airflow obstruction is the internal nasal valve. The internal nasal valve can be thought of as an angle between your nasal septum and your upper lateral cartilage. When you squeeze the side of your nose to make it collapse this is your upper lateral cartilage. If the angle between your nasal septum (which is the cartilage between your nostrils and the upper lateral cartilages) is too narrow, it will impair airflow. This may also be made worse with inhalation through your nose for the same reason as your nostrils collapse. This is why products like Breathe-Right strips help you breathe through your nose- by widening that internal nasal valve angle. A permanent surgical solution requires recruitment of your own cartilage, commonly from your nasal septum, and interposing it between the upper lateral cartilage and the nasal septum to permanently widen that angle. While many may think that doing this would make your nose looked wide and ugly, it does not lead to this type of result. In fact, placement of these struts allows me to narrow your nasal bones without compromising your airway and creates a sharper contour that better defines your nasal anatomy. In my opinion, it gives you a more defined and sculpted looking nose that breathes better.
In most cosmetic rhinoplasty procedures that I perform, I place spreader grafts to improve airway flow. I believe that this truly confers both functional and cosmetic benefits. Sometimes additional maneuvers may be needed (turbinate reduction) to further enhance airflow. The synergy between functional improvement and improvement in form is what makes rhinoplasty one of my favorite and most popular procedures. It is quite satisfying to remove internal nasal splints in my patients at one week and to hear their satisfaction when they can “finally breathe”. To reiterate, the technical name for surgical placement of permanent “Breathe Right” strips is called a septal spreader graft. Reinforcement of the external nasal valve by adding cartilage to make the nostril stronger is called alar rim graft or alar batten graft. Different surgical maneuvers can achieve similar functional and cosmetic results. Taking the extra step in rhinoplasty to improve function also leads to long-term protection and maintenance of the result that can be achieved on the table. Skin is strong, and cartilage likes to warp. A thoughtful appreach creates a strong framework that will prevent collapse and warping over time. Having said that, choosing the right plastic surgeon initially to perform a strategic series of steps will give you the best result in both the short term and the long-term.
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